1. 1 Effects of Currently Available Smart Home Technology on Frail Elders Machiko R. Tomita, Ph.D. Department of Rehabilitation Science University at Buffalo Presented at NYSOTA Conference Buffalo, NY, September 27-29, 2007

2. 2 Rationale for the Study Elders with disabilities are likely to experience functional limitations, dependence on caregivers, and depression, which could lead to institutionalization.Elders with disabilities are likely to experience functional limitations, dependence on caregivers, and depression, which could lead to institutionalization. Smart Home utilizing a computer may improve safety to prevent falls and injury, enhancing mental and physical activities that can keep frail elders at home longer.Smart Home utilizing a computer may improve safety to prevent falls and injury, enhancing mental and physical activities that can keep frail elders at home longer.

3. 3 SH for frail elderly in the world SH technology (X10) was introduced in early 1980’s from Scotland.SH technology (X10) was introduced in early 1980’s from Scotland. In 2000, SmartBoIn 2000, SmartBo used an intelligent building control system (European Installation Bus) that controlled all lighting, most electric power outlets, the motorized lock of the entrance door, and motorized blinds, curtains, and window openers. When a person leaves the bed at night, dimmed lamps lighted the way from bedroom to bathroom. If the person does not return to bed after a pre-set time, the caregivers would then be alerted.

4. 4 SH for Frail Elderly in the US Allegheny Hospital McKeesport Aging Project in Pennsylvania.Allegheny Hospital McKeesport Aging Project in Pennsylvania.

5. 5 Comprehensive Needs Assessments for SH

6. 6 Purpose of the Study To conduct a two-year randomized controlled trial on sustainability of independent living at smart home among home-based older adults with chronic conditions.To conduct a two-year randomized controlled trial on sustainability of independent living at smart home among home-based older adults with chronic conditions.

7. 7 Model toward Optimal Management of Independence through Technological Adoption Independence (Living at Home) Personal Factors Physical Activities Cognitive Activities Psychological State TA&HETA&HE Family and Friends Social/Community Support

8. 8 Research Questions 1. Would frail elders accept the SH, if it is provided to them? 2. Do older adults using SH maintain physical function better than the control group? 3. Do the users of SH maintain cognitive function better than the control group? 4. Do the users of SH experience less depression than the control group? 5. What are subjective evaluations of SH by frail elders? 6. Is the rate of remaining at home for SH residents higher than the control group?

9. 9 Method: Design Randomized Controlled Design NotationRandomized Controlled Design Notation Initial1 year2 years R T O X O X O R C O O O R C O O O Where R is randomization, T is treatment group, C is control group, O is observation (assessment), and X is intervention (SH)

10. 10 Method: Sampling Older adults (60+) who live alone, have difficulty in IADL or ADL for 90 days, and are cognitively intact (MMSE>23), and intend to remain living in their own home.Older adults (60+) who live alone, have difficulty in IADL or ADL for 90 days, and are cognitively intact (MMSE>23), and intend to remain living in their own home. Sample size: 90 (Based on power analysis)Sample size: 90 (Based on power analysis) Initially 46 Treatment and 67 ControlInitially 46 Treatment and 67 Control 2 years later 34 Treatment (26% attrition)2 years later 34 Treatment (26% attrition) and 44 Control (34% attrition) and 44 Control (34% attrition)

11. 11 Instruments X-10 ActiveHome kit and other modulesX-10 ActiveHome kit and other modules

12. 12 Active Home Kit Includes: Two-Way Transceiver Module 5-in-1 Remote Control Lamp Module Interface

13. 13 Computer Operated Automated Functions

14. 14 Automated Lighting System

15. 15 Remote Control

16. 16 Coffee Maker Connected to X 10

17. 17 Door and Window Sensors

18. 18 Motion Sensor for windows and doors for security

19. 19 Alarm System Chime and Lighting

20. 20 Power flash to control lights and chimes

21. 21 X10 devices used in the Study X10 signal through existing wiring Outlet Computer ActiveHome Software Remote Control Transceiver Module Lamp Module Lamp Lighting Motion Sensor Interface Radio Frequency Window Door Security Flash Unit Chime Module Appliance Module Coffee Maker Wall Switch

22. 22 Procedure A computer and/or Internet were provided, if not owned.A computer and/or Internet were provided, if not owned. An OT or a nurse visited a participants home for a 2.5 hour assessment.An OT or a nurse visited a participants home for a 2.5 hour assessment. The initial installation, done by Jim, took three to nine hours depending on the size of the home.The initial installation, done by Jim, took three to nine hours depending on the size of the home.

23. 23 T raining of Computer Use A computer should be running 24/7 for the automatic lighting features but the monitor can be turned off when it is not in use. Kathy visited participants an average of 5 times for training.

24. 24 Devices That Help Computer Access Keyboard Enlargement Tabs Trackball

25. 25 Instruments for Outcome Measurement Functional StatusFunctional Status –FIM for ADL, OAR’s IADL, CHART mobility Cognitive StatusCognitive Status –MMSE (Center for Functional Assessment Research,1990; Fillenbaum, 1988; Gilson, et al. 1975; Wolinsky, Callahan, Fitzgerald, & Johnson, 1993 Folstein, Folstein & McHugh, 1988)

26. 26 Results: Initial Demographics and Health Data of Participants who Survived for 2 Years T (n=34) C (n=44) T (n=34) C (n=44) Age 72.0 75.6*Age 72.0 75.6* Gender (F) 30 (88.2%) 39 (88.6%)Gender (F) 30 (88.2%) 39 (88.6%) Race (Minority) 10 (29.4%) 8 (18.2%)Race (Minority) 10 (29.4%) 8 (18.2%) Housing (Own) 19 (55.9%) 24 (54.5%)Housing (Own) 19 (55.9%) 24 (54.5%) Education (≤HS) 11 (29.4%) 26 (59.1%)Education (≤HS) 11 (29.4%) 26 (59.1%) Diabetes 4 (11.8%) 14 (31.8%)*Diabetes 4 (11.8%) 14 (31.8%)* Urinary tract d. 1 (2.9%) 9 (20.5%)*Urinary tract d. 1 (2.9%) 9 (20.5%)*

