Transcript Slide 1

INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY
SECOND MASTERCLASS IN GERONTECHNOLOGY
TUE, EINDHOVEN, NL NOVEMBER 13-14, 2007
Methodologies in Compensation and Care
Technological Interventions
James L. Fozard, Ph.D.
School of Aging Studies
University of South Florida
Tampa, FL 33260
For electronic copy of slides, send
me an e-mail request at
[email protected]
Gerontechnology’s Tools for planning
compensatory and care interventions
• Several steps are involved in developing gerontechnology
interventions
– Identify the domain(s) of human activity that is the target of the
intervention—health, housing, communication, transportation, work and
leisure
– Identify the critical information needed from the technology disciplines
and the gerontological disciplines—put together and interdisciplinary
team as needed
– Identify the typical age of the target population and the relation of that
age to stage of secular development of technology to be used
• Is user interface ‘friendly’ to intended cohort of users?
– Identify the target of the intervention
•
–
Physical, mental, emotional
Identify the site of the intervention
•
Person, environment, interface
Gerontechnology Impact matrix
Slide courtesy of Prof. Dr. Herman Bouma 5/22/06
Life Domain
Health &
Selfesteem
Housing &
Daily
Living
Mobility &
Transport
Communication &
Governance
Work &
Leisure
Enhancement
& Satisfaction
Telemedicine
Internet
Wireless /
remote phone
GPS navigation
Mobile phone
Internet
Digital
camera
Internet
Prevention &
Engagement
Healthy diet
Home trainer
Smart
ventilation
“Intelligent” car
Video links
Focused
lighting
Compensation
& Assistance
Passive
alarms
Smart IADL
Rollator/walker
Battery powered
wheelchair
Hearing aids
Power tools
Robot pet
Care Support &
Organization
Smart intake
Control-PDA
Electronic keys
Powered lifting
Care networks
Video links
Robots
Goal of
Intervention
Person
Receptors Internal
Structures
Effectors
Human
aging
System
Output
Measure
Interface
Secular
change
Future
Social Built Natural
Time
Environment
Age-related and secular changes affect
system output dynamics
Past
Identify the typical age of the target population and the relation of that age to stage
of secular development of technology to be used. Is interface ‘friendly’ to user?
Putting the 4 gerontechnology
interventions to work
Fozard, JL Impacts of technology interventions on health and selfesteem. Gerontechnology, 2005, 4, 63-76.
• The next steps include identifying the
– Desired impact, e.g. prevention vs.
compensation
– Target of intervention
– Site and placement of technology
– Timing of intervention
Planning Practical Application of
Gerontechnology Concepts
IMPACT?
IMPACT?
INTERVENE:
Prevention
Enhance
TYPE, SITE?
Prevent
Compensation
Person:
Compensate
Care/organization
Care/organization Train, motivate
Select
Enhance
Personality
Demographics
FUNCTION? Environment:
TARGET?
Physical
Physical
Mental
Cognitive
Emotional/social
Emotional/Social
Built, social, natural
Device on person
Device: located
Fig.2
near or Fozard,
remotely
Person
System
Output
Environment
Time
Technology for compensation vs.
care
• The distinction between compensation and
assistance and care support and organization is
partly one of degree care
– Care referring to a person with a significant and
specific disability, e.g., paralysis of the legs
– Compensation describes one with a relatively
common age associated limitation in vision, hearing,
mobility, etc.
• Care and compensation are not mutually
exclusive: a person who may not be able to
move without assistance may also have a
limitation in hearing that is typical for older
persons.
Technology for Compensation in
Perceptual-Motor Functioning
• Technologies to compensating for age
related hearing loss
• Technologies to compensate for age
related vision and complex perceptual
motor function
HL (db)
HL Changes in 424 men with
Initial Ages from 30s to 70s
16
14
12
10
8
6
4
2
0
30s
40s
50s
60s
70s
2
4
6
8
Years
From Morrell, et al. J Acoust Soc Am 1996; 100;1959
10
12
14
Hearing: Compensation 1
• Improve Auditory Image Quality
– Amplification by hearing aids and direct signal
transmission, aural rehabilitation
– In 2005, about 22,000 adults and 15,000
children had chochlear implants
– In St. Petersburg FL, All Children’s Hospital
serviced 17 implants in local children in 2000.
