Abstract
Due to better living conditions and progress in medicine older adults today are the main group of population in terms of growing speed. Furthermore, together with disabled people, they represent the most frail category of individuals. Indeed, they are likely to present different constellations of impairments (both at physical and cognitive level). Older adults and individuals with disabilities strongly benefit from being properly assisted or from prolonging their individual autonomy. Such interventions can be implemented levering on the IoT technologies. The present paper describes a project that aims at providing older and disabled people with smart buildings that will be equipped with IoT technologies, e.g., environmental and wearable sensors. The identification of such technologies will be based on co-design activities that will focus on their accessibility and usability. Concurrent laboratory tests will be carried out to assess the best methodologies of wireless communication between the smart devices. These ambient-assisted living tools will be installed in two real-world scenarios, i.e., a nursing home and a co-housing solution. Such tools will facilitate older and disabled people in carrying out daily activities, ensuring their safety and privacy protection. The outcomes of the project will provide pivotal information on how to improve human living in different environmental contexts.
1 Introduction
At present, individuals over 65 are the population segment growing at the highest speed in Western countries [4]. The main reason behind this occurrence is the increased life-expectancy, resulting from of both an amelioration of the living conditions and the progress achieved in the field of medicine, together with a drop in the birth rates [20]. The increase of the average lifespan is a crucial achievement, but at the same time it brings tough challenges. The normal ageing process leads to numerous declines affecting the cognitive skills and the perceptual and motor abilities [10, 6]. In addition, older adults become more likely to develop multiple diseases [4], raising healthcare costs exponentially [19]. Oftentimes, all these conditions reduce older adults’ autonomy. Besides seniors, it is pivotal to consider another vulnerable part of the population, that is people with disabilities, who, to some extent, share with older adults the same needs. Indeed, in some cases, these two groups are overlapping in the measure that elderly people may present physical (i.e. motor) or mental (e.g. dementia) disabilities.
A number of different interventions can be taken to support these frail adults and to relieve national healthcare systems from the expensive cost of assistance. As a matter of fact, older adults with reduced autonomy and individuals with disabilities, benefit from remaining in their homes rather than being hospitalized or going into a nursing home/retirement home [12]. Several studies showed that, compared to nursing home, community-based interventions yield to beneficial effects for the elderly with regards to their physical functioning and their level of independence [2]. Unfortunately, it is not always viable for them to stay at their homes independently, because they may suffer from of incapacitating disease and may be alone. Therefore, in many cases these individuals need to be admitted into a nursing home in order to receive proper assistance. However, addressing the needs of individuals at their homes is associated to a reduction of the medical costs on the long term [12] and to higher psychological well-being of seniors [17]. Nevertheless, in some cases elderly people that are living alone need to access retirement houses. In this respect, social-housing projects have the potential to provide residents with adequate assistance, yet leaving them reasonably independent and recent evidence indicate that they are also well-received by senior residents [8].
In this paper we thus present the intervention we have planned for assist older and younger adults with reduced autonomy to enable them to enhance their living conditions.
2 Needs to Be Addressed
The assessment of the capacity of functioning in a community is typically based on Lawton’s Instrumental Activities of Daily Living (IADL) Scale [13], which basically considers the extent to which an individual is capable to perform a number of self-care activities autonomously (e.g., toileting, bathing, shopping). Based on the score gained by the individual, one can decide whether it is safe for him/her to live independently or not. Many of the activities included in the list are effectively linked to precursory signs of mild cognitive impairment [11], but also to more general and contextual factors. For instance, older adults may tend to neglect food-related activities because they are lonely [14]. Likewise, a number of different contextual factors can be considered and addressed exploiting technology, thus prolonging individual autonomy. Because of the reduction of mass muscle and strength and the tendency of leg bones to bow and under the body weight [1], older adults may struggle to take objects that have an upper location, just like their younger counterparts on a wheelchair. Again, because of the normal changes due to the ageing process, seniors tend to get tired sooner, thus reducing their ability to stand or move for long time intervals [9], ultimately limiting their mobility.
Similarly, the life events that are more frequent during old age (i.e., retirement, grieves) together with the reduced physical activity, tend to increase the likelihood of social isolation. Targeting these conditions can result in an improvement of health, both in terms of mental well-being and quality of life, in older people [3, 18]. In addition, loneliness was found to be a risk factor connected to the likelihood to develop cardiovascular diseases (i.e. hypertension, heart disease and stroke). Social and/or family support are pivotal to counteract the negative effects associate to loneliness and social isolation [18]. In addition, the unobtrusive monitoring of the activities of individuals with reduced autonomy, either elderly or not, can effectively reduce the likelihood of minor or major accidents (e.g., falls) and eventually promptly signal an emergency.