27. 27 Results: RQ 1 - Would frail elders accept the SH, if it is provided to them? 100% Computer100% Computer 65%Active Home software65%Active Home software 68%Remote control and chimes68%Remote control and chimes 67%Wall switch67%Wall switch 62%Power flash for window/door security62%Power flash for window/door security 62%Lighting62%Lighting 53%Motion detector53%Motion detector 52%Coffeemaker52%Coffeemaker

28. 28 Results: RQ 2 - Do older adults using SH maintain physical function better than the control group? Physical Dysfunction Level (<.001)

29. 29 Results: RQ 2 - Do older adults using SH maintain physical function better than the control group? CHART Mobility (P<.001)

30. 30 Results: RQ3 - Do the users of SH maintain cognitive function better than the control group? FIM Cognition (p<.001)

31. 31 Results: RQ5 - What are subjective evaluations of SH by frail elders? Importance of PC (Very Important): 26.5% (1 st F. ) 82.4% (2 nd F.)Importance of PC (Very Important): 26.5% (1 st F. ) 82.4% (2 nd F.) 84.6%Knowledge gain 71.8%More mental stimulus 59.0%Increased socialization 43.6%Better health and wellness

32. 32 Results: RQ5 - What are subjective evaluations of SH by frail elders? NotSome A Great Deal Benefited from SH: 0 21%77%Benefited from SH: 0 21%77% Improved daily life: 30% 20%50%Improved daily life: 30% 20%50% Gained confidence12% 35%53%Gained confidence12% 35%53% Recommend to NoYesRecommend to NoYes older adults6%91%

33. 33 Results: RQ5 - What are subjective evaluations of SH by frail elders? Reasons for recommend or not recommend Recommend (n=31, 28 answered) 50% Security,28.6% Safety, 14.3% Easy access to lights, 2% comfort Not Recommend (n=8) Bad experience, Erratic, The system is not working, Not very reliable

34. 34 Results: RQ6 - Is the rate of remaining at home for SH residents higher than the control group? TreatmentControl Initial 4667 2 years later Still in the study 34 (73.9%)44 (65.7%) Died 6 (13.0%) 6 (9.0%) Institutionalized 1 ( 2.2%) 3 (4.5%) Quit due to illness 3 ( 6.5%) 3 (4.5%) Phone Disconnected 0 10 (14.9%) P<.05

35. 35 Discussion It is possible to create a SH for under $300, excluding the computer and labor.It is possible to create a SH for under $300, excluding the computer and labor. The major problem was lighting, but if a person learns how to reset the timer on the computer, this became the most preferred feature for safety reasons and the reason for continuity of living at home.The major problem was lighting, but if a person learns how to reset the timer on the computer, this became the most preferred feature for safety reasons and the reason for continuity of living at home. SH/computer users maintained physical and cognitive functions over two years in contrast to a significant decline among nonusers. Although increased comorbidity usually translates to declines in motor function, for the treatment group, SH systems could have prevented falls and injuries, and allowed more independent daily activities. It is difficult to measure what was prevented by use of SH. SH/computer users maintained physical and cognitive functions over two years in contrast to a significant decline among nonusers. Although increased comorbidity usually translates to declines in motor function, for the treatment group, SH systems could have prevented falls and injuries, and allowed more independent daily activities. It is difficult to measure what was prevented by use of SH.

36. 36 Discussion Finally, SH users continued living in their own home significantly more than nonusers (80% vs. 66%). SH may have prevented an injury and promoted an active life style. Psychologically, feeling secure also may have encouraged frail elders to continue living at home. Creating a SH needs skill, and living in a SH requires patience in learning how to operate SH technologies. Nevertheless, we conclude that retrofitting an older home with smart home technology can be an effective coping strategy for remaining in one’s own home, increasing quality of life for older adults with chronic conditions.Finally, SH users continued living in their own home significantly more than nonusers (80% vs. 66%). SH may have prevented an injury and promoted an active life style. Psychologically, feeling secure also may have encouraged frail elders to continue living at home. Creating a SH needs skill, and living in a SH requires patience in learning how to operate SH technologies. Nevertheless, we conclude that retrofitting an older home with smart home technology can be an effective coping strategy for remaining in one’s own home, increasing quality of life for older adults with chronic conditions.

37. 37 Appendix Detailed statements of installation, problems and solutions can be found in www.agingresearch.buffalo.eduDetailed statements of installation, problems and solutions can be found in www.agingresearch.buffalo.edu www.agingresearch.buffalo.edu An example of SH technology was recreated in the basement of the Independent Living Center on Main Street in Western New York, near the South Campus of the University at Buffalo.An example of SH technology was recreated in the basement of the Independent Living Center on Main Street in Western New York, near the South Campus of the University at Buffalo.

38. 38 “I like Smart House and only wish this place were larger so that I could take more advantage of it.”

39. 39 Crews for the study Machiko R. TomitaMachiko R. Tomita Kathy StantonKathy Stanton William MannWilliam Mann Jim PeronJim Peron Vidya SundarVidya Sundar Akihiko D. TomitaAkihiko D. Tomita Mary BeckerMary Becker Maria CastiloneMaria Castilone Patty JahnPatty Jahn RERC-Technology for Successful Aging This project was funded by NIDRR, USDE