In 2007 it services more than 200
• Reduce temporal distortion from
reverberation and time compression of
signals
Hearing: Compensation 2
• Reverberation
– Clearly age-related—interventions available
•
Schieber F, Fozard JL, Gordon-Salant S, Weiffenbach J Optimizing the
sensory-perceptual environment of older adults Int J Indust Ergon
1991;7:133-162
• Speech too fast, e.g, speech compressed
– Clearly age-related—one intervention is processor
to slow broadcast speech without frequency
distortion
Mutsuhashi T Human-friendly broadcasting technology NHK R&D 1998;50:53-59
• Reverberation and time compression often occur
together in public places
Poor Distribution of Hearing
Aids in US
• Poor hearing is 4th most frequent complaint of
older persons in USA surveys
• Only about 20% of hearing impaired persons
use hearing aids consistently
• Aggressive, misleading advertisements often
confuse consumers
• Evaluators/Vendors often have conflict of
interest
Hearing Aids: People often do
not trust providers or vendors
• “Free evaluations” by vendors often link need to
product(s) being sold by vendor
• Professional Physician/Audiologist evaluations
are also often linked to sales of specific
products—evaluation cost usually covered by
medical insurance; cost of device not covered.
Patient must depend on honesty of
professionals.
Hearing Aids: People often do
not trust providers or vendors
• Best advice in my popular articles and talks:
Find audiologist and physician who do not have
conflict of interest—In USA often available at
teaching hospitals and clinics
• Obtain information from NIH websites or read
excellent review in Consumer Reports, a
magazine published by independent testing nonprofit Consumers’ Union
Compensation: Vision 1
• Improve visual image quality
– Increase illumination, contrast, letter size
improve target quality, reduce glare, and
requirements for light/dark adaptation
• Decrease requirements for fast adaptation
and speed in complex visual tasks.
– Target magnification, longer presentation
times, cueing
Compensation: Visual acuity in
clinical testing conditions
• Longitudinal data on monocular acuity (better
eye) obtained with standard apparatus confirms
earlier published data showing that presenting
acuity changes little until the 70s for both men
and women
• Example of resolution acuity comes from data
from the Baltimore Longitudinal Study of Aging.
Same finding with letter acuity.
Snellen
Fraction
Squares=men;Circles=women Data from BLSA,
Womens’ data unpublished; Mens’ data: Gittings,
N., Fozard, J.L. Exp. Gerontol., 1986, 21,423-434.
20
30
40
50
60
Estimated US % w/Acuity<0,5: 4
70
4 9
80 Age
16
Compensation: Vision 2
• The loss of sensitivity with age extends
across visible spectrum:
– Discrimination between white light and
mixture of white light and monochromatic light
(420-680 nm) showed that older adults were
less able to discriminate color at 2 levels of
illumination after controlling for pupil size,
retinal luminance etc.
•
Kraft JM, Werner JS Aging and the satuation of colors. 1.. Colorimetric
purity discrimination J Opt Soc Am 1999;16:223-230.
Color Discrimination for 2 Age
and Luminance Levels
3
2.5
2
30-10
74-10
30-250
74-250
Log(1/Pc) 1.5
1
0.5
0
420
500
570
640
420
500
Wavelength (nm)
Data from Kraft JM and Werner JS, 1999
570
640
Compensation: Visual Acuity
• In everyday situations, poor illumination,
contrast and target characteristics greatly
reduce acuity and contrast sensitivity of
older persons.
• Examples from Japan and the Netherlands
follow. Both illustrate lighting and contrast
needed to reduce/eliminate age
differences.
Visual acuity
measured by letter or
Landolt Ring
increases as much as
80% with luminance
and brings oldest
group almost to level
of youngest at lower
luminance levels.
Data from Research
Institute of Human
Engineering for
Quality Life, Osaka
Japan, 1999.
Illumination and Contrast
Effects on Readability of Type
•
.
• Size of lower case Times Roman type
needed to read standard passages by
Dutch adults in four age groups was
measured. Three levels of illumination
(10,100,1000 lx) and 4 levels of contrast
(10, 33, 100 black on white and 100 white
on black used.
