Remote Monitoring of Older Adult's Daily Routines: A case study

Background: The boom of in-home monitoring technology offers unprecedented information about an individual’s interaction with the environment, as they experience changes in health. A variety of low cost sensors can continuously and unobtrusively collect information about various activities in the living space. Capturing and analyzing changes in the daily routines of vulnerable older adults residing in these “smart homes” may allow clinicians to identify changes in functional status and predict negative health consequences. Purpose: to identify features of daily routines that are most sensitive to changes in health, using a currently developed in-home environmental sensor network. Methods: A collaborative, multi-campus project between the Schools of Nursing and Department of Electrical and Computer Engineering analyzed sensor data from an aging-in-place community. The apartments were equipped with a wireless network consisting of motion, depth and hydraulic bed sensors that collected continuous information about resident’s activity. This descriptive retrospective single case examined the change in daily routines of an 88-year-old female resident who experienced dramatic health changes in the last two months of her life. Ten features of duration, frequency and timing of apartment activity, extracted from the sensor data were inspected for trends. These trends were examined for association with clinical assessments and nursing notes extracted from the electronic health record. Results: The resident experienced six health changes in the two month period prior to a prolonged hospitalization culminating in her death. Two trends were noted from the extracted features. There was a sudden dramatic increase in time spent in the bedroom from an average of 8 hours/day to 12 hours/day two days prior to hospitalization. A long-term trend was noted in the decreased frequency and increased duration of activity in the bathroom/closet area of the apartment 30 days prior to hospitalization. Implications: Abrupt changes in time spent in bedroom may signal a need to monitor the individual more closely to assess the reason for the change and to intervene. Long-term changes in bathroom activity parallel the deteriorating functional status of the resident. Passive in-home monitoring provides objective information about the older adult’s activity that can supplement nursing assessments. As the cost of technology adoption decreases, nurses can use these innovative tools to coordinate care and intervene early to prevent or mitigate the functional decline associated with vulnerable older adults.