Patient Jessie Maisby poses for a photo in the SAM3 apartment at the Élisabeth Bruyère Hospital in Ottawa. Photo: Politics/Matthew Usherwood
My 98-year-old grandmother, Mimi, still lives on her farm in Southern Ontario, and she does it pretty much autonomously. To live to be 98 is an anomaly. To be able to stay in her home with only a modicum of assistance is exceptional.
It’s also not going to be all that uncommon as the boomer generation grows older, experts predict.
Mimi has lived an active life, eats well and even practises yoga in the living room. She also loves to keep up with friends and family, keeping a land line and a cellphone always in reach. Every time some young doctor makes the mistake of suggesting she move into town — at least for the winter months — she thanks them for the advice and promptly ignores it.
That’s no susprise to Dr. Véronique French Merkley, Medical Chief of the Department of Care of the Elderly, at Bruyère Continuing Care in Ottawa.
“Overwhelmingly our patients are keen to stay in their homes as long as possible. A lot of it has to do with maintaining their quality of life and retaining as much autonomy and dignity throughout the aging process,” she said. “This isn’t always easy as their own children and caregivers are often in a sandwich situation where they are still working and have children and grandchildren requiring their assistance as well.”
Fortunately, there are places like the Bruyère Research Institute (BRI) dotted across Canada that have already assessed and predicted the needs of our aging population. Using a mix of sensors and machine learning — also known as “artificial intelligence” — they are experimenting with unique, innovative environments where researchers specializing in both health sciences and engineering can partner with clinicians, families, patients and industry members to develop new ways that older adults will be able to use smart technology to live longer, healthier and more independent lives; hopefully within their own homes.
For Dr. French Merkley, this means working with Dr. Heidi Sveistrup, CEO of BRI, to create and maintain meaningful connections between the worlds of research and patient care. Often, it’s as simple as setting up an smartphone to passively record activities, offer reminders for pills and meals, and reassuring older people that if they are worried about becoming forgetful, the always-handy mobile device will serve as the first line of defence. And, for many, that simple life hack might allow them an extra decade or more living safely and happily in their homes.
Drs. Bruce Wallace, Frank Knoefel, Véronique French Merkley and Heidi Sveistrup pose for a photo at the Bruyère hospital in Ottawa.
“It is about figuring out what technology will be welcomed by patients and useful to clinicians. It is also about using technology in a personalized way to tweak and improve the physical, medical and social aspects of a patient’s wellness.”
Dr. Frank Knoefel, of the Bruyère’s Memory Program, finds the paradox of the work being done at the BRI to be very exciting.
“We have the oldest buildings in the city, we have the oldest hospital in the city, we have some of the oldest patients in the city and yet, we have some of the newest technology,” he said, adding that he loves his work. “Older adults are the most interesting group of people you will ever meet. Their lives are fascinating and they have done incredible things and witnessed the transformation of this country. I feel society owes them as they are the ones that built the Canada we have today. We have to acknowledge and be grateful for that and this is a small way that I can help and thank them for what they have done.”
What happens when a simple memory tool isn’t enough? That’s where large tech companies are focusing huge amounts of attention. Upstairs in the Bruyère, there’s a cheery one-bedroom apartment known as the SAM3 (Sensors and Analytics for Monitoring Mobility and Memory), which is a collaboration between the BRI and Carleton University in partnership with the AGE-WELL Network Centres of Excellence. That it smells of an omelette prepared earlier that day suggests it’s not just your average medical lab. This fully equipped living research space is used by clinicians, researchers and companies to demonstrate and validate technologies designed to assist older adults with aging well in their own residences. Perfected at an offsite lab, the technologies are ready for patient use by the time they arrive at SAM3 and in some cases to be installed at home.
A tour of SAM3 with its executive director, Dr. Bruce Wallace, begins in the living room with a demonstration of how researchers, working with a home security company, are currently testing the use of motion sensors throughout the apartment to measure an individual’s activities of daily living, while still maintaining patient privacy. Someday this passive technology might provide an alternative to lifeline lanyards of the infamous “I’ve-fallen-and-I-can’t-get-up” variety.
Memory
Gradual cognitive declines often go unnoticed and rarely happen in a straight line. There are good days and bad days, but they weigh on the elderly and can sometimes lead to much bigger problems. Having the technology around the house learn one’s habits and oversights and then offer helpful reminders can considerably reduce the stress of living autonomously.
As an example, Dr. Wallace said putting a simple monitor on the door of her fridge, as they have done in the SAM3 kitchen’s standard refrigerator, accidentally leaving the fridge door ajar would result in the audio cue of “Fridge is open, please close fridge.” That simple sensor can reduce stress and potentially avoid bigger problems such as food poisoning.
Always looking for ways to improve on and expand existing technology, Dr. Sveistrup would next like to see this or similar technology, which can already determine whether a fridge door has been opened, adapted further so that caregivers will be able to know if and what an older adult has eaten, much like modern minibars in hotels automatically charge guests for their late-night dalliance with the macadamia nuts. Instead, designated family members could receive a text that says “Your mum is in the house but does not appear to have eaten lunch or dinner. Would you like to call her?”
In the adjacent bedroom of the SAM3 apartment, researchers have figured out a new way of assisting older adults with dementia in the night, through the use of a sensor pad under the bed mattress, without waking their caregivers. Sensors reacting to a sleeping individual, moving to an awake and upright position, are able to activate visual cues such as turning on the bedside lamp or hallway light, or even illuminating a walker to enable a safer trip to the washroom. If an older adult should wander further throughout the house, a warm automated message, using a loved one’s voice, is triggered to redirect them back to bed.
