Table 2.

Areas for efficacy testing of potential LTC technology and Examples

Areas	Technology	Examples of potential technology use
SAFETY/PREVENTION/DETECTION
▪ Falls	Gait and motion sensors, Global Positioning System (GPS) devices, ambient displays, and actuator networks	Sensors installed in the facility to monitor gaits and motions of residents. Example: Activity sensors are placed in a wall or within each living space in the facility. The sensors track the elder’s gait, stability, and movement pattern and identify pattern changes that reflect an increased risk for falls. They also detect any fall and alert staff immediately for intervention (e.g., in field testing: “In-Home Monitoring System” by University of Virginia). A wireless pendant or wristband with a personal help button Example: Pushing the button alerts staff to send help. (e.g., in market: A “personal help button” by ADT security services)
▪ Wandering	Wireless motion sensors and a GPS location system	Location, object, and person tracking around the facility. Example: Sensors will send alert to staff if elders with AD exit doors and wander out of facility (e.g., in development: “Lifeline” by University of Colorado). Example: A resident at risk for wandering may wear small necklaces, key-chains, or other familiar devices embedded with GPS devices. These can be attached to clothing and other items to track and locate a resident who has left the facility. (e.g., in market: “Wheels of Zeus” by Apple Computer co-founder Steve Wozeniak)
▪ Pressure Ulcer	Biosensors	Sensors installed on personal items Example: Sensors are attached to a pair of socks and detect swelling in a resident’s feet and relay the change to staff (e.g., in concept proposal: CAST, 2005). Skin images are sent for dermatological analysis. Example: Sensor attached to a mattress monitor pressure distribution, detect any skin change of a resident, and alert staff (e.g. ,in development: “Smart Bed” by University of Florida, or Remote teledermatology in home treatment study at Partners Telemedicine)
▪ Wellness monitoring	Biosensors, behavioral sensors, and bodily diagnostics Information fusion and inference engines	Real-time, routine chemical analysis Example: The real-time biosensors track routine blood chemistry analysis and monitor any changes. Sensors in the toilet also do chemical analysis and track any changes. Functional and cognitive ability measurement and assessment/personal baselines and alerts to meaningful deviations Example: Physiological and behavioral changes are monitored through sensors and assessed for depression, cognitive decline, and dementia. The data supplied by sensors will be evaluated for changes over time, thus ideally enabling trend analysis and assessment of residents’ physiological, cognitive, psychosocial wellbeing. (e.g., in development of a basic room and staff monitoring systems: “digital danskin” by MIT, or “Automated Care System (ACS)” at the Oatfield Estates assisted living facility, Milwaukee, Oregon)
ACTIVITIES OF DAILY LIFE
▪ Bathing	Sensors, information transfer, decision guidance systems	Remodeling and redesigning bath environment Monitoring and heath promotion with sensors Example: Handrails in the bathtub not only prevent residents from a slip or fall but also check vital signs and skin status. Sensors in the tub measure the water temperature and self regulate the inflow water temperature (e.g., in development: “Smart Bathtub” by the University of Florida). Example: A sensor in a toothbrush analyzes saliva and identifies any vitamin, mineral or enzyme deficiencies, along with a resident’s current blood sugar levels. The information is sent to staff for possible adjustment of dosages of vitamins and prescription drugs (e.g., in concept proposal: CAST, 2005).
▪ Eating	Sensors, wireless information transfer, and decision guidance systems	Sensors for assessment, monitoring and detection. Information transfer and decision guidance systems for evaluation and planning Example: The bathroom scale detects weight changes of a resident and sends the information to rehabilitation equipment such as a treadmill, which customizes his/her weekly workout program. A menu-planning program simultaneously increases or decreases the daily calories and fat in a customized daily menu plan and sends the information to the kitchen. Weight and oral intake information is sent directly to the electronic medical record (e.g. in concept proposal: CAST, 2005).
▪ Mobility	Sensors, robotics, and mechanical engineering	Assisted mobility Example: Ceiling mounted lifts are activated by a resident pushing a wall button. They move from room to room and attach to multiple overhead track systems to lift, transfer, and transport residents with physical limitations to and from a bed, toilet, bath, chair, and the floor. (e.g., in development: “Lifting and Transferring” at “Technology for Long-Term Care”) Example: An intelligent walker or autonomous robotic wheelchair with adaptive guidance may tell a resident with low vision directions to avoid any obstacles, allow him/her to power across gravel, grass, and other uneven terrain, and hold a conversation on the move ( e.g., in market: “iBot Mobility System” by Johnson & Johnson, Inc.).
▪ Sleeping	Wireless sensors	Information of sleep behaviors Example: A mattress pad in the bed can detect the sleeping position of a resident, the minutes of nighttime sleep, the number of awakening, the count of breaths per minute, % of time in bed, and the level of room light. The information is sent to staff for monitoring. (e.g., in field test: “Sleep-Monitoring System” by University of Virginia). Example: A care system for use in the homes of people with cognitive disabilities such as Alzheimer’s disease includes security system control pad, a wireless receiver, motion sensors, door opening sensors, and a bed occupancy sensor. No alarms go off after the client goes to bed. This allows caregivers to move around in the home without triggering the alarm. The system automatically activates once the client rises (e.g., in development: “CareWatch” system by Rowe, Lane, & Phipps 2007).
