Emerging Technologies to Support an Aging Population

Transcript

1 EMERGING IES TO TECHNOLOG AN AGING SUPPORT POPULATION A Report by the TASK FORCE ON RESEARCH AND DEVELOPMENT FOR TECHNOLOGY TO SUPPORT AGING ADULTS COMMITTEE ON TECHNOLOGY of the NATIONAL SCIENCE & TECHNOLOGY COUNCIL March 2019

2 About the Nation al Science and Technology Council National Science and Technology Council (NSTC) is the principal means by which the Executive The coordinates entities science and technology policy across the diverse that make up the Federal Branch and developme nt enterprise. A primary objective of the NSTC is to ensure that science and research policy decisions and programs are consistent with technology the President's stated goals. The NSTC prepares research and development strategies that are coordinated across Federa l agencies aimed at organized national goals. The work of the NSTC is accomplishing under committees that multiple science and oversee groups focused on different aspects of subcommittees and technology. working More information is available at http://www.whitehouse.gov/ostp/nstc . About the Office of Science and Technology Policy The of Science and Technology Policy (OSTP) was established by the National Science and Office Organization, and Priorities Act of 1976 to provide the President and others Technology within Policy, Office of the President the advice on the scientific, engineering, and technological Executive with aspects of the economy, national security, homeland security, health, foreign relation s, the environment, and the technological recovery and use of resources, among other topics. OSTP leads assists interagency and technology policy coordination efforts, science the Office of Management and Budget with an annual review and analysis of Federa l research and development in budgets, and serves as a source of scientific and technological analysis and judgment for the President with respect to major policies, plans, and programs of the Federal Government. More information is available at http://www.whitehouse.gov/ostp . the Task Force on Research and Development for Technology to About Aging Adults Support Task Force was established under the NSTC Committee on Technology to examine the The of potential echnology to maximize the independence of aging by increasing opportunities for social t Americans and connectivity as well as reducing the impact of any cognitive and engagement physical limitations . About this Document that identifies a range of em erging technologies have significant potential to assist older This report with successfully aging in place , each categorized by adults role in supporting a set of primary their capabilities It identifies a number of focus areas . that could support each capabilit y and provides recommendations for research and development (R&D) that are required to develop key technology solutions the coming decade . Cross - cutting topics that affect multiple capabilities are also over se recommendations are offered as a guide for both discussed. public and private sector R&D . The The , is to improve the quality of life goal enhance individual choice, reduce the financial and overall emotional burden of care to individuals and families , and reduce the burden of providing care on the Ame healthcare infrastructure . rican Copyright Information This document is a work of the United States Government and is in the public domain (see 17 U.S.C. OSTP. §105). I t may be distributed and copied with acknowledgment to Published in the United States of America, 201 9 .

3 EMERGING TECHNOLOG TO SUPPORT AN AGING POPULATION IES TECHNOLOGY COUNCIL NATIONAL SCIENCE & Staff Chair Director, OSTP Kelvin Chlo é Droegemeier Kontos , Executive Director, NSTC , ON TECHNOLOGY COMMITTEE Chairs - Staff Co Under Secretary of Commerce Director Assistant Principal , Whitman Lloyd Walter Copan , and Sciences Physical for for Standards and Technology, and of OSTP Di Engineering, rector NIST, DOC Science, for Secretary Under , Dabbar Paul DOE Michael Kratsios , Deputy Assistant to the President, OSTP FORCE RESEARCH AND DEVELOPMEN T ON FOR TECHNOLOGY TO TASK RT AGING ADULTS SUPP O Executive Chairs Secretary - Co , NSF Grimm J. Vijeth Iyengar , ACL Michele NIH Nina Silverberg , OSTP Liaison Whitman , OSTP Lloyd * Members Beth , NASA John NSF , as Lin Allen Anderson , HUD Link Greg ACL , Alicia Partha NIH , Bhattacharyya Roger Miller , NIH Bierman , Arlene Wendy Nilsen , NSF AHRQ Lisa Elizabeth Cochran , HUD NIH , Opanashuk Caroline Ingrid USDA , Crocoll Parrington , D O D Annette Phillips John SSA , , Dabbs Devito ONC DOE Augie Diana , NIH Ashley Predith , z Erten FDA , Simone Deni Lisa - Lyons , VA Haven NSF , Stout David USDA , Jackie NIH Erika Tarver NIH , Iturriaga Erin , , Jackson Shelly Tilly , ACL Jane DOJ Lyndon Joseph , HUD , Rij Van Leigh NIH B , Yousuf Mohammed DOT Naomi Karp , CFP VA Kind , Amy Naomi NIST , Lefkowitz time the at member affiliated As * . report this to contributed each – i –

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5 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES of Contents Table ... List of Abbreviations and Acronyms iv ... ... ... ... v ... ... Executive Summary Introduction ... ... ... ... 1 I. and Organization of This Report Scope ... ... ... 1 II. Key Activities of Independent Living ... ... ... 3 ... ... ... ... 4 Hygiene ... ... ... ... ... 6 Nutrition ... ... ... ... ... ... 6 Medication III. ... Cognition ... ... ... 8 Monitoring ... ... ... ... 8 Cognitive Training ... ... ... ... 9 Cognitive ... ... ... ... 10 Financial Security IV. Communication and Social Connectivity ... ... ... 11 ... Hearing ... ... ... 11 ... ... Diverse Communities ... ... 13 Communication with Communication Technologies Social ... ... 13 ... Personal Mobility ... V. ... ... 14 ... 14 ... ... ... Assisted Movement ... Rehabilitation ... ... ... 15 ... ... and ... ... ... ... Safety 15 Monitoring Transportation ... ... ... 16 VI. ... ... ... ... ... 17 Driving ... ... Transportation ... ... ... Public 17 Access to Healthcare ... ... ... ... 19 VII. ... ... ... ... Telehealth 20 ... ... ... ... ... eCare ... 21 Planning VIII. Cross - Cutting Themes ... ... ... . 23 System Needs ... ... ... ... ... 23 User ... ... ... ... ... 24 Adoption ... ... ... ... Functionality 25 ... ... Security ... Privacy ... ... 26 and Data and Algorithms ... ... ... ... 26 Evaluation ... ... ... ... ... 27 Technology Safety and Performance Needs ... ... ... 27 ... Family Caregiver Needs ... ... ... 28 ... 29 ... ... Smart Homes ... ... – – iii

6 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES of Abbreviations and Acronyms List ACL for Community Living Administration American community survey ACS Alzheimer’s diseas e AD a ctivities of d aily l iving ADL Agency for Healthcare Research and Quality AHRQ Consumer B Financial Protection Bureau CFP Department of Commerce DOC O D Department of Defense D O D Department of Energy E O J Department of Justice D T nsportation Department of Tra O D care eCare electronic Communications Commission FCC Federal Food and Drug FDA Administration GPS global positioning system Services Department of Health and Human HHS HIPAA Insurance Portability and Accountability Act of 1996 Health Development Urban and HUD Department of Housing IADL nstrument al activities of daily l iving i technology information IT internet of things IoT m ild impairment MCI cognitive National Aeronautics and Space NASA Administration NIH National Institutes of Heal th Technology National Institute NIST of Standards and NSF National Science Foundation NSTC National Science and Technology Council ONC Office of the National Coordinator for Health Information Technology OSTP Office of Science and Technology Policy &D R research and development Social Security Administration SSA TAAG Telecommunication Act Accessibility Guidelines TRL technology readiness level VA Department of Veterans Affairs Content WCAG Web Accessibility Guidelines Agriculture of nt USDA United States Departme – – iv

7 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Summary Executive the U.S. Bureau projects that the number of people in Census United States aged 65 or older will The to 95 million by the year 2060 and comprise nearly a quarter of the population. The grow combination projected g rowth of this segment of the population and the desire of many older Americans the of to in their homes and communities make s independently it critical that the Federal G overnment live develop strategies, tools, and recommendations to enable them to proactively l ive healthy, independent lives. The Task Force on Research and Development for Technology to Support Aging Technology established under the NSTC Committee on to examine the potential of Adults was to maximize independence for older Americans by sustaining health, independence, and technology social engagement. opportunities for report identifies a range of emerging technologies that have significant potential to assist older This public adults, it is offered as a guide for both and and private sector resear ch and development ( R&D ) cut of to improve the quality healthcare life, enhance individual choice, reduce caregiver stress, and cost s The Task Force identified six primary functional capabilities as being critical to individuals who . to maintain their independence as they age and for which technology may have a positive impact . wish Key Activities of Independent Living. Living independently requires the ability to perform of a 1. of activities that impact our daily lives. Many be assisted through range of these activities can and medication management. technology, including those that support good nutrition, hygiene, Cognition. Cognitive changes are common during aging, with increasing prevalence 2. at older varying the ability to live independently as — in severity and impact. These changes can affect ages personal safety. Technology holds the promise to help older adults monitor changes well as in to reduce the impact of these changes, and create systems their cognition, provide mental training that assist individuals and families to maintain financial security. Communication and Social Connectivity. Older adults may face communication challenges 3. as the result and loneliness, especially in economically distressed and of hearing loss, social isolation, connections to rural communities. Technology can improve hearing and strengthen larger communities. Personal Mobility. Mobility is a key factor in successful aging. To live independently, an individual 4. to comfortably and safely move around the home and throughout the larger must have the ability community. Technology can assist older adults and able to safely perform ke y in staying mobile activities necessary for day-t o-day life as well as interact with their communities. 5. True independence requires mobilit y Transportation. outside of the home and neighborhood. individual and limitations are dictated to an extent to by the changes Transportation needs physical and cognitive abilities that come with age. While some older adults remain completely and continue to drive without assistance, others may to drive but require independent be able to assist them while operating a vehicle. vehicle modification and/or advanced technologies New technolog ies could also help older adults more safely and easily use public transportation. Access to Healthcare. Access to healthcare plays a critical role 6. e in helping older adults stay activ and independent and strategies that support the maintenance of function as they age. Activities coordination of these efforts through and independence with age are multifaceted. Alignment and technology can increase the effectiveness and efficiency of these services. In the process of identifying primary capabilities and focus areas in which te chnological advances can are have a positive impact in enabling older adults to age in place, several areas emerged that associated with a number of technological solutions and were therefore not specific to individual R&D . Themes recommendations . These areas are included in the final section of the report , Cross - Cutting – v –