•
Steenbekkers LPA (1998) Visual contrast sensitivity. In LPA
Steenbekkers CEM van Beijsterveldt (Eds) Design-relevant
characteristics of ageing users. Delft, NL: Delft University of
Technology Press, pp.131-136
Type Size Needed to Read
Illumination, Contrast Effects
Illum
Age
Contrast
10
33
100
100
10
25
lux
75
100
25
10.0
5.0
4.0
3.2
12.6
10.0
8.0
8.0
4.0
4.0
3.2
3.2
lux 1000
75
25
8.0
8.0
6.3
5.0
3.2
3.2
3.2
3.2
lux
75
6.3
6.3
5.0
4.0
Need Multiple Approaches to
Improving Image Quality
• Applied research on equivalent visibility
functions across age--using combinations of
illumination, contrast, and targets
• Consumer education: Mockups of kitchen,
home office etc. that allow older people to see
how to improve personal lighting etc. Mockups
could be in lighting stores, Optician stores,
senior centers etc.
Need Multiple Approaches to
Improving Image Quality
• Consumer services: Small portable lighting aids
in restaurants for menus and bills; better design
of price tags, directions and prices of
merchandise.
• Improved use of electronic reading devices:
flexible print size and contrast.
• Device to automatically change focal lengths of
lens for presbyopic viewers.
• Greater use of digital hearing aids that selectively
amplify frequencies and suppress very high
intensity signals
Vision: Compensation in
Complex Tasks
• When improving visual information helps
performance in complex task depends on
specifics of task requirements for
– attention and search
– visual guidance of control movements
– maintenance of balance and gait.
• Behavioral slowing with age results in a
reduction of reserve capacity needed for
complex behavior
Vision: Compensation in
Complex Tasks
• Visually controlled movements
• Elderly adults require relatively more time to
complete a repetitive movement task as
difficulty increases. For small and long
movements, smaller targets mean longer
times.
•
Welford AT, Norris AH, Shock NW Speed and accuracy of movement and their
changes with age Acta Psychol 1969;30:3-15.
Brogmus GE (1997) Effects of age and sex on speed and accuracy of hand
movements and the refinements they suggest for Fitts’Law. In WA Rogers (Ed)
Designing for an aging population. Santa Monica CA: Human Factors and
Ergonomics Society, pp.25-29.
Data from Brogmus,
1991. Women
performed better than
men. 15 year
longitudinal followup of
men showed an initial
practice effect followed
by poorer performance
because of greater
variability in location of
spots in the target
space.
Visually Controlled Movements
• The slowing of making single and repetitive
movements occurs mostly in the last segment
of the movement. Practice does not help
reduce age difference in speed.
• Target magnification, control damping,
improved contrast provide best ways of
improving performance in tasks like moving the
computer screen cursor with a mouse control.
•
Seidler-Dobrin RD, Stelmach GE. (1996) Practice and visual feedback in the
elderly. In G Huber (Ed) Healthy aging, activity and sports. Heidelberg
GE:Health Promotion Publications, Pp.109-117.
Vision: Compensation Driving
• Self reports by current and former drivers
identify same visual problems found in
laboratory studies; in one study complaints
correlate with age declines in carefully
measured contrast sensitivity.
•
Kline DW, Kline TJB, Fozard JL, Kosnick W, Schieber F, Sekuler R Aging and
driving: the problems of older drivers. J Gerontol 1992;47:27-34
•
Schieber F, Kline DW, Kline TJB, Fozard JL The relationship between contrast
sensitivity and the visual problems of older drivers. Warrendale PA: Society of
Automotive Engineers Technical Paper 920613 1992 pp 1-7
Ratings 1-3: none to
moderate difficulty. Age
trends in all 7 complaints
predicted by contrast
sensitivity data
From Schieber et al 1992
Vision: Compensation: Driving
• As in static visual environments, illumination
levels and glare profoundly affect visibility for
signs and objects while driving
• Compensations include better sign lighting and
increased size of sign symbols
•
Schieber F, Kline DW Age differences in the legibility of symbol highway signs
as a function of luminance and glare level. Proceedings of the Human Factors
and Ergonomics Society 38th Annual Meeting 1994 133-135
•
Dewar RE, Kline DW Mark I, Schieber F Symbol signing design for older
drivers. Final Report, DTFH-61-C-0018 McLean VA: Federal Highway
Administration, 1994
Vision: Compensation: Driving
• Steering task study and illumination
• Old adults are involved in relatively fewer night
time automobile accidents than younger drivers.