▪ Medication	Biosensors and medication dispensers with motion sensor	Targeted drug delivery and effects analysis. Example: The real-time, non-intrusive biosensors will track medication dosage and frequency, fluid and solid nutritional intake, which could be modified based on the analysis. Then, the effects on blood chemistry could be quickly and easily assessed. Example: The amount, frequency, type of medications are tracked and monitored through sensors on automated medication dispensers. Automated medication dispensers improve safety and reduce errors. These dispensers are equipped with audio and visual reminders and personal emergency response systems. (e.g., in development: “MedTracker” by Oregon Health and Science University, or “Chester the Talking Pill” by University of Rochester)
▪ ADL helper	Artificial intelligence and robotic engineering	Reminding and assisting in activities of daily living Example. A robotic aids residents with dementia by reminding them about activities of daily living, taking vital signs, and fetching items (: e.g., in development: a “nursebot” named Pearl)
	Adaptive, distributed interfaces	Personalized interactive experience for daily activities Example: Residents use their desktop, or overbed table, as the screen for selecting meals, adjusting their personal schedule for the day, and connecting with others.
COGNITION
	Ambient displays and actuator networks	Assistive cognition and mental fitness Example: For the elder with cognitive impairment, a digital portrait will display reminders such as time, date, and faces and names of family members. The auto reminders and prompts are customized to individual specifications, employing strategies to retain and stimulate cognitive reserve. The elder can call up virtual reels from a personal library of family portraits, videos of past pictures or family events of significance, movies, documentaries, books, and plays for viewing (e.g., in development: “Smart Mirror” by University of Florida). Adaptive cognitive orthotics
	Cognitive orthosis technology	Example: Autoreminder, an intelligent cognitive orthotic, provides adaptive reminders to residents with dementia based on their evolving needs and actions (e.g., in development: “SHARP” by University of Washington, or “MAPS” by University of Colorado).
SOCIAL CONNECTIVITY/ COMMUNICATION
	Wireless broadband, remote community and collaboration	Multiple modes and media for communicating across distances Example: Wireless broadband enables the elder to engage in contacts both within and outside the institutional environment, virtually connecting with family, friends, and professional colleagues around the globe. Ways of representing and feeling “presence” at lonely times Example: Using a digital monitor projected on the wall and voice commands or other prompts, elders will virtually connect via videoconferencing with friends, family, and professional/hobby colleagues at a distance. Example: The computer face will light up when an internet friend or family member has checked in or is available. Somewhat like the current ‘instant messaging’ technique, the elder is alerted through a visual or auditory notice that ‘others’ are present and can be prompted. Rich and multiple streams of information delivery Example: Elders may choose to have health information sent to family members or to other professional providers, including independently-hired geriatric case managers, who advocate on their behalf (e.g., in development: “Digital Family Portrait” and “Dude’s Magic Box” by Georgia Institute of Technology).
RECREATIONAL/ SPIRITUAL ACTIVITIES
▪ Recreation	Computer technology and virtual reality systems	Desktop, laptop, handheld computers Simulated room/environment created by a virtual reality system Example: Residents use computers to watch a big-screen display of scenery pictures with music, create a greeting card, or play computer games for enjoyment and mental stimulation. Example: Residents with mobility limitations may walk around a virtual garden or bike trail created by a virtual reality system (e.g., in market: “Simcycle”, a simulated bike exercise program by It’s Never 2 Late, Inc.). Example: Residents use publishing software to write their life stories and publish them on the Internet. (e.g., in market: Silver Stringers).
▪ Companion- ship	Robotics	Artificial intelligence pets for support that may help decrease feelings of isolation or depression Example: A “smart” cat (robotics) may calm an agitated Alzheimer’s patient by purring at the bedside or responding with movement when held and stroked. (e.g., in market: AIBO, a robotic dog, by Sony Corporation).
	Computer technology	Example: Residents use computers to visit with pastors of their churches via videoconferencing.
STAFF AND FAMILY SUPPORT
▪ Resident	Sensors and monitoring robotics	Facility driven by technology Example: Staff monitors the medical condition of the residents with a robot that is equipped with sensors and is linked to a large screen in the nurse’s station (e.g., in development: “Tama, a robot teddy,” developed by Matsushita Electric).
▪ Electronic health records	Information Technology	Central repository for personal and professional health information Tools for easy visualization of long-term trends and care evaluation and planning Example: The personal and longitudinal health records across settings from home to hospital to LTC facility can allow staff to assess comprehensive health information about an individual’s biobehavioral patterns and to evaluate and plan for care.
Family involvement	Wireless broadband Networking	Mobile communication and computing devices (MCCDs) Internet access between family member and LTC facilities Example: LTC facilities open access to data reflecting the daily routine of their family members. This process allows the family member greater input and involvement in their loved ones’ care. Example: Family members join virtual caregiving networks, exchange information about publicly and privately provided health care services, and receive formal or informal support.
	Personal health informatics	Central repository for personal and professional health information Tools for easy visualization of long-term trends Example: Personal health information is projected to designated family caregivers, independently hired personal care managers, or friends who are serving as advocates. Information is translated into a language and format understandable to the layperson. When needed, best evidence care protocols may be included with each projection of information.