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9 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Introduction I. number The Americans aged 65 or older is growing rapidly — increasing by 40% between 2000 and of 1 50 million people , over 15% of the total population to — and is expected to grow to 2016 approximately 2 Americans of the population by 2060 . a For older quarter living outside of a nursing home, 25% nearly those aged 65 to 74 and 50% of those aged 75 and older have reported of some kind of disability , such 3 with vision, hearing, or mobility. The combination of the projected growth of this segment as problems the homes population and the desire of many older Americans to live independently in th eir and of make Federal it critical that the G overnment proactively develop strategies, tools, and communities s to enable older Americans to live healthy, independent lives for as long as possible. recommendations on the verge of new technologica l revolutions that could improve “We’re every aspect of our lives, create vast new wealth for American workers virtually families, and open up bold, new frontiers in science, medicine, and and 4 - Donald J. Trump communication.” President has made finding Trump solutions for an Administration aging population a research and The 5 priority. development The overarching goals of this R&D should be to enhance the functional (R&D) continued safety, well - being, and health and older Americans , while reducin g overall independence of costs and the stress on the N ation’s economic healthcare infrastructure. Achieving these goals will :  i mprove the quality of life and continued contribution s of active and independent individuals to the community and economy; the greater e nhance i ndividual choice with respect to living arrangements;  educe the financial and emotional stress on  informal and unpaid family caregivers; and r system,  the cost to the American healthcare r including not only hospital and nursing home educe services expenses support. and expenses, but also related to long - term care While primary purpose of this report is to broadly identify for both public and private sector the R&D that is needed to create stakeholders technology to support an aging population, the the to lities enabled by such technology also hold promise capabi improve and enrich the lives of all Americans with challenges common in older adults, such as mobility, social connection, cognitive changes and general health and nutrition. The development of t echno logy to assist older adults is a , large and rapidly growing industry that could be accelerated by R&D in areas highlighted in this report . of Scope and Organization This Report In preparing this report, the Task Force first identified the primary capabiliti es that older adults must maintain continue to live independently (e.g., the ability to perform the Key Activities of Independent to to , Living) well as more focused areas deemed key those capabilities and most likely to benefit from as advances in technol ogy (e.g. , hygiene, nutrition). It then reviewed a diverse spectrum of emerging technologies systems designed or with the potential to maintain those and capabilities within each 1 https://www.census.gov/newsroom/press releases/2017/cb17 - 100.html - 2 https://www.census.gov/newsroom/press - releases/2018/cb18 - 41 - population - projections.html 3 http://www.disabilitystatistics.org/StatusReports/2016 - PDF/2016 - StatusReport_US.pdf 4 https://www.whi tehouse.gov/briefings - statements/remarks - president - trump - american - leadership - emerging - technology - event/ 5 18 - content/uploads/2018/07/M 22.pdf - https://www.whitehouse.gov/wp - – – 1

10 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Based on this review and a subsequent gap analysis, the Task Force iden tified functional needs area. (e.g. oral health) that could potentially be met by new technological advances (e.g. , develop maintain , personalized dental regimens) and the R&D support required to develop those technology to systems over the next five t o ten years. This report and solutions the technologies discussed herein do not comprehensive review of the current state of each field but are intended to highlight a a represent range and /or key technologies in each of promising the focus areas of the report. of n addition to scientific I and engineering research needed to further the development of the technology itself, the report includes recommendations for research necessary to inform the development of nu policies. In addition, the report notes a mber of social and behavioral science factors standards and will impact acceptance and implementation of new technologies . A chieving a ll of these advances that and partnerships between the public will private sectors for both R&D and implementation , require in pri vate sector leading the way with product development and deployment . the The recognizes that the abilities of individuals Task and their needs for technology will vary Force in ges significantly — both within the population and for individuals over time. Age - related chan cognitive physical abilities are not static and, in some cases, may be either transient (e.g., and variable following joint replacement) or time - movement (e.g., sundowning phenomenon of limitations the dementia). to monitor and as sess the Therefore, needs of aging individuals over time, and to ability identify appropriate technologies or adapt technologies to these changing needs, will be key to each of these areas of technology R&D and implementation. In addition, the needs of older adults living at home are expected to differ from the general population, and research targeted at identifying these optimized unique factors is recommended such that appropriate and solutions can be developed. The discusses six primary capabilities identified as b eing critical to individuals who wish to report technology independence as they age and for which maintain may be able to have a positive their impact, as well as a set of cross - cutting themes relevant in all or most of the six primary areas : • Key Activities Independent Living of Cognition • Communication and Social Connectivity • Personal Mobility • • Transportation • Access to Healthcare • Cross-Cutting Themes Each primary capability is divided into a group of focus areas . Each focus area includes a set of key technology functional ne eds that are ripe for innovative solutions, followed by a bulleted list of solutions. those recommended R&D topics needed to develop – 2 –

11 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Key Activities of Independent Living II. ability The live independently requires performance of a range of activities. These key activities are to eating, of Daily Living (ADLs) and include bathing, dressing, toileting, transferring, the called Activities 6 managing continence. walking Instrumental ADLs (IADLs) , another category of activities and are for functioning in community settings and include driving, using the telephone or necessary cooking, shopping, keeping track of finances, managing medication, doing laundry, computer, and . housekeeping integration The home technologies such as sensors, apps, and even robots represents an opportunity of In living among the older population . independent addition, these home technologies can to support home care, impact only by making it more efficient in terms of costs and timing of health - related not also b y offering solutions that encourage but independent living and enhanced quality of treatment, for aging adults. For solutions life be effective, ongoing assessment of an individual’s level of function to and need for assistance is required. Early on, small home modificat ions may suffice; however, over time, interventions may be needed , including user - friendly assistive technologies. Changes in health more function can be a factor when an older adult and his or her family decide that institutionalized care and required, and it may be possible to defer that decision through the use of appropriate and effective is An evolving suite of t echnologies will assistive be required to maximize independence technologies. continuum of care. throughout the basic devices have been d eveloped to better support the key activities of independent living, but Many their technologies are in many infancy and/ or not widely available. What is available may assistive require evaluation before be ing implemented more widely further or may benefit from research into its methods best Understanding for effectiveness and value . how older adults use technology and the teaching how to utilize the technology to meet their needs is key to supporting adoption and them user frustration. Cost and conveni ence also play a role in adoption of technology for older avoiding since many older technology live on fixed income s . New assistive adults, research should fill a adults need that is not already being met for older adults; otherwise , the technology will not be cons idered useful and may be adopted. not When evaluating the needs of assistive technology for ADLs and IADLs, three f ocus a reas were identified that were deemed key to independent living as well as potentially benefitting from technology:  : bathing, o ral care, and skin care , including wound prevention and care Hygiene  Nutrition : meal preparation, shopping, and eating  Medication : management and adherence While the cap ability to walk and transfer is considered to be an activity of daily living, the importance topic of this ability to all other activities has prompted the Task Force to consider the in an independent V section of the report ( Section , Personal Mobility ). 6 - surveys - across national https://aspe.hhs.gov/basic - report/measuring - activities - daily - living - comparisons - – – 3

12 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Hygiene following functional needs are related to maintaining proper hygiene and can be enha nced The new Recommended R&D topics are listed for technology. each. This structure of listing through needs for each focus area , followed by a bulleted list of recommend ed R&D topics to fulfill functional need continues throughout the report. that , Saf and Regular Bathing and Showering to Maintain Healthy Skin . The bathroom is one of Enable e 7 dangerous places for older adults. most Bathing and showering can be a challenge for people the mobility and flexibility is limited. This challenge can result whose in sl ips and falls that can cause serious, life - altering injury or death. Being able to bathe or shower regularly and safely is essential to important and dignity at any age and is especially for older adults who wish to live maintaining health R ecommendations for R&D to enable safe and regular bathing and show er ing and to independently. transfer minimize include the following: pathogen and test smart showers that can sense the presence of an  individual and accordingly Optimize adjust the timing, water flow, and /or temperature meet the person’s specific needs. Showers to and temperature, water could include sensors that time water flow and water direction, regulate control dispensing . soap and Advance technology that supports self - monitoring provides alerts to caregivers that  care may be needed. This technology could provide a range of patient data that can be intervention via caregivers and/or primary care professionals a wireless application system, by accessed time - stamped data, location, water usage , wa ter temperature, and unique physical and including: changes. behavioral resulting Assess the impact of home technology and the changes in the  hygiene - related aspects of care systems on their effectiveness and value . delivery the actual  of dise ase or Determine infection due to bacterial transfer from handheld incidence technology. This information may support the development of effective messaging and behavioral in modification to encourage proactive behavior strategies terms of hand hygiene.  Develop cost - e ffective materials that can reduce bacterial colonization on items that are robust, frequently handled (e.g., mobile technolog y, TV remotes). The ability Maintain Oral Health . maintaining to care for and keep one’s own teeth is important in smell, quality life. Oral h ealth is related to taste and which are also factors in healthy eating. Avoiding of also reduces out - of - pocket and insurance charges. The current approach to oral health for dentures to involve s going to the dentist regularly promote preve ntion and obtain periodic adults older and care . Because there is more variability in oral health in older professional adults than assessments in younger groups , monitoring and support for prevention in oral health at home is critical . adults  oral health devices for u se by older Design that can account for low visual acuity, poor coordination, poor hearing, and, in some cases, diminished ability to understand instructions .  Expand sensor measurements beyond the amount of time that someone brushes to also include brushed. pressur e, contact angle, and the tooth surfaces that are 7 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a1.htm?s_cid=mm6022a1_w – – 4