• Older adults make more steering errors in
driving simulator under poor illumination than
young adults
•
Owens DA, Tyrell RA Effects of luminance, blur and age on nighttime visual
guidance: A test of the selective degradation hypothesis. J Exp Psychol:Appl
1999;5:1-14
Steering
errors in
driving
simulator
under four
luminance
levels. Data
from Owens
and Tyrrell
(1999)
30
20
10
Luminance (log cd/m2)
Compensation: Falls and Gait
• Poor illumination, confusing information
resulting from bad stair design implicated in
many studies of falls and accidents.
•
Architect John Templar documents these in a 1994 multivolume book.
• Population based studies show consistent
relation between visual acuity and contrast
sensitivity and measures of gait and history of
falls and hip fractures.
•
Klein BEK, Klein F, Lee KE, Cruickshanks KJ Performance-based and selfasssessed measures of visual function as related to history of falls, hip
fractures and measured gait time:Beaver Dam Study Ophthalmology
1998;105:160-164.
Comments on technology in
perceptual-motor function
• Focus has been on perceptual motor
applications because these are relatively
resistant to prevention based technology
interventions
• Person oriented interventions such as
training in how to fall without injury need
more research and development attention
Care support and organization-1
• Care support and organization--use of
technology for self-care by elderly
persons with physical limitations or by
caregivers—often elderly themselves—
of elderly persons with disabilities.
Care support and organization-2
• Technological support of care-giving
activities include
– devices that lift and move physically disabled
persons,
– machines that administer and monitor the use of
medications, and
– equipment that provides information about
physiological functioning.
Such products are used increasingly in the home by
nonprofessionals, e.g., family caregivers.
The ergonomics of such equipment becomes
increasingly important as the range of users
increases.
Care support and organization-3
• Aid to caregivers usually falls under the public
health rubrics of tertiary or secondary
prevention.
• Mann and colleagues demonstrated the cost
effectiveness of multiple technological devices in
prolonging life and improving it in very impaired
elderly patients. In comparison to a usual
treatment group, the availability of the
technologies was reduced the amount of nursing
and institutional care.
•
Mann, W.C. et al. Effectiveness of assistive technology and environmental
interventions in maintaining independence and reducing home care costs for
the frail elderly: A randomized trial. Arch. Family Med. 1999, 8, 210-217.
Technology for compensation
and care interventions
• Established technologies include
– Hearing and vision aids
– Text to speech converters
– Electronic memory aids
• Emerging technologies include
– Smart homes and environments
– Robots
– Telemedicine
– Location aware cueing
Newer technologies for care
• Telemedicine and communication applications using
video over Internet
– Mobile-Health Toolkit wirelessly measures blood pressure, blood
glucose, etc. and relays information to patient records
• Ultra-wideband radio allows for precise location of
persons within a home and communication among
appliances
Common feature of examples is, “…enhanced
communication between people and people, people and
machines and among machines that themselves are
networked.”
•
Kearns WD, Fozard JL High-speed networking and embedded
gerontechnologies. Gerontechnology 2007;6:135-146
Personal service robots
• Honda “Asimo” does some chores and
caregiving under voice, hand gesture control
• “Pearl” is used in an assisted living settings
escorts patients to medical appointments at
pace set by patient
• Sony “AIBO” robotic doll provides 6 simulated
emotions to actions of person using it
• “PARO” a robotic hear seal provides comfort and
calming to nursing home patients with dementia
Using location aware
technology in dementia
• RFID can identifies where dementia
patient and caregivers are, improving the
management of wandering
• GPS can locate patient who wanders
away from home
• Cellular telephone used to reveal location
of dementia patient to caregiver; could
also provide message to patient, e.g.,
“Turn around, face house, enter house.”
Comments about technology for
care
• Care support technology derives mostly
from medical and nursing services
provided in institutional settings
• Future extension of the concept to home
settings involves
– Exploration of human to machine
communication possibilities
– Exploration of the comfort value of machines
to human users