Giving meaning to quality of life through technology: cutting-edge research on aging-in-place technologies at Carnegie Mellon University/University of Pittsburgh.

How can technology improve quality of life for older adults and people with disabilities? Is such technology achievable? Can it be affordable?

Research demonstrates that most people simply want to live and work independently in the community as long as possible. The setting may be one's personal home, a neighborhood or, finally, a nearby institution. Technology can be used in all these situations to assist with daily task completion so that a person can maintain the lifestyle of his or her choosing. Sensor-rich, intelligent technology, whether stand-alone devices or integrated systems, can provide functional and cognitive support while monitoring the health status of those individuals who are aging in place or those with unstable medical conditions who often transition abruptly among various care settings.

The Carnegie Mellon University/University of Pittsburgh Quality of Life Technology (QoLT) Center (www.qolt.org), through research and development (R & D), is crafting intelligent devices and systems in response to the needs of older adults and people with disabilities--regardless of age, use of informal and formal caregivers, or type of institution. The QoLT Center, established in 2006 by a National Science Foundation Engineering Research Center grant, aims to realize a modern vision of quality of life. The QoLT vision is being actualized through transformative R & D by leading technologists, with practical involvement by the industry, end users, providers, clinicians, and other stakeholders.

Beyond technology R & D, the QoLT Center has taken a proactive stance toward understanding the myriad demographic, market, regulatory, and health system challenges involved. By carefully integrating technology and social research, the Center aims to enhance theoretical and practical knowledge about individual acceptance and societal adoption of the contexts in which the technologies are applied. Thus, researchers ask questions such as: What technology is needed, and what are the barriers to individual acceptance? Responses will be varied and may include such nontechnical issues as complexity, cost, aesthetics, and infringement on privacy/dignity. Other questions involve product market potential and regulatory requirements. Using survey research, focus groups, and other methodologies, QoLT researchers are collecting, analyzing, and sharing this information with technology and support provider partners.

[ILLUSTRATION OMITTED]

Intelligent systems are the cornerstone of QoLT research. Using sensors and software, future devices will be able to anticipate a person's intent, understand his or her capabilities of achieving that intent, and provide assistance as needed and desired. The QoLT Center's R & D strategy defines four families of engineered systems that embody the Center's vision and research foci: (1) Virtual Coach, (2) Active Home, (3) Personal Mobility and Manipulation Appliance, and (4) Safe Driving. Prototypes of each family will be integrated and tested in real-world settings such as a continuing care retirement community (CCRC) and a 10-acre neighborhood, a natural community that features homes, stores, a community center, and civic infrastructure to support older adults, people with disabilities, and others who simply seek better quality of life.

An example of quality-of-life technology is CareMedia, an automated video and sensor analysis system for geriatric care that was developed by computer scientists at Carnegie Mellon University under the auspices of National Science Foundation funding. CareMedia uses computer analysis of video and other data to capture continuously, and in real-time, a record of activities, behaviors, and social interactions of extended-care facility residents. The non-private spaces of dementia units are instrumented with ceiling-mounted video cameras that record continuously for extended periods. Even as a prototype, CareMedia has helped staff identify how and when residents with Alzheimer's disease have tried to elope from a locked dementia unit and has documented an increased frequency of aggressive behaviors by these residents toward the later part of the day. Such information permits staff to consider individually tailored pharmacological, behavioral, environmental, or staffing adjustments to ensure a safe living (and working) environment.

Likewise, CareMedia has also demonstrated, quite vividly, the discrepancies between reports of aggressive behaviors as documented in the federally mandated Minimum Data Set and data captured by the continuous monitoring approach of CareMedia. Such a system could conceivably assist long-term care facilities in compliance with state and federal regulations and simultaneously reduce the human effort of preparing such reports.

Building on human activity awareness technologies such as CareMedia, the QoLT Center is developing Virtual Coach technology, which will monitor user performance of activities and provide appropriate feedback and encouragement rather than rote reminders. By sensing a person's movements and locations, a computer can infer the activity being performed and recognize the steps for which the person needs help. Virtual Coach may assist with activities as basic as self-care and as advanced as driving. It will also learn to adapt to changes in the user's abilities. For example, as a user relearns a particular task, Virtual Coach will reduce the number of verbal cues it provides. The aim is to ensure the safe functioning of individuals with cognitive impairments in their homes or residential settings. Through simple, easy-to-use interfaces, a care provider can upload new capabilities to Virtual Coach as required--for example, to be more vigilant or to monitor additional activities, potentially without even an office visit. Virtual Coach will also provide constant and consistent observation or monitoring, preferably on a real-time basis, thereby extending the clinician's guidance beyond episodic patient examinations.

By combining a perceptive environment with physical assistance that can provide services in the home, the feature known as Active Home will perform actions for and with the inhabitants. For example, intelligent appliances and personal robots in Active Home will assist with transfers between chairs, beds, and toilets, as well as assist with cooking and eating, cleaning, dressing, and home maintenance. Similarly, the controller of the Personal Mobility and Manipulation Appliance will anticipate that an individual using a wheelchair is approaching a closed door, and it will recognize the door, identify the door handle, and automatically move its robotic arm to grasp it, and then coordinate the movements of both the arm and chair to allow quick entry into a room.

Safe Driving seeks to enable older adults and people with disabilities to independently and confidently operate personal vehicles for years longer than currently possible. Our initial work is developing a system that will constantly monitor driving actions and behavior to assess a person's capability to drive a vehicle. This is based on a legacy of computer-based vehicle driving that uses cameras and distance sensors, as well as instrumented steering, accelerator, and brake controls, all of which makes this type of assistance possible. One possible future system will automatically provide customized route instructions tailored to a user's driving capability and the prevailing conditions; another will automatically adapt the vehicle's displays and controls to the driver's particular needs.

Today's consumer, caregiver, and provider share a common interest in a person's ability to drive a car, make rational judgments, and live in the community as long as possible. Fulfillment of these needs will require technology that is more intelligent than in the past. QoLT aims at just that--enhancing quality of life through smart technology. We welcome the input and participation of all stakeholders.

Katherine D. Seelman is Associate Dean of Disability Programs and Professor of Rehabilitation Science & Technology, and Co-Scientific Director, QoLT Engineering Research Center, University of Pittsburgh, Pittsburgh. Diane M. Collins, PhD, OTR/L, is Researcher, Rehabilitation Science and Technology, University of Pittsburgh. Ashok Bharucha, MD, is Assistant Professor of Psychiatry, Univeristy of Pittsburgh School of Medicine. Jim Osborn is Executive Director, QoLT Center, Carnegie Mellon University, Pittsburgh. For more information, call (412) 383-6727 or visit www.shrs.pitt.edu. To send your comments to the authors and editors, please e-mail seelman1007@nursinghomesmagazine.com.

BY KATHERINE D. SEELMAN, PHD; DIANE M. COLLINS, PHD, OTR/L; ASHOK J. BHARUCHA, MD; AND JIM OSBORN