13 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Develop systems to support personalized dental regimens based on in - home assessment of the  biological mouth’s ( e.g., salivary biomarkers). Such regimens are expected to improve conditions future dental and reduce the cost of interventions. Communication of data to l individua health and others identified by the user could also provide an early indication users of changes in an health. individual’s overall Advance systems of reminders, alerts, and rea l - time feedback to patients on their - home oral  at would replace and improve upon These patient education materials. These active, care. current dental care systems may personalized include smart toothbrushes or embedded devices in mirrors. Additional resea rch on the use and effectiveness of these tools is warranted. Monitor, and Properly Care for Wounds . Wounds may result from many chronic illnesses , Prevent, as diabetes and peripheral vascular disease , or may result from pressure - induced skin such tion in individuals with limited mobility (bedsores) . Wound degenera monitoring and care is a complex and intricate process that may be difficult for some older adults to manage. Success at personalized wound care requires both cognitive and physical ability. Curre nt methods treat wounds after they smart in Advances occur, which misses an opportunity for prevention or monitoring for faster healing. technology, as sensors that can detect bacteria, may prevent nursing home admissions or such and by dramatically reduce there treatment costs. hospitalizations Evaluate and advance the use of smart textiles to augment natural sensation in individuals with  For prototype example, optical - fiber - based smart socks have been demonstrated neuropathy. 8 measure plantar pr ess ure and temperature in shoes. can Adoption of such technology could that the occurrence of diabetic foot ulcers and other conditions that may progress and result in reduce amputation. Enhance automated systems for skin pressure variation in order to prevent pressu re ulcers due  to in a wheelchair or bed. Current time recommendations for manual shifting of weight continued an individual to have adequate upper body strength and be aware of the need to shift his require be weight, both of which can her reduced in ag ing individuals. or advance Assess and technologies  that automatically monitor existing wounds and infections , such as bandages” that detect movement, deliver drugs, monitor healing, detect infection, and “smart 9 directly to the physician . transmit results Ev aluate and advance current systems that help clinicians detect wound infections at the bedside  the or doctor’s office. Th ese systems would allow clinicians to prescribe appropriate therapies in sooner, lower healthcare costs, and improve patient care outco mes. For example, inexpensive, disposable electrochemical sensors that can immediately reveal or correctly identify the type of 10 11 bacteria a specific location and simple image analysis can both be effective at within ing monitor wounds. an integrated system  implantable Design biomaterials that will administer biochemical, of electrical, or mechanical factors conducive to specific cell types to promote healing, while app monitoring bacterial growth and communicating data back to an or caregiver. 8 https://www.ncbi.nlm.nih.gov/pubmed/28513212 9 https://www.ncbi.nlm.nih.gov/pubmed/26821765 10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853203/ 11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062001/ – – 5

14 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Nutrition Daily Nutritional Requirements . M eeting daily nutritional requirements is vital for the Mee t emotional of and mental health as well as for physical well - being . E nsuring healthy eating maintenance older adults , who may have challenges in obtaining and prepa ring food , is left to the in or individual may be come a factor in the loss of independence. caregivers and and price comparison services empower consumers to pursue a Develop improved geolocation • to and location of food have been cited by older adults healthier and more nutritious lifestyle. Price 12 as to adopting a healthi barriers er diet. to food preparation to ensure that user needs • Validate virtual assistants/coaching services related e outcome and that these services are having a measurable, positiv on behavior. are being met 13 as robotic systems, • Evaluate automated food preparation systems, such to and continue R&D advance these systems a s warranted. Enhance understanding of how older adults are employing existing technologies, such as on- • well as and online-diet coaches, demand meal/grocery delivery to meet daily nutritional demands any factors that may impede their adoption. as One’s Self . Beyond acquiring and preparing food, individual s must be able to feed themselves to Feed independence. maintain 14 robotic feedin g systems uate that are Eval designed to allow individuals to feed themselves and  to advance the technologies to improve their continue effectiveness .  educational and outreach programs to support the acceptance of these robotic tools and Develop stigma and/or negative perceptions about overcome the use of robotics. preexisting be Determine ways in  which these assistive systems may made more cost effective ; for example , communal homes. amily by first deploying them in f living environments rather than in single - Medication of Medication Levels . Efficacy and safety prescription and over - the - counter Maintain Therapeutic medication relies on an individual maintaining proper dosing and avoiding negative drug interactions . For older adults, taking multiple , duplicative , or unnecessary medications as well as taking certain that drugs increase the risk for serious adverse reactions can could lead to falls or cognitive impairment, limiting functional independence and requiring additional health resources. Adva ncements in as technologies should be considered during drug development part of patient - centric approaches to products developing can that better address the specific needs of older adults who may face challenges with dexterity, and cognition . vision, Dev sensors that integrate monitoring of real - time physiological and pharmacological  factors , elop levels such blood glucose, heart rate, and drug as , with real - time monitoring of medication adherence and physical activity. Such sensors could move the field to ward a “precision and adherence” that guides highly personalized model tailored therapeutic approaches , including real - time drug dosing . 12 https://www.aarp.org/content/dam/aarp/aarp_found ation/2016 - pdfs/Healthy_Living_Diet_Perceptions.pdf 13 For example, see http://uhra.herts.ac.uk/bitstream/handle/2299/17234/07322264.pdf 14 https://www.resna.org/sites/default/files/conference/2016/emerging_technology/chung.html see For example, – 6 –

15 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION that integrated sensor approaches to help avoid dangerous drug toxicities or interactions  Design from over m edicating result improperly mixing medications . may or Improve adherence monitoring by leveraging tools like wireless medication pill organizers,  and electronic digital pills. Passive sensors offer novel opportunities for real - time packaging, adheren ce feedback, delivered alone or intervention in combination with cellphone - based and technologies. Develop technology to help people with  impaired vision identify their medications, read medication labels and inserts , and verify that they are accurately taking their medica tion s .  mobile phone - based adherence interventions beyond daily reminder s through more Advance of text message content and timing . sophisticated Interventions should also diversify comparisons set beyond to better incorporate a broad text of existi ng and emerging wireless and messages connected health technologies. These tools provide exceptional capacities for tailoring adherence and interventions response to personal preferences in observed behaviors through adaptive programming or artificial intelligence . Additionally, such technologies could assist older adults may with timing their medications when foods or other drugs positively or negatively affect their effectiveness and safety . between ionships relat  Develop context - aware technology that can detect and understand the surroundings, user their environment s and activities (e.g. , and work and home routine s , exercise s to support precision regimens. A dvances in analytics may allow technology to actively habits) user’s a to needs. adapt medi Develop automated support cation reconciliation systems and clinical decision  systems that allow clinicians to understand a person’s full medication use to reduce the simultaneous use of therapy multiple medications and unintentional duplication of , and ultimately to adopt simplified prescription regimens that are more effective, safer, and easier for users to follow . providing  Identify the most effective ways to report information on adherence back to by providers data is accessible, actionable, and delivered at the that ri ght time to the appropriate members of healthcar e teams , including pharmacy staff.  Integrate mobile adherence data with electronic health records to foster better individual large adherence outcomes as well as facilitate the testing of interve - scale system ntions and health generat information . Such data integration could exchanges e evidence to improve medication management across populations . Whether at a large or a small scale, proven and promising health adherence interventions with mobile and connected t echnologies should be moved into science. implementation routine care settings and tested through rigorous – – 7

16 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Cognition III. changes Cognitive common during aging, with increasing prevalence at older ages and spanning in are to from the ubi quitous “senior moment” advanced dementia. Cognitive decline and impact severity a person’s ability to manage chronic health conditions that interferes are known risk factors for with high blood pressure, high blood glucose levels, including and various forms of heart disease. , dementia technologies that help to monitor these Therefore, conditions and coordinat e care will increase the individuals to live independently. (Technologies for coordinating patient care are discussed in ability of c VII Access to Health are. ) , Section 2017, there were 50 million cases of dementia across the globe. In the same year, In the United States 6 million people over the age of approximately with clinical Alzheimer’s disease (AD) or mild had 65 itive impairment (MCI) due to AD , along with a pproximately 47 million people with biological signs cogn of (amyloidosis, neurodegeneration, or both). By 2060 , the number of people in the United States AD 15 of AD or MCI due to AD is predicted to grow to 15 million. As a result of the prevalence AD with clinical dementias , along with the estimated increase to other 2 million cases worldwide by 2050, the and 15 16 Health Organization declared dementia to be a public health priority. S G iven the aging of the U . W . orld models of care are needed population, to meet the demand for high - quality, person - innovative care. centered of AD is expensive, both to families and society. Estimates from 2010 suggest that care for Management with AD in the United States cost up to $215 people billion dollars that year , and that most of this cost 17 born e by family or informal caregivers. wa For s example, care - related costs for a person with than an for dementia are predicted to be $184,500 higher over a lifetime (86% incurred by families) 18 individual dementia. without and futu re technologies offer both challenges and opportunities in the everyday assistance of Existing for older adults. Incorporating the perspective and preferences of older adults , including cognition differences may exist based on gender, ethnicity, that and socioecono mic background, is important in intervention planning that involves technology. The manner in which older adults relate to technology as a potential support for everyday life — both present and future — will determine the role that these technologies play. Tec hnology advances may help remote ly monitor older adults for changes in cognition, for changes in for their ability to maintain independence in daily activities , and focus safety in their daily lives . Three areas been identified for mitigating changes in have cognition: cognitive monitoring , cognitive training , and financial security. As in the prior section, each focus area includes a set of key functional needs followed by a list of recommended R&D topics . Cognitive Monitoring Regularly Assess Reasoning , M emory, and Communication Abilities . Because baseline cognitive assessments ability significantly from person to person, and varies can often be influenced by a person’s quality and duration of education as well as many other factors, determining what is no rmal 15 https://www.ncbi .nlm.nih.gov/pubmed/29233480 16 https://www.who.int/en/news - room/fact - sheets/detail/dementia 17 https://www.ncbi.nlm.nih.gov/pubmed/23902508 18 https://www.ncbi.nlm.nih.gov/pubmed/28815557 – – 8

17 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES an individual is not straightforward. Many changes in cognition are recognized only after the fact, for more when impairment is identified, and subsequent efforts to prevent decline may be too late. severe eliminate many of the inh erent can issu es with current standard assessments by Technology help - frequent, unobtrusive, objective measures that allow time, detection of more subtle, pre - allowing real changes . R ecommendations for R&D to address the need to regularly assess symptomatic reasoning , , and communication abilities include the following : memory health/social Determine feasibility, validity, reliability, and the impacts of technological  for cognitive assessment . Evaluations of technologies should be based on their use approaches by iverse, real - world populations. Research should particularly address older adults living within d contexts or from disadvantaged low - resource groups. highly Obtain data related to the cost effectiveness of these technologies as well as which groups are  most likely to ben efit from them. Understand how remote technologies can be practically integrated into health system operations  healthcare as well as what format improves clinicians’ delivery, willingness and comfort using and technologies . these A ssess whether the perceiv ed benefits  monitoring technologies outweigh potential concerns of autonomy , and consent ; determine who is privacy, permitted access to and use of the regarding gathered, especially for continuous monitoring; and clarify who is responsible information any for action bas ed on the information gathered. Training Cognitive in Baseline Ability . There is considerable identifying methods that will improve Enhance interest to help stave off decline. Thus far, most cognitive training technology available t o the cognition public has been developed for the direct - to - consumer market. Although there has been empirical support for modest improvements to narrowly - defined aspects of cognition following intervention s in research independent by market settings, the efficacy of most products on the research. ha s not been supported  whether cognitive training , and which type of cognitive training , is an effective method Determine improve or delay age - related cognitive and/or onset of pathological cognitive to decline Determine which domains of functioning are affected and for how long. This research impairment. 19 , 20 the potential benefits as considered by evidence - based reviews. would clarify cognitive  development of novel and engaging Promote training applications and rigorously a ssess of long - term cognitive improvement s that impact daily functioning. This research may evidence be facilitated through the development and use of interventions that target a specific neural it technology easier system/functional domain, making existing to assess change . A ugmenting adults platforms are already accepted among older that may lead to improved adherence. Research programs with more training and longer follow - up timeframes are also needed. on  Foster and improve evidence and research cognitive training programs wherein training related to a particular such cognitive domain , as memory or information processing/speed , is readily Encourage generalizable real - world situations and needs. to research that addresses actual needs in terms of cognitive training, ideally tailored to individual needs and situations. 19 https://effectivehealthcare.ahrq.gov/topics/cognitive - decline/research - 2017 20 - for opportunities - https://www.nap.edu/catalog/21693/cognitive - aging - progress - in - understanding - and - action – – 9