In summary, regardless of the specific individual characteristics (i.e. elderly or disable people), there is a need to find innovative solutions to provide users with more comfortable and safe environments. Priority must be given to the promotion of a healthy and active style of lifestyle and to guarantee a degree of independence (different according to the specific cases).
3 Buildings, Sensors, and Internet of Things
The concept of smart building refers to a regular construction that is equipped with various types of sensors and actuators. The sensors could be divided in two main categories: environmental, that is integrated into the rooms, and wearable/mobile, that is attached to the user’s body. Examples of the former are motion (e.g. individuals’ movement), presence, and pressure sensors (on the floor or on a chair), magnetic switches (e.g. door opening/closing), cameras (general activity). In consideration of the wearable and mobile sensors, we list accelerometers, glucometers, global positioning system (GPS), electrodes for monitoring physiological (e.g., electrocardiography, ECG; galvanic skin response; GSR) and cognitive activity (e.g. electroencephalography, EEG). Smart buildings are designed with the objective to provide a greater comfort to inhabitants and for monitoring their physical and psychological/cognitive health. Data from all these sensors is acquired and processed (in real-time) in order to implement a series of automated actions that aim at supporting residents in several different cases. These actions are triggered by means of the actuators.
In consideration of facilitating users’ daily activities data collected through a GPS sensor, presence sensors, cameras could be utilized to enable automatic door opening and closing or turning lights on and off. In terms of residents’ safety, abrupt changes in the signals acquired through the wearable sensors (e.g. ECG) may trigger an alarm signal to inform a health care professional, a caregiver (a family member) or a doctor (inside a hospital or a retirement home) about an individual in need of an urgent medical attention [5]. Furthermore, the environmental and wearable sensors may be utilized in order to detect falls of elderly people through smart cameras [7] and so providing immediate assistance.
Thus, these digital smart buildings are substantially changing the human-environments interaction as they are capable of sensing and adapting in an unobtrusive way to the humans’ needs (Sandri 2011). Recently, the concept of ambient intelligence has been popularized to describe these adaptive environments, while the term ambient-assisted living (AAL), [16] applies to smart devices that means to assist elderly people (i.e. in terms of well-being and general health). In the information and communication technology (ICT) research field another key concept has to be considered, namely the Internet of Things (IoT). The term refers to the modification of everyday physical objects (e.g. light bulb) with the embedding of electronic components that are capable of communicating with one another and/or with the humans. These smart objects are featured with a physical embodiment, they are able to receive and reply to digital messages, they have the capability of basic computing, they may possess sensors for monitoring physical facts (e.g. temperature variations) and trigger actions through specific actuators. In the context of IoT an aspect that is pivotal is the security related to the confidentiality and privacy regarding the collected users’ data [15]. Confidentiality and security have to be ensured to the relevant stakeholders. In consideration of the former, it is fundamental to guarantee the access to the data not only to users themselves, but also to authorized persons (e.g. physicians, researchers). With regard to the latter, especially when IoT is applied to the healthcare domain, it is crucial to enact proper mechanisms to ensure it. Indeed, the acquired personal data may be particular sensitive.
4 Smart Buildings Solutions for Elderly and Disabled People
The current project “Sistema Domotico IoT Integrato ad elevata Sicurezza Informatica per Smart Building” (POR FESR 2014-2020, Asse 3, Azione 1.1.4) involves both academic and industrial parties in the frame of Regional policy related to R&D projects. The project is funded by Regione Veneto and it includes different universities, each contributing with knowledge in various domains (e.g. cognitive ergonomics, computer science, etc.), and 22 industrial partners operating in several sector (e.g. lighting, automation, etc.). The total duration of the project will be 36 months (i.e. from 07/11/2017 to 06/11/2020). A graphical representation of the work packages and related activities is depicted in Fig. 1.
The project aims at examining the alleged benefits related to the introduction of ambient-assisted living tools [16] in living spaces shared by fragile people. One of the main limitations of current home automation systems is the difficulty in achieving a full interoperability among the different IoT components and services. Indeed, to fully exploiting the effectiveness of IoT, the smart objects have to be connected at the same time both to one another (in terms of finding/being found, accessing/being accessed, managing/being managed) and to the Internet. In other words, the objective is to overcome the physical and functional gap between the devices in the smart environment through the definition of standard protocols enabling a better communication and data exchange among the different smart tools and buildings. By doing this we foreseen to overcome current issues related to the lack of shared protocols of communication among the different smarts tools, for instance the lighting system and the automatically operated service door. The project will target two different contexts with specific features: nursing home and social-housing/co-housing. At the nursing home the older residents may have various levels of autonomy and cognitive functioning. In the social-housing situation the residents will be people with disabilities (e.g. severe motor disability). In both situational contexts, user interfaces and control units will be designed to properly respond to the specific needs of the inhabitants. For instance, in the co-housing scenario, the height of the control and display devices will be automatically adjusted to the current user’s physical characteristics. This adaptation will facilitate the individuals in both unfolding the daily activities and easily accessing the information about the smart environment.