Additional sensors can be used to wake a sleeping caregiver should an exterior door be opened. These wander-detection-anddiversion technologies have been used in various trials for more than a year, and researchers and doctors are seeing the benefits to patients and caregivers.
Dr. Knoefel shared the story of an older woman with dementia, living with her son who occasionally had to work the night shift.
While optimal for some patients, the use of smart technology to keep older adults independent also offers the prospects of saving the healthcare system billions of dollars. Well deployed, technology will also relieve the stress on caregivers and reduce the number of days they are required to take off work.
“The technology was set up so that if she got out of bed, a message in his voice would respond saying, ‘Mom, you are at my house. I am at work. Go back to bed. I will be home soon.’ The son would also receive a message on his phone letting him know that his mother had gotten up but gone back to bed. Both of them felt reassured and wanted to know how they could get this system permanently installed.”
Physical Health
Another impediment to people living autonomously as they get older is the need for doctor visits. The SAM3 bedroom is also the testing site of a system that health-care providers will be able to use to speak with patients while remotely testing the patient’s vital signs, such as weight, temperature and blood pressure. What’s most interesting is that most of the supplies are available commercially: a computer or phone with Bluetooth technology, and an array of simple-to-use devices available from a pharmacy, and the patient’s television.
Data Collection for Tracking and Research
Beyond the practical benefits of these smart technologies, physicians and researchers like Dr. Wallace are also looking for ways to collect data from the use of systems like these to track health changes over a longer period of time and for research purposes. “Pressure sensor pads under the mattress provide images that are recordable throughout the night. If the data can be effectively summarized by a computer, health-care providers will be able to look at the patterns to see if the patient might be a restless sleeper, creating a higher risk for a fall. Or perhaps they are not moving enough, which could put them at risk for pressure ulcers. Homecare agencies could even use the data to effectively prioritize their patient visits so that those who have had a bad night can be seen first.”
The pressure sensor mats have also been used in recent studies to monitor respiration rates and the distribution and retention of fluid in the body. According to Dr. Sveistrup, “The potential of these devices is limitless.”
For the past two years Dr. Knoefel and his team have been using specifically designed cognitive games in a controlled research environment, played on tablets by patients in the hospital’s day program. These games help patients with memory problems and collect data, using a sensor, that will help to monitor cognitive function indirectly over time. “We can now take a specific brain function, incorporate it into a game and then measure response. Over time we can track their abilities in that game. From one appointment to the next, a year later, people can go from mildly cognitively impaired to having dementia. Data collected from games played over time could help us to determine whether this resulted from an acute event or a gradual change.”
Getting Oustide
While the team agrees that having smart technology in the homes of older adults will have a tremendously positive impact, they would also like see it used to help them to get out into the world as, in the words of Dr. Knoefel, “People stuck at home get depressed, cognition goes down and they deteriorate very quickly.”
While the elderly have often taken taxis, the fear of getting lost or robbed often becomes a deterrent as they begin to fear their cognitive lapses. Uber, and other ride-sharing technologies, offer patients and caregivers many more options for getting out and about, which is good for their health and well being.
Dr. French Merkley expects we will see further innovations in transportation technology, whether through automated vehicles or apps that would allow those unable to drive to have greater control over their outings.
Doctors and researchers at the BRI are also studying collected data to better understand how the aging process affects a person’s ability to drive. By doing this they hope to be able to help older adults keep their licenses longer by retraining them at pivotal points or adding crutches such as sensors and cameras to their vehicles. This same technology will be useful to patients recovering from strokes and injuries. Plans are underway to build a state-of-the-art driving simulator so that researchers can study safely the driving habits of older adults in real time.
Saving Both Healthcare and Taxpayer Dollars
While optimal for some patients, the use of smart technology to keep older adults independent also offers the prospects of saving the healthcare system billions of dollars. Well deployed, technology will also relieve the stress on caregivers and reduce the number of days they are required to take off work.
According to Dr. Sveistrup, “The potential of these devices is limitless.”
Dr. Knoefel believes that using devices, like those featured in the SAM3 apartment, will help to detect medical problems earlier and avoid hospitalizations. “We know that one trip to the emergency room costs about $1,000, an overnight stay $1,000 and surgery $25,000. And that is just for one Canadian.” Dr. French Merkley agrees, noting that small inexpensive additions to an older adult’s care could make a huge difference. “About 10 per cent admissions to acute care are due to adverse drug reactions. The cost of attaching a simple sensor to a blister pack is substantially less and could potentially alleviate some of these admissions and trips to the emergency room. It would not only improve the patients’ lives but also the health of the system.”
Despite the many ways that smart technology can enhance the lives of older adults, many families and caregivers express concern that the elderly person in their care will struggle with accepting or learning how to use technology. It may be too late to incorporate some of these recent advancements into Mimi’s world, especially as she recently reported having, “finally unplugged and taken apart that grey machine in the corner.” But there are many other devices that would surely be of great benefit to her. By starting early and using the tips provided by Dr. French Merkley and Dr. Sveistrup, more families will hopefully be able to assist the older adults in their lives with welcoming smart technology as a tool for enhancing both independence and peace of mind.