18 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Cognitive Rehabilitation . When individuals begin to experience age - related cognitive decline, Provide may able to mitigate the changes. Remote interventions may provide advantages over technology be in - in visit s, which may not be feasible person certain circumstances. With the increased use traditional mobile devices, wearable sensors, and novel human - computer interfaces, new possibilities are of to cognitive expand the tele - rehabilitat ion paradigm. In the past, cognitive rehabilitation emerging have office visits with unmonitored required assignments between visits. would Determine the efficacy of available training for individuals  impaired cognition. Current with limited becaus e studies have often remains underpowered, short in duration, or evidence been ing a standard , baseline assessment. lack  design opportunities and considerations when applying emergent pervasive computing Explore to cognitive tele - rehabilitation. technologies clinicians Develop iter ative process for use with rehabilitation an that can take into account a  changing recovery trajectory. patient’s Develop and validate baseline measures and tools through which the effectiveness of  be assessed . can interventions Security Financial Independent Financial Management and Prevent Enable Exploitation . It is important to enhance or extend independent financial management by older adults, including those experiencing early and Many of the financial self - assessment tools on cognitive e market, ranging from books changes. th websites to financial planners and downloadable apps, geared toward a younger population. Scant are financial geared The assessment. work has been toward elderly population s and their specific needs for increasing ation, rapid changes, and frequent use of technological systems create an sophistic taken which older adults may be environment advantage of . in assist or  adapt existing technological tools to Develop in simplifying the financial decision - making process for older ad ults as they address the burdens of managing expenses and life - changing choices . the impact of the increased  availability Examine of financial health measures through technology or the i nternet and how these might affect decision making after learning one’ s score, including targeted how well a product works for a population and for specific purposes . have  Utilize technology to ensure that all adults exposure to financial literacy training as part of their interactions in order to provide them with a more solid foundation on which to base financial help them decisions to plan for the future. and interfaces  online banking and automated Adapt teller machines to support older adults . for  Regularly and publicly evaluate existing financial monitoring techniques fo r efficacy, feasibility, and including methods employing : t hird - party, acceptability, read - only access to accounts ; fraud detection and notification ; a ggregated account monitoring for indicators of financial exploitation ; and anomalous transaction alerts.  Assess the efficacy of existing and developing technologies for identification , such as both financial . exploitation wearables, biometrics, and geolocation, to prevent elder – – 10

19 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION Older Adults with Reduced Financial Capacity . It is important to effectiv ely and efficiently Identify financial individuals who may be at greatest risk of exploitation, with an appropriate plan for identify to these risks that match with a person’s individual responding . goals  Convert existing tools for assessing financial capacity into electronic formats to allow wider use. the Financial Capacity For Instrument is a standardized psychometric instrument example, 21 assess financial activities and abilities designed relevant to community - dwelling adults. to However, it requires training to administer the instrument and interpret the results. Technology might the need for training and make it more widely available. reduce existing understanding of the relationships between  measurements of financial Advance , functioning of other types of functioning and such as computer use, driving, cell assessments phone use, and mobility , to determine how non - financial deficits may predict declines in financial capacity. basis prediction of risk on an individual  Improve to increase the benefit from intervent ions regarding finances . IV. Communication and Social Connectivity Communication between older members of society involves three separate factors: the physiological (language another one a bility to communicate (hear, speak , see, and touch ); the ability to understand and differe nces); and the technological ability to communicate across distances for social and cultural interactions This third aspect includes relatively . close - proximity communication (face - to - professional that can be addressed with hear ing devices, as well as long - distance communication that can be face) information and communication technologies (e.g. , i nternet applications and social by enhanced All three factors are integral to maintaining social connectivity media). among the aging populat ion. (An addition al area of communication that impacts the health and independence of the aging , population telehealth , discussed in Section VII is Access to Healthcare . ) Hearing Communication challenges for the aging population may be due to hearing loss resulting from a n injury or illness or simply as a result of the aging process. Advances in hearing assistance technologies can dramatically improve the quality of life experienced by older adults. However, much needs to be done technologies to make these and more accessible through simplified operation, improved performance, reduced What is promising, however, is that the baby boom generation is comfortable cost. with technological advances and is much more inclined to embrace their benefits. Provide Effec tive Hearing Assistance . The ability to hear is key to the ability to communicate for most hearing people. can provide assistance when natural Technology has deteriorated. Devices are needed to help hearing impaired individuals understand speech in noisy e nvironments. Current hearing - devices assistive are generally designed for one - on - one conversations at close distances and are less the effective of these specifications. R ecommendations for R&D to address outside need for effective hearing assistance inclu de the following :  Develop systems that include the ability to share audio channels between hearing aids, electronic smartphones, microphones, and other consumer remote devices through a non - wireless link with the short latency needed to unders tand speech. proprietary, 21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712121/ – – 11

20 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Develop open protocols for wireless communication of the audio input of hearing aids with other  including systems, microphones, and other wearable electronics. These protocols smartphones, users expand needed ability of hearing aid to to utilize other common technologies. are the Advance the technology used to collect and process sound, as well as the computational power of  to improve performance in noisy environments , noise - source identification and assistive devices, auditory loca lization and recognition , and , (or visual closed - caption) cancellation speech reconstruction. enhance and advance necessary technologies to  the computational power of hearing Identify systems so they could take advantage of existing or future smart systems t o improve their assistive functionality. computational power would also increase the ability for hearables to interface More other smart systems that could offer enhanced features, such as reminders of forgotten with via face recognition, health alerts to fitness monitors and smart watches , and names synced from Global Positioning System information ( GPS ) applications . navigational Develop appropriate policies, requirements , and technologies for the sale of over  the - counter - 22 aids . hearing and Imple mentation of Hearing Assistance . The willingness of individuals to Expand Acceptance their need for assistance with hearing, and even accept importantly their wil lingness to obtain a more professional assessment of their hearing, is the step to obtaining an assistive device. first online hearing through  Develop the ability to check or levels using automated hearing tests initial common devices. This advancement will make assessment of hearing loss smart discrete, and convenient and should increase the rate of as sessment among inexpensive, . individuals Develop enhanced hearing loss simulation programs that allow hearing - impaired individuals to  impact their hearing loss to demonstrate to family members and friends the replicate hearing loss Programs has the ability to understand what is said. on should permit the individuals to input their speech into the program and modify the listening situation to simulate restaurant noise, small and large groups, etc. , to demonstrate how a specific hearing loss degrades speech clarity in var ious communication environments. to assistive adjust  Develop standard, open remote protocols that can be used hearing and tune proprietary devices. hearing aid adjustment s are Currently, to each manufacturer. This limits choices for individuals seeking service or tuning requirement of their hearing aids, especially in rural areas. Standard and open protocols that read and set fitting and operational parameters for hearing aids would allow hearing professionals to access the settings of an from aid purchased provide another vendor , enable telehealth applications to professional assistance to users in remote areas , and allow users to self - fit devices. and self - adjust their order  Conduct research into policies and standards in to make hearing devices more easil y and . audiologists affordably accessible , especially in areas underserved by 22 ctsandmedicalprocedures/homehealthandconsumer/consumerp https://www.fda.gov/medicaldevices/produ roducts/hearingaids/default.htm – – 12

21 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES with Diverse Communities Communication Conversations Translate Physicians and Patients . According to the 201 6 American between language , 21% of Survey U . S . residents speak a (ACS) other than English at home , including Community 23 born in the U nited S tates and 1 5 % of those over the age many 65. It can be difficult for people of understand medical jargon, and this difficulty is exacerbated if they do not share a first patients to their guage healthcare provider s . lan with developing are multiple benefits that would come from technologies to assist in translating There between physicians and patients . These were conversations by one technology developer categorized as: reduced costs; re duced administrative and staff burden; increased quality and accuracy; mobility; clinical applications — capturing the spirit and intent of the communication by recording the actual and 24 benefi the interpreted/translated version. and These same ts could be realized for communication Americans, their caregivers, and family members. Additionally, verbal or non - verbal aging s provider communication and patients from diverse communities can lead to improved between empathy. rapport and Continue to i mprove and expan d automated translation technology. Achieving nearly universal  utomated translation is technically very challenging because there are between 6 , 000 and 7 , 000 a is dependent. context languages and dialects , most languages are not written , and every language enable Advances artificial intelligence have the potential to rapid , reliable, real - time translation in one language into another , including idiomatic language patterns . of in the ability to convert recorded audio (including Expand video s) into text. This capability has  steadily improving, with the availability of However, many free software programs. been more across research needed to expand these abilities is many languages and idiomatic language patterns , including transcribing into the source language and into an alternate language of the individuals, listener Such software could support aging . their families, and healthcare providers by providing them with written documentation of conversations, instructions, and written communication . s in their primary languages Social Technologies Communication Connections . S ocial isolation Maintain loneliness Social among older adults are linked to and depressive symptoms, poor cognitive functioning, disrupted sleep, lack of physical activity, and 25 mental hea lth — all of which have implications for increased mortality. impaired the  Promote systematic research demonstrating interventions effectiveness of , including online social , to reduce social isolation and loneliness networks among seniors , as well as the mechanisms by which the interventions exert effects. predatory  Develop technological solutions to minimize the risk of social media campaigns. 23 https://factfinder.census.gov/faces/ tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_B16007&pr odType=table 24 - http://www.healthcarefinancenews.com/news/5 - benefits - healthcare - transla tion technology 25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383762/ – – 13

