A Tech Test to Keep Seniors in Their Homes Longer
Sensors monitor daily activity, from taking pills to driving, in an effort to flag early signs of medical problems
By Sumathi Reddy | Jul 25, 2018 | This article originally appeared in The Wall Street Journal
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James Moore had his house reconfigured so it can track his every move.
One morning earlier this month the 75-year-old Portland resident watched as a research assistant from Oregon Health & Science University tested and placed eight sensors in his studio apartment.
Mr. Moore is part of a large, national study called CART—Collaborative Aging (In Place) Research Using Technology Initiative. Researchers will monitor his daily activities using sensors and other technology installed in his home.
The motion sensors will feed real-time data on Mr. Moore’s movements throughout the day. They will measure things like how often he enters different rooms, how often he enters and exits his home, his computer use and what his walking speed or gait is.
The goal: to see if researchers can monitor and detect health changes in older adults and enable them to live longer in their own homes. For example, early signs of cognitive decline may be detected through changes in computer use or driving. Changes in gait and movement may flag frailty issues.
“The technologies that we install are designed to detect changes that are basic to people’s daily function and their ability to stay independent,” says Jeffrey Kaye, director of the Oregon Center for Aging and Technology, part of OHSU, and lead researcher on the study.
The $7 million, four-year study is funded by the National Institutes of Health and Department of Veterans Affairs. Researchers installed the technology in about 50 homes, but ultimately hope to outfit about 250 homes. The participants have consented to having the system in place at least through 2020.
Mr. Moore is part of a group of low-income seniors in the Portland area. A second group includes veterans in rural Oregon and Washington. There is also a site consisting largely of African-Americans in Chicago, and another group of primarily Spanish speakers in Miami.
Laurie Orlov, founder and principal analyst of Aging in Place Technology Watch, a Florida-based consulting firm, says a number of commercially available, sensor-based products monitor elderly people at home. But no company has had a “breakout success” due to the logistics of installing the sensors and configuring them so someone acts when an alert occurs.
A system like CART could present a big opportunity for managing patients sent home from the hospital who need monitoring, she says: “It’s not just alerting that someone has fallen down, but it’s looking at behavior change.”
At the recent installation, research assistant Nathaniel Rodrigues surveyed the small studio apartment, filled with the acrylic landscapes that Mr. Moore paints and prescription medicine bottles.
Mr. Rodrigues placed small, white, barely noticeable sensors on the walls of the bathroom, kitchen, living space and front door, as well as four on the ceiling. They’re also easy to remove should the need arise.
“There’s no cameras, no video. It’s just getting real-time, passive data as Jimmy goes about his day in his apartment,” explains Jennifer Marcoe, a CART project coordinator. (If Mr. Moore were to have a medical emergency, someone would need to call 911, as before. This program monitors only its participants’ behavior.)
Zach Beattie, director of data acquisition and analytics at OHSU, notes that a slowed gait can suggest several health problems, including a decline in cognitive abilities. Leaving the house less often could signal depression. “The hope is to be able to find early digital biomarkers of problems much earlier than they’d be found in the clinic,” he says.
Mr. Rodrigues gave Mr. Moore a pillbox for each day of the week, with sections for morning and evening. The pillbox is embedded with small sensors that measure when Mr. Moore uses it. “So now we know every single time one of these boxes are open for each day of the week,” he told Mr. Moore.
Mr. Moore takes about a dozen pills each day, including blood thinners he’s taken since he had a heart valve replaced. He has medication for high blood pressure and an enlarged prostate, one for neuropathy in his feet and some to help him sleep.
Mr. Rodrigues also gave him a watch, which will help researchers track his daily steps and sleep. The watch, Mr. Moore says laughing, was a big incentive in joining the study. It replaces his flimsy, multicolored plastic watch.
Mr. Rodrigues handed him a scale and instructed him to step on it daily. The scale can measure body composition, weight, heart rate and arterial stiffness, a measure of cardiovascular health.
Participants have software installed to measure how much time they spend on their computers. And for those still driving, a sensor goes under the dashboard to monitor how often they get behind the wheel.
Most information doctors get is based on patient recall, Dr. Kaye notes. It can be difficult for patients to remember something from weeks earlier. The use of technology provides a more objective measure of ongoing health.
The researchers hope to add more devices to homes as the study progresses. Dr. Kaye says they are already testing a sensor-embedded mat to place under a participant’s mattress, which will give researchers better measurements of sleep, such as continuous heart and respiration rate.
The computer monitoring doesn’t look at emails or specific URLs. Instead, it tracks time spent on the computer, the name of applications in use and how users maneuver the mouse and keyboard, Dr. Kaye says.
Ms. Orlov says privacy is always a potential issue with home monitoring systems, depending on where the data goes, how it’s managed and who gets to see it. “It’s the same problems with all data collected: the risk that the data is mismanaged or hacked,” says Ms. Orlov. She says it’s less of an issue for a system like CART used as part of a research study than with a commercially available product.
Dr. Kaye says the data is all de-identified and the study’s participants consent to its use.
He adds that it would be extremely difficult for anyone outside of his research team to interpret or know which sensor any information is coming from. The data is also encrypted and uses a system that undergoes an independent safety review. It isn’t stored in a cloud, but through their university’s advanced computing center, which lends an extra level of security.
Mr. Moore says he’s fine with the monitoring. He’s noticed the sensors a few times since they were installed. But they don’t bother him as he goes about his normal daily activities: meditating, painting, napping and walking his dog, Oly.
“If someone was taking pictures of me or watching what I did on the computer, that might bother me,” he says. “But this is quite anonymous.”
Carol Kendig, a 70-year-old, semiretired Portland resident, also had her home outfitted. She says Mr. Rodrigues put sensors in all the rooms she uses.
“It seems like a very noninvasive study,” she says. “It doesn’t require that I take anything or particularly do anything. Basically they just want me to live my normal life. If they can extrapolate some information from this study that is helpful to following generations, that’s great.”
The researchers hope that with more funding, they will be able to scale the project to thousands of homes. “Ten thousand homes is the pipe dream,” says Nina Silverberg, program director at the Alzheimer’s Disease Centers, part of the National Institute on Aging, and project scientist for the CART study.