The project will operate at two levels. Firstly, the desiderata and the different impairments (residents) of the stakeholders (i.e. residents, operators, management) will be considered in order to identify a set of suitable automated and to design the software. For this purpose, co-design activity will be carried out as well as laboratory tests concerning the accessibility and usability of the smart devices. Furthermore, the technical feasibility of the selected smart devices will be tested in the laboratory and later they will be installed in the target buildings where they will be evaluated by end-users (i.e. system accessibility, usability, security, users’ experience, acceptance, satisfaction, and safety). An additional test will involve residents’ and operators’ performance in carrying out their activities in order to assess the efficiency (i.e. speed in carrying out these tasks) and the accuracy of the interaction with the smart environment (i.e. reduction in errors made).
In the second scenario, namely the co-housing, the project will pursue a further goal targeting an increased independence of disabled people, yet ensuring professional assistance when/if required (e.g. healthcare professionals or other caregivers).
The adaptive “actions” that will be implemented in these smart environments will be based on the residents’ needs as well as their daily habits. In relation of the former an example may be triggering an alarm signal to the nearest operator when a person’ fall is detected, while concerning the latter, a light that will automatically turn on/off the moment a person is starting/finishing to read a book. Considering the social-housing scenario, the level of customization of such smart environment may be further enhanced on the basis of the individual preferences (e.g. the level and type of lighting, kind of access to the various rooms).
The project will address both end-users and various stakeholders, comprising residents of the nursing home (i.e., older people with and without disabilities), professional caregivers and members of the managerial staff (i.e., nursing home scenario), and young adults with motor disabilities (i.e., co-housing scenario).
The second operational level, will constitute a real/the technological challenge. Indeed, the project will aim at overcoming the actual limitations, highlighted in the domain of IoT, which are tied to the wireless protocols in anticipation of the massive development that is expected in the immediate future. All the smart devices will communicate through a shared protocol in order to ensure efficiency and efficacy of the exchange of information and in real-time resulting in an increased quality of the human living. Furthermore, the aspect of data security too frequently neglected because of the high computational costs, will be seriously considered. More specifically, in order to protect the data, the project will develop cost-effective communication protocols based on cryptography. In so doing, for the speed of data transmission and the battery life of wireless devices will be preserved.
An additional consideration will be given to the privacy protection of individuals. The smart sensors that will be installed will let to distinguish different activities occurring in the smart buildings. Thus, allowing operators interventions in case of emergency. However, the detection process will be based on physical characteristics and events protecting the actual identity of the residents. For instance if the system would detect that users have fallen on the basis of variations in the positions of their body shape. Moreover, it will be possible to monitor the passage of users through specific gates in order to locate and count the amount of people within the building.
5 Conclusions
In summary, several relevant aspects of the human living will be considered: accessibility, giving the elderly and disabled people the opportunity to access to goods and services; care, helping to alert the operators health professionals in order to provide critical emergency assistance; safety, detecting individuals’ falls and controlling their access, monitoring gas leaks, fires and other dangerous situations; health and well-being, increasing both at physical and psychological level.
The project will contribute to both increase the scientific knowledge in the field of smart buildings tailored on the needs and characteristics of frail individuals, and to open significant market opportunities. The outcomes of the project may be extended to different scenarios such as the industrial setting in which older and disabled people work and may benefit from the enhanced safety provided by the introduction of these smart technologies. Finally, the expected socio-economic impact of the project will be: a decrease in the costs related to health care (i.e. fewer accidents) as well as an improvement in the general quality of living, especially in regard of the co-housing situation, insofar as mood disorders, depression, and decline in cognitive functions may be better contained when people lived at their own home [2].
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Acknowledgements
This paper was supported by the project “Sistema Domotico IoT Integrato ad elevata Sicurezza Informatica per Smart Building” (POR FESR 2014-2020).
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Gamberini, L. et al. (2019). A Cyber Secured IoT: Fostering Smart Living and Safety of Fragile Individuals in Intelligent Environments. In: Leone, A., Caroppo, A., Rescio, G., Diraco, G., Siciliano, P. (eds) Ambient Assisted Living. ForItAAL 2018. Lecture Notes in Electrical Engineering, vol 544. Springer, Cham. https://doi.org/10.1007/978-3-030-05921-7_27
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