22 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION Promote collaboration between device manufacturers and the academic community to design  adults address the need for s ocial connectedness in older , starting with the initial that ducts pro phase . design Advance understanding of the technological  of older adults with disabilities. This needs imperative, because disabled older adults are generally is less likely to us e understanding 26 technology. communication Personal Mobility V. key a Mobility factor in living independently . Mobility generally refers to all movement, including basic is from a bed to a chair, walking for leisure and the completion of daily t asks, ambulation, transferring in activities associated with work and play, exercising, engaging a car, and using various forms driving 27 public transport. of Simply put, mobility allows people to where they want to be, when they want get to be there, without impediments , safely an d reliably . As documented by the National Household Travel 28 Survey o lder adults tend to become less mobile with age . , the to truly live independently, an individual must have ability to control his or her movement In order mobility), avoid slips and falls, and (basic be able to move around the neighborhood and larger community. Each of these requirements has its own challenges and, therefore, distinct set s of technologies that hold promise to address these challenges . The needed technologies can be grouped into focus areas : assisted movement, rehabilitation, and monitoring and safety . Some of the focus three (e.g., been addressed within an experimental paradigm have robot navigation) but have not yet areas been demonstrated in the community. A dditional resea rch is needed to fully assess user needs in this tools area and develop the data analytics and software that will make technologies fully successful in and independence. maintain helping older adults achieve Assisted Movement Assist with Naviga ting the Home and ance Neighborhood . When individuals experience either Provide or cognitive deficits, they are often unable to navigate their homes or local communities physical involve Assistance may focus on guidance or assistance. a surrogate system to move around without the home and conduct some basic activities , for example , pick ing up needed items located in another room. for R&D to provide assistance Recommendations with navigation include the following :  Design robots that are robust enough to require little ma intenance or troubleshooting and that have long battery life and are easy to recharge . pick  Design accessible drop - off and automated - up stops for assistive mobility robots , including use vehicles low - speed shuttles for mixed and within neighborhood s and co mmunities.  Develop affordable control systems , appropriate sensing, information processing, and decision - making algorithms to allow robots to negotiate the navigation environment of the home, such as dynamic and static obstacles, uneven floors, stairs, var ying lighting conditions, and door thresholds. smart robotic technologies that not only  Develop to an individual’s needs but also can respond learn and modify a robot’s behavior based upon the owner’s requirements and usual habits . 26 http://www.pewresearch.org/fact - tank/2017/04/07/disabled - americans - are - less - likely - to - use - technology/ 27 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464831/ 28 https://nhts.ornl.gov/ – – 14

23 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Compensate for Reduced Strength and Mobility . Individuals with reduced Mechanically function musculoskeletal require assistance with balance and/or range of motion. Current often solutions, including exoskeletons, is on primarily occurring in clinical research technological involving individuals with paralysis and their caretakers. Real - world ilitation rehab centers often involve everyday tasks that are challenging and have the environments potential to be unsafe. assistive mobility technologies for less supervised environm ents and tasks, like traversing  Develop stairs), or down a street curb, walking on uneven terrain ( e.g . , ramps, or walking up to a counter up grab an object . to Address control, comfort , and safety - related functionalities in wearable mobility systems, such as  keletons exos and incorporate hybrid features that allow control to transition between the , and the user. exoskeleton brain Advance and engineering focused on employing a science - computer interface for controlling  exoskeletons. Develop algorithms for activity  ecognition and indoor location detection that are suitably reliable r enough for real - accurate use . and world Rehabilitation In - Home Rehabilitation . Current rehabilitation programs require Enable older adults to go to clinical facilities, which limit s who ca n attend and for how much time they will receive therapy. To minimize , maximize access , cost and maximize the amount of time that can be spent pursuing rehabilitation activities, systems enabling in - home therapy are needed . in functional the  Explore dependence role of virtual real ity and gaming systems for improving among adults. There is evidence that virtual reality can be use d by older adults at home to older 29 been gait following a stroke . their It has proposed that virtual reality and gaming improve 30 may enhance physical activity and improve health, but evidence for success is weak . The syst ems such systems warrants further research , including into how to use these systems with of impact adults more effectively . older Design and develop affordable rehabil itation devices to promote intensive practice of a gait - like  for older individuals with physical pattern disa bilities and chronic conditions . movement Examine the use of smart - home technologies for rehabilitation purposes , including  monitoring for improvem ent or prevention of functional decline. Safety Monitoring and Movement and Activity . Changes in activity are an indication of individual well - being Monitor . Measures of movement and activity can indicate both and gradual changes in well - being . acute  Impro ve the reliability and usability — including battery life and comfort — of sensor s ystems and - algorithms focus on either activity - and fall that recognition or indoor location detection in order to support deployment in the real world. Systems need to be more usable so that they can be effectively deployed for extended use to assess possible declines in individuals and enable early interventions. 29 https://www.ncbi.nlm.nih.gov/pubmed/23614694 30 4351549 https://www.ncbi.nlm.nih.gov/pubmed/2 – – 15

24 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION Promote research efforts and examination of systems to dynamically assess sit - to - stand transfers.  need to be collected to determine normal ranges and cut - off values for time to transfer Parameters well transfer as body movements during the that canno t be reliably recorded manually. as from algorithms that fuse and combine data multiple movement and activity sens ing  Develop to provide increased accuracy for the assessment systems of individual well - being . These may include the application of artificial intelligence and should provide useful information to users, as and caregivers, appropriate. healthcare providers, t Falls . Falls result in significant morbidity and mortality among the aging population , so t heir Preven to prevention key to maintaining independence. Systems are needed that can train individuals is minimize fall risk and assess those most at risk for falls.  De velop technology - based strategies , especially for in - home use , for fall prevention training. Older 31 adults be trained to rapidly adjust their behavior to prevent a fall in experimental settings, can for strategies should be adapted the home setti ng. but these Determine the key parameters for assessment of fall risk as they relate to the cognitive aspects of  fall prevention, particularly measurement of reaction time as a means to determine an individual ’s ability to correct a loss of and prevent a fa ll . balance  Develop technologies to measure the reaction time of individuals during instances where they lose their must recognize the perturbation, and must correct it before falling . balance,  use of larger trials on the Promote use of existing technologies, including accelerometers, to the investigate reaction time as a measurement for fall risk, and include both a healthy aging that population and those with other progressive conditions could increase fall risk , such as cognitive of measurement dementia. These tools have the potential t o become standard s for decline slowed processing that could be used both to prevent falls and to assist in determining and someone needs a higher level of assistance or care . when Transportation VI. around and beyond the c ommunity is key for individuals to be able to access social, health, Movement and business facilities. As each person is unique, so too is his or her ability to live independently , along with the resultant transportation needs and limits associated with each person ’s physical and cognitive abilities. Some older adults are completely independent and continue to drive without assistance , while others may be able to drive but require vehicle modifications and/or some advanced technologies altogether, to assist them. Other older ad ults have transitioned away from driving to sometimes due transportation age disabilities, and rely fully on public related and a variety of other transportation - services. Finally, there are older adults who also rely on services and technologi es, not only for 32 - but for basic day - to day mobility as well. transportation, For the purpose of this document, the broader community area was defined as being greater than one may mile the home. Technologies to support transportation from vary depending o n the distance of travel planned. Movement around the broader community can be via private vehicle (driving) or public also transportation the two focus areas for this capability topic . (Similar technologies are — needed to and assist with long - distance air rail travel.) 31 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335723/ 32 https://rosap.ntl.bts.gov/view/dot/31320 – – 16

25 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Driving Driving Fitness and Help Drivers Maintain their Driving Fitness . As drivers’ cognitive and Assess abilities physical with age , driving skills need to be evaluated. If a driver’s physical or cognitive change it is possible to develop have that could allow that individual to continue to declined, abilities systems independently and safely . Technological systems that can supplement or replace physical or drive actions by the driver would extend the ability of individuals cognitive to driv e following chronic or acute ability . Current best practice is to use some form of testing (most often vision) at license reductions in periods, driving leaving long periods of unassessed skills and different rules in different S tates. renewal that are based on drivers ’ resources, meaning tations those with resources will be better Current adap to extend their driving time . R ecommendations for R&D to address driver fitness and help drivers able maintain driving fitness include the following : their Determine what measurable factors best assess driving fitness in order to develop tools that can  both - assessment and professional ass essment of self fitness for driving , including support cognitive ability and demand related to human factors measuring and situationa l awareness. tools that can accurately and objectively measure Develop these factors of fitness and provide the  of an assessment to the driver or a professional on whether the individual results likely to be fit is to drive or may need assistance . a real - time link between self - assessment and access to the vehicle, such that individuals  Design should not be driving without assistive technology will not do so . This who link would apply to drivers with a drop in cognitive function as well as those with a reduc tion in physical fitness (e.g. , vision, muscle strength, of motion). range in changes for  Develop assistive technology that can be easily adjusted to account musculoskeletal that affect fitness to drive. Such technology would extend an individual’s factors drive without requiring substantial time or monetary resources to implement new ability to systems as physical abilities change. assistive provide to advance the development of automated vehicles , which will Continue broader access  the vehicles to for private aging population .  Continue to enhance advanced safety and driver assistance systems to improve road safety and fitness reduce crash incidence in general. R esearch is needed to determine the level of inherent en that must be demonstrated by individuals ev with the availability of these systems.  Encourage the development of future training systems that allow aging drivers to practice driving driving with “unexpected” scenarios and thereby develop or reinforce confidence in Lack ability. ( of can result in a greater chance confidence of driver error due to indecisiveness. )  Develop systems to allow individuals with mobility impairments to independently access their their vehicles and easily store wheelchairs (manual or power) or scooters inside vehicles, ther eby independence improv their transportation ing . Public Transportation Public transportation may involve any combination of personalized and mass transit systems, including The taxis ride sharing, shuttles, buses, ferries, and trains. availability of each of these systems varies , significantly from community to community. This document does not address the general availability of public transportation options, which is a primary user need. It focuses instead on the needs of transportation individuals for assistance with n avigation , scheduling, and access, assuming that public is available. – – 17

