Technology-based assistance systems: Aging in place

In this REHACARE.com interview, Alexander Karl talked about the research behind the AAL Living Lab and describes the variety of technical assistance systems.

Mr. Karl, what is the primary objective of the AAL Living Lab?

Alexander Karl: Our research and development efforts pertain to technical assistance systems that enable people with physical or mental impairments to live longer in their own four walls.

People tend to associate AAL with big technology, which typically also requires a big investment. For me, AAL also means integrating smart solutions, which don’t necessarily have to be technical and include the sensible placement of grab bars ad handles for example. For many people, you only have to adapt the apartment and reposition things, which enables them to live more independently again. And for some people, it takes more money and effort. As a general rule, this always requires a case by case assessment.

What does your research work entail?

Karl: Even though the Living Lab is a setup of the university, it is in actuality a residential living laboratory located in a retirement home as part of a living cooperative. We have equipped the rented apartment with various technology-based assistance systems and have integrated the Living Lab into the curriculum – as part of the Faculty of Electrical Engineering and the Faculty of Social and Health Sciences. We also plan to integrate the Faculty of Computer Science in the near future. I offer students many options of completing sustained research projects and dissertations in this area. For all intents and purposes, development begins here. The majority of the systems are developed by the students. There is a problem statement that is either created by me, the advising professors or the students themselves. This is followed by creating a problem-solving concept and might involve the design of a bathroom mirror and height-adjustable vanity for example. Earlier this year, I had a dissertation pertaining to this subject that was successfully completed.

Armed with their idea, I send the future engineers to care facilities or affected parties to align their concept with reality. Genuine feedback from the primary users of these types of systems is crucial to ensure that subsequent developments are met with user acceptance and support. This generally also serves to hone the concept. Subsequently, students have three to four months to put their concept into practice.

What types of technical assistance systems do you use in the Living Lab?

Karl: That depends on the situation. For example, our kitchen accommodates the needs of wheelchair users. The kitchen’s upper cabinets and countertop are height adjustable, allowing wheelchair users to access the contents.

We also have a stand assist bed, permitting users with physical impairments to change from a lying to an upright standing position without the need to exert physical strength.

We also use a fall sensor system for fall detection: If someone falls and is unable to get up after a certain amount of time has passed, family members can be notified or an emergency call can be made. You can also illuminate the area of the fall by turning up the lights. And if the front door lock is part of the smart home setup, it can be automatically opened up in an emergency, allowing the fire department to enter without the need to break down the door.

We also installed biodynamic lighting, designed to support the circadian rhythms of older adults. This method of lighting mimics the cycle of natural daylight, changing color temperature and intensity throughout the day. In the case of dementia patients, light is an external factor that provides more orientation and structure throughout the day.

We are also exploring the option of a smart toilet, i.e. a telemedicine support system. It can track multiple medical parameters such as blood pressure, heart rate, oxygen saturation, produce an ECG and measure urinary output. These are typical vital parameters that family physicians use and which can be tracked via the telemedicine system and the smart toilet. In the future, you could store this sensitive data in a database and make it available to a family doctor who resides several kilometers away and remotely monitors the data. But we are still in the prototype stage and will enter the active research phase next year. Our first step is to ensure accurate and reliable parameter measurements. Needless to say, you also have to conquer various legal issues and ethical concerns that arise during the course of digitization.

Who will ultimately benefit from your research?

Karl: Older adults are the primary users of these systems. But there are also secondary users who will benefit, including family members who take on most of the everyday caregiving responsibilities. For example, the stand assist bed relieves caregivers by not subjecting them to pulling or lifting the patient. Right now, many caregivers are typically forced to leave their profession at the age of 40 or 50 due to the severe impact on their physical health. This is where the assistance system comes in as it reduces the physical caregiver burden when the machine takes over. The idea behind technical assistance systems is not to replace people but to offer assistance and support.

What are some other challenges of technical assistance systems?

Karl: The problem with assistance systems or digitization in general, is that you have to try to build a functioning system around a person. It all starts with the need for different devices to talk to one another to ensure they are connected together on your network. What’s more, it may require the not-so-tech-savvy to work with technology: people in their 90s are confronted with the latest technology and may have never even held a smartphone in their hands. This aspect is even more complex when you consider dementia cases. These are just some of the challenges we should tackle on a case-by-case basis. Nevertheless, we somehow try to generate a solution that suits the needs of as many people as possible.

Financial aspects are also a major concern. A big technical assistance system costs a lot of money. Not all health insurance companies and long-term disability insurance providers offer coverage at this point. The insurance company would have to spend 8,000 euros to pay for a stand assist bed. Meanwhile, its impact would be far greater. After all, inpatient care amounts to at least 8,000 euros in just two months. That’s why this type of bed would quickly pay for itself from the health insurance company’s perspective. But unfortunately, the reality in Germany is still different.

How will the market develop?

Karl: The past two years have already confirmed my hunch that the market is slowly adapting to satisfy the needs of the elderly. We will have to focus more on individuality and not rely on standard solutions. Over the next ten years, we will see a capital and economic shift toward older adults. We will see many changes, especially as it pertains to the area of caregiving and healthcare. I can already see it in the market trend for technical assistance systems: more and more start-ups are entering the market – offering fall detection sensors, lighting solutions or everyday helper tools.