26 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION with Navigation and Scheduling . Planned navigation of a route and real - time scheduling Assist traffic along the ability to adapt to changes in with or schedul e information, are some of information, key factors that support ease of use the public transportation. Current technologies that can address of are not generally designed to take into needs account the specific needs of older adults. these Implement pre - t r ip wayfindin g  navigation systems that connect a planned route ( within and wearable devices and smart displays ) to real - time information that enables independent travel including systems that help plan accessible , routes, remind users about their planned and mobility rips, and provide reminders about what to bring, when t leave, etc., for the entire trip . These to technologies are available but are not fully designed or deployed to meet such needs .  Enhance wayfinding and navigation systems to incl ude electronic orientati on aids that can determine individual’s location and plot the most suitable route to the destination. an guidance dynamic maps and real - time navigation can include a variety of Improvement of including robotics, crowdsourcing, advanced path p lanning, and multi - modal technologies, of some interfaces. these systems were developed specifically for people with visual While the , t he disabilities technology could be refined to meet needs of the older adult population — in particular those with cognitive deficits.  nhance the accuracy of map and infrastructure information for built and pedestrian E such include information within wayfinding tools , environments as the location of stairs and to elevators, grade of ramp, and surface roughness . Industry has taken on the ch allenge of in developing accurate maps, but research is needed into how to best bridge the gaps information are obtained from various databases. Common policies needed regarding the types of so cuts) that infrastructure information that is encoded into these maps (e.g. , elevator s , curb scalable can be developed rather than relying on regional solutions. applications rather wayfinding and navigation apps that can predict, than react to, changes in the  Develop in order to provide more independence and environment a sense of security to users. Research is required into how to provide this forward - socially aware guidance. In addition, systems looking, that can notify an individual if he or she is about to make a wrong decision , such as get ting on the wrong o r train, will significantly improve user confidence and independence. bus  both robust and accessible interfaces and Develop training methods for smart phone navigation applications. While smartphone apps do exist to support wayfinding on public transportation, many individuals m not comfortable using this aging technology or interfacing with the system. Systems must support individuals with reduced visual acuity or manual dexterity and need to be using developed information “ universal design ” and inclusive and communication technologies .  technological tools that can inform family members and caregivers if the rider makes a Develop and navigation. These tools would reduce individual family stress levels and improve mistake in safety, especially among i ndividuals with diminished cognitive function. individual actually Facilitate Public Transportation . Once a route is planned, the ability to Access access public to transportation without significant delays or transit times is important. extended  Develop systems that can quickly and safely secure wheelchairs (manual and power), scooters , and assistive devices (e.g., oxygen cans) within all public transportation systems, ideally other systems without the transfer of the passenger. Encourage requiring to be design ed to address the needs of individuals with disabilities, including safe securement and restrain t systems. These are needed to facilitate the use of public transportation by users of personal mobility systems without and buses public adversely affecting system efficiency. Curren t systems to secure wheelchairs on – – 18

27 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES often require time that can disrupt the planned schedule for the bus or train. In addition, trains stations charging powered wheelchairs or scooters that are integrated into transit vehicle s for atly spent expand the distance that could be traveled or the time that can be gre away from would home base. a architectural design standards that meaningfully consider how persons  assistive Implement using devices navigate through public sta tions . mobility transportation Enhance wayfinding and navigation apps to access real - time updates on public transportation  including infrastructure, the status of elevators or vehicle lifts/ramps. Planning for these variations routes important to all travelers , including th ose is with disabilities , and for all surface in needs. Real - time updates on public transit infrastructure are important to transportation all all types of trips to all destinations. travelers on Develop remote or assistance strategies to reduce wait tim es and maximize the efficiency  robotic staff, such as of distance - based control of gates, elevators on request, and moveable robotic ramps/lifts for train access at stations . Develop shared neighborhood autom ated vehicle networks that can provide access to  and for all individuals, at all times, to all destinations. Smaller vehicles lized transportation persona also prove to be a key strategy in addressing may first - last mile challenges. Such vehicles would be usable without a driver’s license to accessible by individuals with wheelchairs or need and in order to be usable by the broad community as scooters a connection to public transportation. N vehicle designs and technology developments are necessary to meet the expanded needs of ovel aging population. the to Develop t echnology and policies, including pertaining privacy issues, to support machine -  personal profiles for travel support and human readable in transportation , as well as to services identify the appropriate services that meet the user ’s . For example , providing data to transit needs mobility personal companies system, regarding the ability and needs of an individual (e.g. , type of ability transfer, and description of assistance needed) would allow appropriate assistive to time. staff support to be a vailable at the appointed technologies Such personalization will or reduce improve the efficiency of scheduling, and positively wasted impact quality of life. time, VII. Access to Healthcare Access to effective healthcare plays a critical role in helping older adult s stay active and independent majority as age. Currently many older adults, the they of whom have multiple chronic conditions, receive suboptimal, fragmented, uncoordinated and , at times , contradictory or harmful care from multiple provi ders in multiple ca re settings . Many different individuals have important role s to play application with respect to the of activities and strategies support the maintenance of function and independence with age. Participants in this that include : patients/clients ; their families, care caregivers , and communities; clini cians ; social system services. support systems ; and community and Alignment and coordination among these services participants through technology can increase the effectiveness and efficiency of these services. In a eCare digital system, telehealth and electronic care ( healthcare ) planning — the focus areas discussed below — can enable older adults to maintain their independence by increasing access to effective care, coordinating this care, providing support for pre vention and chronic disease management, and help ing . clinicians and to reduce the stress on older adults, their caregivers, – – 19

28 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION Telehealth is defined as a collection of means or methods for delivering and enhancing Telehealth healthcare, and hea lth education delivery health, support using telecommunications technologies, public and 33 of the capabilit ies or location s of care recipients. regardless Synchronous telehealth in real (occurring time) or asynchronous telehealth may include : ( 1) clinical video telehealth (two - way, real - time, between patients, synchronous caregivers, or providers using audiovisual interactions the telecommunications 2) secure messaging in technology); collection and transmission of health ( information to monitor or manage chronic condition s; and ( 3) care management using telehealth , such as text messages or apps that help patients with reminders to adhere to specific care targeted 34 T elehealth can deliver services to patients feasibly, regimens. and in a way in which both safely, patients an d healthcare workers are satisfied with those services , and is already a priority of the Trump 35 to expand access to care for Veterans . A dministration Improve Health c are Access and Quality . To access comprehensive and appropriate healthcare, it is care, important that older adults can receive primary specialty care , and community services regardless rural, for underserved, of their physical mobility or location. This need includes providing access to care and risk individu als and communities, including V e terans. In addition, older adults who cannot easily at - healthcare need to be able to communicate with their providers. The use of telehealth can travel outcomes such as mortality, quality of life, and resource utilization for several chronic improve s, including cardiovascular and respiratory disease. R ecommendations for R&D to improve condition include the access following : healthcare  Develop, implement, and evaluate scalable and sustainable telehealth programs.  innovative telehealth technologies that incorporate the use of smartphones, sensor Develop faster i nternet to expand the technology, range and functionality of telehealth services. and  Evaluate the impact of different telehealth applications and models of delivery on patients, related families, and clinical tea ms, including : outcomes to time, costs, and healthcare utilization ; the quality of communication and care ; and health outcomes. in different  Conduct rigorous studies to determine what types of telehealth are most effective settings for what con ditions , and how and when telehealth can be incorporated into provider and workflow the lives of patients in ways that and promote quality of life and improved health outcomes. makes Promote Care Transitions . The use of telehealth Smoother it possible to monit or older adults when making transitions between care settings , such as going home from the hospital. Without such of monitoring, many older adults are at risk being readmitted. Telehealth can be used to identify critical issues , including changes in mental status, weight, or blood pressure, thereby facilitating intervention adults to prevent hospital readmission. Many older and are transferred to nursing homes for treatment heightened monitoring to ensure their safety. Telehealth potentially offers an alter native , so that they home can remain in their safely s and communit ies . 33 https://www.cchpca.org/about/about - telehealth 34 https://effectivehealthcare.ahrq.gov/sites/default/fil es/pdf/telehealth_technical - brief.pdf 35 t - elehealth - https://www.whitehouse.gov/articles/president - trump - secretary - shulkin - announce - veteran initiatives/ – – 20

29 EMERGING SUPPORT AN AGING POPULATION TECHNOLOGIES TO and evaluate different payment models to promote reimbursement for innovations in  Create to increase its adoption, efficacy, scalability, reach , and efficacy. telehealth  interop erability standards and information technology ( IT ) infrastructure to integrate Advance of with other digital sources services health information technologies , including telehealth electronic health record systems , as an integral part of the health data/informatio n sharing/communications IT infrastructure. health 36 Management Support . Telehealth can provide - effective self - management support — Provide Self people assisting chronic conditions to manage their health , including helping t hem to become with more informed ab out their conditions and assume a more active role in their treatment. Telehealth also their provides new ways for patients to participate in own healthcare by helping them record, measure, and collaborate monitor, and manage their conditions , and remotely share informati on, communicate , with . providers patients user - friendly , self - management support applications that  Develop to focus on enable priorities and achieve of care. goals  Integrate self - management support applications with other technologies that enhance chronic disease , including those for remote management patient monitoring and medication adherence.  Evaluate the impact of different approaches to self - management support on patients, families, outcomes and clinical teams, including : related to tim e, costs, and healthcare utilization ; the quality communication and care ; and health outcomes. of eCare Planning technology is an important component Information care planning that supports care coordination, of communication, and collaboration among membe rs of the healthcare team — older adults, families , and needs to address the full spectrum of a patient’s — across all settings and over time . providers Care plans commun ity and provide support to older adults and their caregivers related to accessing information 37 resources well as making connections to formal and in formal support services. e C are plans could as and enhance care planning activities improve communication, leading to better outcomes and and fewer events. Well - designed e Care plans support adverse p atient - centered and coordinated care for older adults. They are developed in conjunction with patients and families, are based on the patient’s well goals preferences , and optimize autonomy and and - being . Additionally, e Care plans are individualized, are b ased on comprehensive assessments, are dynamic , and integrate information history about multiple factors, including health needs , family and social , home environment , values , goals , and preferences. Improve Coordination of Care . Older adults with multiple chronic conditions and complex health needs support from a variety of providers and services in order to optimize their health and require coordination, tus and to prevent or slow functional . However, in the absence of overall care sta decline these service s may be lacking, redundant, ineffective or potentially harmful. In addition, resulting , health outcomes may be less than ideal, while costs escalate. Therefore, there is a need to implement deliv robust coordination across settings and disciplines to care er care that is integrated and truly patient - centered. 36 https://www.ncbi.nlm.nih.gov/books/NBK379320/ 37 https://pcmh.ahrq.gov/page/coordinating - care - - - complex - care - needs - patient - centered - medical - home adults and - 0 - challenges – – 21

30 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Conduct and publish a systematic review and evaluation of existing eCare planning models to  successes, learned, and challenges. understand lessons and evaluation Support comprehensive , shared implementation eCare plans using health IT  of are aimed at maintaining and improving the functional status of older adults living in the that community. Facilitate Care Planning . As the capabilities of health IT tools increase a nd a nationwide Shared for electronically sharing health information grows, patients and stakeholders across the infrastructure single continuum are around a vision where a eCare plan can be created, dynamically care converging and utilized in a secure and appropriate fashion by pati ents, caregivers, and any member of updated, interdisciplinary virtual, the care team. patient’s Support research on the development, testing, and implementation of health IT solutions to  communication through and foster continuity of care eCare plans . optimize in Enc plans are developed by patients ourage conjunction with their primary care providers  that serve a key role in coordinating and integrating care across settings) and that are appropriate (who for - dwelling older adults. Such plans will enhance p roviders’ capacity to deliver care community a person’s goals and preferences. aligned with Develop tools that optimize communication and foster continuity of care through eCare plans  as older adult’s transition between settings, including primary care, specialty ca acute care, post - re, acute care , and home care. and for  Encourage the development and adoption platforms of health IT certification standards the and exchangeability of eCare plans. Emerging technologies for appl ication accessibility interfaces for remote - monitoring devices may help accelerate implementation. programming Care ly Plan Care for Complex, High - R isk Patients . planning promote s a focus on the patient, Proactive s outcomes , and reduce s the costs of care. Ideally, an improve eCare plan should ensure easy access by patients, their families , and providers alike, using a s tandard shared care plan format . Care coordinators (or other appropriate personnel) conduct assessments and work with the patient to identify goals, preferences, gaps in care, unmet beh avioral health needs, and other social or community foods and needs, such as safe housing , caregiver support , access to and availability of healthy , transportation. plans must be systematically re - evaluated Care and adjusted to assure patients’ needs are b eing met, especially as their needs or circumstances change or progress . other  Support research that identifies social and contextual and human factors that influence design along with end - users’ acceptance, use of, and adoption of eCare plans eams among care t for high - risk patients. complex, with diverse stakeholders  the health Partner and social care system, including clinical across leaders, professional groups , and workforce educators , to better prepare members of the health models and social care system to ad opt team - based of care and spearhead adoption of IT - enabled patients . shared care planning tools for complex, high - need – – 22

31 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION Cross Cutting Themes VIII. - section contains cross - cutting needs and challenges identified during the consideration of the six This challenge capabilities discussed above . N ot every need or applies to every capability ; r ather, functional are needs that may be these with a number of po ssible technology solutions that are not associated necessarily specific to individual R&D recommen dations. Some represent opportunities for leaps in innovation, may be R&D priorities in their and own right. Others may just represent technology thus issues that should be considered during other efforts. Although s ome sections are more detailed than othe rs the level of detail is not intended to convey relative importance. Note that many of the issues , this highlighted notably those related to health IT, open data, connectivity, in and cybersecurity, section, 39 40 , , 38 priorities Administration Trump . are Syste m Needs Many of the priorities identified will rely on traditional system implementation requirements, such as GPS communication network infrastructure as well as and connectivity. These systems also include general - purpose platforms used in technology imp lementation , such as computers, tablets, and mobile include phones Some research needs might also . “custom” infrastructure, such as the instrumentation devices the (e.g., of a physical location (e.g., a “Smart Home ”) and technology to support connected Int ernet of Things , or IoT) . areas require system s to transmi t and exchange information , varying by application, which Many focus includ e the following design parameters: generally  Timeliness of information needed . bandwidth) of alarms/notifications (high  impo rtance, low Inclusion .  Need to data . transmit  Need to “store and forward” (acquire and store locally, transmit when needed) .  to implement “ live interactive devices” (video over phone Ability or i nternet ) .  Maintenance of quality/integrity . data  Management of data volumes ranging from low data rates (e.g., wearables, transactional) to high video, data rates (e.g., telehealth) . (for  Remote control use in closed loop applications or to remotely set parameters) . The are additional challenges and needs for these IT system s : following availability, need to improve day - to - day system dependability, including  reliability, A maintenance support . maintainability, and lack of system availability  various times The or locations due to cellular telephone coverage, at GPS s ignal visibility, power outages, etc. Inconsistent broadband coverage in existing urban buildings remote areas often prevents universal rollout of and these technologies. 38 https://www.performance.g ov/PMA/Presidents_Management_Agenda.pdf 39 https://www.whitehouse.gov/presidential - actions/presidential - executive - order - streamlining - expediting - - requests - broadband - facilities locate rural - america/ - 40 - https://www.whitehouse.gov/presidential - actions/presiden tial - executive - order - strengthening - cybersecurity - critical - infrastructure/ networks federal - – – 23

32 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES System resiliency in emergency or disaster situations when power or servi ces are sign ificantly  O ffering alternate functionality or leveraging alternat ive infrastructure or resources can impacted. ameliorate this risk. mproved cybersecurity I for connected devices.  considerations A dditional wireless spectrum for IoT - connected devices.  Suppor homes for use in smart and the broader environment. S mart home technology is still  t immature but improvements in system integration , sensor deployment , and data relatively , enhance the ability of connected environments to address issues such as algorithms should prediction and health - related quality of life (e.g., fall prevention) disability .  M ethods to verify personal identity using technology, such as using wearable technology, and geolocation. biometrics, Adoption User design — inherently access ible to people regardless Universal of age or disability — including u ser entered d esign, is critical for older adults who may be impacted by a range of factors, including : age - c hearing in vision, related , or memory; psychosocial factors, such as fatigue, dist ress , or native changes and languages other than English ; or extrinsic factors, such as ambient noise , inadequate primary , or socioeconomic factors . Development of usability standards and the application of these lighting of circumstances standards diminished to the design of technology for older adults, even under functional will provide efficient and effective support. Increased research efforts are neces - capacity, to the optimal accessibility and usability guidelines to support older adults using IT . sary determine technology is p articularly appealing for enhancing safety, but implementation should be Monitoring must interactions must be kept simple, and it friendly, be as invisible as possible. More invasive user such as and video monitoring, must addres s ethical consideration s monitoring, the threat to autonomy, and is recommended that algorithms it balance intrusiveness and usefulness . Specialized training and support can help overcome resist ance to adopting new technologies , and a combining with human interaction provides technology more effective educational method compared videos or phone tutorials alone. Continual learning and adjustment to technological to services and updates , however, can also be a barrier to using rapidly changing technology. New platforms in that technol ogy should be able to leverage existing with older adults are already familiar order ease the transition. to technology by older Adoption is also of driven by value and affordability, accessibility, adults independence , and confidence. Li sted below are some factors important to user adoption: the  To maximize the probability that the user will find interacting with the technology useful, assessment design of the technology should include adequate of user needs, usability analysis and s, studie focuses and design methodology that on the appropriate user base. This assessment should needs - finding through interactions with older adults from a range of include socioeconomic backgrounds , caregivers, and clinicians ( geriatricians ) , recogn izing that including users will have a range of different attitudes towards and experiences with technology.  Usability studies have traditionally been qualitative; however, studies should use a quantitative and usage approach and theoretical framework to explain the main dete rminants of adoption behaviors. – – 24

33 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION Use of universal design principles is key, including gathering requirements from the appropriate  all groups and development of a single interface for functions, rather than separate user the or interfaces. devices “Zero - effort technologies” that require little or no effort from the user  wil l limit the opportunity for use error. Designers and engineers should place the burden on advanced computational r interpret data and be responsive techniques to user needs. to an wearable  design input should include For assessment of the appropriate sensor size sensors, and the need for compatibility with human tissue, especially for systems to be used over an extended of time. When possible, truly non - invasive solutions sho uld be sought. It must period and recognized also that wearing the sensors should be comfortable , be garments should be durable to survive washings . multiple  When considering user adoption, “user” should also include clinicians and caregivers. The ease of collect volumes of data can lead to information overload. Users do not necessarily want more ing data — they want meaningful data. It is important that data be rendered in a meaningful way and that systems do not produce inaccurate results, especially false positive s for emergency or to measures meaningful predictive situations. ( Some of the challenges related to linking raw data and are discussed in the Data Algorithm s section below.) also Current F ederal and industry standards focus on IT access rather than usabili ty . To ensure  usable ser vices, including interoperable and medical devices, universal design accessible and must be applied to information communication technologies . Some standards for principles accessibility telecommunications services and web conte nt for have been outlined in the 41 Act Accessibility Guidelines (TAAG) and Telecommunication the Web Content Accessibility 42 (WCAG). Guidelines The TAAG and WCAG standards have as their express purpose to make information and communication technology and i nterne t websites more accessible to persons or with a disability. Therefore, IT designed to meet TAAG accessible WCAG standards will be more to adults, including those with disabilities . older Functionality identified R&D recommendations rely on Several methods or technologies, and improvements specific in the current performance characteristics of these technologies are needed for broader deployment . withdrawal  Systems to detect fraudulent bank patterns within financial institutions .  Enhanced algorithms ally to autom atic identify fraudulent emails , include phishing, swindles for Medicare , ” and offers of “free” medical supplies . “refunds  Biometric recognition methods transaction verification . for  Improved systems for accessibility and hands - free use of technology. 41 http s://www.access - board.gov/guidelines - and - standards/communications - and - it/about - the - - telecommunications - act - guidelines/section - 255 guidelines 42 https://www.w3.org/WAI/intro/wcag – – 25

34 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES and Security Privacy and Privacy considerations are a key constraint for a majority of the R&D recommendations . security privacy should be considered: (a) privacy of categories the individual ; and (b) security and Two of of the collected data. Tech nology solutions should aim to achieve the following privacy : goals the need for data with respect for individual privacy .  Balance Ensure HIPAA - compliant encryption and secure transmission for personal health information .  approach Perform cybersecurity risk and apply a systems - thinking to the overall  management design and implementation . system Develop authentication systems for older adults using unobtrusive biometrics or other methods  data to tampering . avoid Address the security vulnerabilities associated with I oT devices, applications , and smart homes .  Incorporate cybersecurity considerations into design, such as the NIST Cybersecurity Framework  43 Program Cybersecurity for Internet of Things . and NIST and Algorithms Data of the recommendations involve collec tion and analysis of data. Characteristics of the data, Many the needs associated with the data, and the sensors used to detect, collect, transmit , and store the data wide range of requirements associated with their have use. Some needs are associated with th e a data itself, including the quality of the acquired sensor , the analysis of the data to produce hardware of above. meaningful measures , and the the infrastructure necessary to support all The of the data collected depend on the intended haracteristics us e. Several types of data streams are c each with different needs and requirements. Each may have different priorities, data rates, possible, quality requirements . and Event and episode detection and alerting systems , such as acute condition monitoring , gener ate  high - low - bandwidth/data content . priority, monitoring monitoring , such as  chronic condition Continuous , generates mid - to lower - priority, high - bandwidth content . the  Detection and presence monitoring , such as detecting opening/closing of a door or sitt ing on a chair , generat es low - prior ity, low - bandwidth /data content . as  Variable data t ype s , such have individual and repeated values, waveforms (2D) , and images (3D) , different related to data needs rates and quality . While processing some types of data an d data streams is straightforward, challenges do exist for several measure applications where the relationship s between the raw data and the outcome s of interest are including not clearly established , the following :  Developing robust methods to fuse and pr ocess data .  the results that come Validating out of the data .  Establishing the usefulness of the outcome measures from the data (i.e. , validating outcome measures and demonstrating that the result is clinically meaningful) .  Creating replicable methods. 43 https://nvlpubs.nist.gov/nistpubs/CSWP/NIST.CSWP.04162018.pdf – – 26

35 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES v of algorithms , deep learning, and computational techniques , often called artificial A ariety can used to process raw data, such as activity recognition, context modeling, location intelligence, be anomaly detection. A goal is to planning, use data from multiple sensors to identification, and and (e.g. , a nighttime bathroom visit) situation detect clinically relevant problems based understand a abnormal behaviors. While there is the potential to use sensor technology to help maintain on appropria derived validation of sensor - data will be necessary. Similarly , traditional independence, te dementia, and assessments, such as cognitive test s for paper should not be simply ported to - - pen formats without appropriate validation that the new formats provide at least computerized equivalent . The following are some o ther challenges for the use of data: results e.g. Aggregating sensor information of different types — , environmental, cognitive, physical, and  — to define new physiological of i nformation and outcome measures . types  Gathering large enough samples from those with disabilities to have datasets appropriate for the especially recognizing the complexity of this analysis , in that there is more than one way analytics, perform an activity . to Differentiating multiple users in instrumented homes .  Considering the use of low - fidelity activity recognition from sensor data to bala nce privacy and  collection . data Ensuring d ata interoperability so that data from individual collections can be compared .  There a number of common , required characteristics for analytic methods . Algorithms should be are , valid , context aware , and learn with the user . In addition, d ata streams need reliable to be reliable, low - sensitive more cost, than current clinical assessments. and Evaluation n is a key factor in developing and Evaluatio any health technology. However , evaluation is a advancing when transmitted is complex issue , and assessment of one aspect of a technology — e.g., whether data it expected — is not the same as whether a project will positi vely affect health or be adopted in the is , , community. multifaceted evaluation of technology targeted to older individuals is required Therefore and evaluation of emerging technologies should include the following steps :  Comparing developed technologies to t he user needs identified through the design process .  a nd gaugi ng the reliability of developed Validating technologies to ensure that the system is functioning as intended and in a consistent manner .  Determining the efficacy and effectiveness of technology in improving health outcomes and assess ing whether it can . do so through large - scale studies  whether the developed technology meets regulatory standards . Assessing and Performance Needs Technology Safety common challenges have been reported that ca n impact user Several and system performance, safety including hardware incompatibilities, unexpected operating system software upgrades, and the need to occasionally reboot a computer. Many of these challenges can be mitigated through the use of open standards, pplication programming interfaces, technology a certifications, and consensus operational guidelines . Other challenges that impact safety and performance include battery life limitations for wearable devices and minimizing the absorption of electromagnetic e nergy by human tissues. The these of challenges. advancement of energy - harvesting techniques in the future may address some – – 27

36 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES Safety security considerations are particularly important for the design and operation of robotic and system to ensure th at end users are not harmed by failures , such as interruptions of assistive systems and /or communications. power u ser c entered d esign can help to ensure that users’ needs are met, designers of technology to While meet research priorities must also consider safe ty principles and adopt robust product these the processes to ensure that potential development are considered at the start of lifecycle hazards development process. Because many technologies will on existing infrastructure (e.g., transmitting rely data, accessi ng sending alarms), technology sensors, designers should assume that systems will at times operate in a hostile environment and identify and mitigate risks related to the ir use in such an start the environment . from Needs Family Caregiver essential fact or to an individual achieving An functional independence is the role of the family caregiver. On a daily basis, family caregivers — oftentimes a spouse, child, or other relative — may be called upon to help manage and execute a diverse set of services, from compl ex medical care to activities of daily living. A 2016 report by the National Academies of Sciences, Engineering, and Medicine estimates that 44 . impairment an there are at least 17.7 million individuals caring for someone aged 65 and older with 45 By estima te, the value of such care in 2013 totaled $470 billion. Given that b y 203 5 there will be 78 one 46 older than 65 ( outnumbering million under 18 for the first time ) , those the number of individuals only and the demands on this group will caregivers incre ase. Therefore, a ddressing the needs of family family caregivers and the role that technology can have in alleviating their stress are important areas of exploration. from family caregiving, is multidimensional — ranging basic support for l oved Caregiving, particularly needing ones help with meal preparation, transportation, and bill paying , to more complex services, such as medication management and assisted decision making. The desire to provide optimal care to regardless their loved one s is u biquitous to all family caregive rs, of the needs of their care recipient s . In in doing so, family caregivers may rely on technology to fill gaps knowledge their of care practices, identify to decrease the burdens of caregiving, and learn how to execute more complex car e methods demands. 2016 report by the National Academies referenced also discusses ways in which technology The above play a role in t he practice of family caregiving and can on the health of caregivers . T he potential methods by which caregivers can employ technol ogy to help in their roles as caregiver s include but are not limited to the following broad areas :  : Consulting i nternet resources to obtain information on care practices and seek social Education support . alleviation : Participating in technology -  sed Burden interventions to reduce the emotional and ba physical burden from caregiving . via  care giving : Monitoring care recipients remotely Remote videoconferencing and sensing technologies . 44 http://www.nationalacademies.org /hmd/Reports/2016/families - caring - for - an - aging - america.aspx 45 - https://www.aarp.org/content/dam/aarp/ppi/2015/valuing - the - invaluable 2015 - update - new.p df 46 projections.html - 41 population - https://www.census.gov/newsroom/press - releases/2018/cb18 - – – 28

37 EMERGING TECHNOLOGIES TO SUPPORT AN AGING POPULATION the coming years, the role of technology in helping family caregivers m ay shift to the growing area of In care support. A national survey of family caregivers in 2012 highlighted the increasing complex 47 which caregivers are providing complex care . with The list of complex care tasks rated by frequency caregivers as diffic ult include d managing medications, wound care, and the use of medical family equipment , dialysis machines). C ommon needs of caregivers identified in the report include better (e.g. how to properly execute care tasks and better communication with h ealthcare knowledge about Technology , in the form of mobile and web - based applications, online professionals. resources, web and sensing/monitoring devices , may help to fill the knowledge gap often by family experienced caregivers in these complex care situations. Smart H omes Some of the technology that will support independence among aging individuals has been considered in planning for smart homes. Smart homes are living spaces designed with sensor networks, motion the i cameras, and robots that provide nteractive technologies and unobtrusive support sensors, infrared to enable people to enjoy a higher level of independence, activity, systems participation, or well - being. Far from being part of a science ficti on fantasy, IoT makes the possibilities of a smart home today’s much more easily attainable. Smart homes can promote independent l iving and safety, and they can on potentia y optimize quality of life and reduce the stress and burden l aged - care facilities as well as l on formal and informal caregivers. Current technology allows s mart homes to consolidate control of a broad range of systems , including easily lighting, temperature, security, and entertainment , in accessible electronic formats that can be nvironments sense could operated through interactive touch commands or by voice. Future s mart e change, normal and abnormal behaviors and physiologic trajectories, and alert users and predict As potentially dangerous behaviors or physiological changes. caregivers individuals strive to to monitoring independ maintain there is a need for their that can identify changes that may put ence, them at risk. Such monitoring could include changes in broader health markers that might suggest the risk cognitive decline. As examples, smart home of technologies have been demonstrated that can 50 49 48 gait, abnormalities onset of infection , and changes in cognitive functioning . identify Smart in 51 technologies in the home have also been used to facilitate social connections , communication 52 healthcare relationships with pro viders, and tele - rehabilitati on. Large studies in smart homes are needed to scale assess the feasibility, validity, and reliability of - functional monitoring and to compare the effectiveness of various technologies. In addition, res earch is needed to determine which parameters should be measured. Evaluation of optimal monitoring and strategies and timing, usability issues, cost should all be performed. Importantly, users’ to preferences be explored to determine what they would like should know and with whom they wish 47 https://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/home - alone - family - caregivers providing - complex - chronic - care - rev - AARP - ppi - health.pdf - 48 https://www.ncbi.nlm.nih.gov/pubmed/25405437 49 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 4444411/ 50 https://www.ncbi.nlm.nih.gov/pubmed/29107052 51 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417513/ 52 https://ieeexplore.ieee.org/document/7002971/ – – 29

38 EMERGING TO SUPPORT AN AGING POPULATION TECHNOLOGIES share that info rmation. Compatibility among different smart home platforms should be considered to vendor avoid on a particular overreliance or solution. to smart homes that are designed to monitor health or deliver treatments to older adults with chronic For conditi needs the technology to be applied in a real - time, accessible, effective, and health ons, considerations obtrusive T hese are some examples of specific for different areas of minimally way. or behavior: pathology Cardiovascular risk factors : Most research to date in this  relies either on self - reported data area (e.g. sedentary lifestyle) or measures evaluated infrequently when the research participant comes , clinic (e.g. , b lood pressure or walking speed). Th ese approaches may not accurately reflect the to a s behavior/measures in the real world. Research on more real - world measures is needed. person’ patterns : The interaction between sleep and aging is not well understood. It is unknown Sleep  whether treating sleep problems will result in improved cognition in humans , and the potential aid to the impact may depend on both the nature and cause of in disordered sleep . Technology monitoring including the sleep stage, in a person’s home may aid in understanding this sleep, interaction. interactions : The optimal fre quency  Social type of social interaction that supports and independence for older adults is not well understood. Research is needed in several areas, including which of the many software and identifying platform options work best to facilitate social interaction and for which people. A uniform solution is not likely to be appropriate because of the numerous factors impacting older adults, including variations in vision, hearing, and range of (e.g., due to arthritis). motion data smart homes should collect, integrate, process, analyze, communicate, and present In summary, so are engaged and empowered in their that own healthcare with reduced burden to care individuals providers. Thus, research is needed to develop deployable smart home sensing packages tailored to m the needs of individuals that are safe, reliable, and effective. Finally, b est practice guidelines eet should be developed through public - private partnerships that are informed by the use of smart range . communities of technology in community testbeds across a diverse – – 30

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