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1 Introduction

Home care and support technologies are receiving increasing attention commercially [7]. Transition of care for seniors from well-structured facilities and centers to the unpredictable environment at home can be challenging for both seniors and their caregivers whether family or professionals. The main research approach in the last two decades is to focus on technologies that support seniors to be self-dependent enough to independently live comfortably and safely in their preferred environment. This can improve the quality of life while delaying the onset of institutionalization. At the same time, it may reduce the burden family caregivers often experience. For this, technologies have been developed to monitor seniors’ activities and interactions around their house to help maintain awareness and allow for intervention at times of crisis. Technology is integrated into most aspects of life and is increasing the scope of communication and care delivery across conditions such as declining cognitive and motor abilities We review here the state of the art in research on technologies for helping older adults remain independent, productive, and socially engaged and connected to family and friends. We discuss some of the factors increasing the adoption of these technologies such as perceived usefulness to both seniors and caregivers. We also discuss how privacy and increased stress on caregivers may hinder the technology adoption.

1.1 Background

Health care and health management are increasingly being carried out in the home with the assistance of caregivers who could be professionals or family members or by the seniors themselves [7]. Often this is complicated by conditions that affect daily living, such as physical frailty or cognitive decline. Mobile health technologies such as smartphone applications and home support systems have been growing rapidly and these can improve collaboration with caregivers and increased independence for seniors. However, Prasad et al. [7] studied aspects related to seniors’ willingness to share private health information and what type of information is being captured and shared from such technologies to caregivers. The study revealed that the sharing behavior is dependent on the type of information shared and with whom it will be shared with. This brings forth the need to balance seniors’ desire for independence and control over the normal running of their lives with keeping what is private or confidential away from those they do not feel comfortable sharing with. The post study interviews carried out in [7] revealed interesting findings regarding the factors that influence the sharing of health information: seniors are less willing to share location information than sensed information, they are more concerned with disclosure of diet and exercise information than medication tracking, they are more comfortable sharing information about health and weight with healthcare professionals rather than their family caregivers, and they are worried that sharing illness details with family or caregivers will burden them and worry them. This illustrated how the relationship with the sharing recipient and the perceived benefit from sharing with others influences how and with whom sharing happens.

Carmien and Fischer [2] have studied the challenges in supporting the healthy, independent lifestyle of seniors. The study reveals that the home environment, unlike a retirement or senior care facility, includes coordination between multiple groups of people with shared (sensitive) knowledge about the senior’s life. However, seniors reported decline in levels of control over their lives due to a wide variety of people acquiring information about their daily running without their permission. Seniors desire to live independently without the help of caregivers. Research efforts have thus focused on developing and adopting new technologies that would meet the seniors’ needs for control over their private information. Tixier et al. [10] have proposed a framework to allow for successful adoption of such technologies for seniors. The proposed framework emphasizes that a successful assessment of the senior’s life using ADL (Assessment of Daily living) is required when developing technologies for seniors. By this, technologies developed are set to be tailored to the individual senior based on the level of independence they acquire [10]. Therefore, the likelihood for adoption of a technology and what needs it targets is proportional to the ability of a senior to perform the basic daily tasks independently [10].

Seniors vary in their health conditions, wellbeing, motor capabilities and healthcare needs. On the other end of the spectrum, caregivers are greatly impacted by their care giving roles in maintaining supervision over seniors. Hence, Consolvo et al. [4] proposed the notion of Computer Supported Coordinated Care (CSCC), which shifts the focus of technologies on keeping the healthy life style of both seniors and caregivers. In addition to continuous updating and monitoring of seniors’ activities, CSCC systems also consider the caregiver and senior’s mental, emotional and overall wellbeing. Among these, two systems introduced four years apart are representative of the potential to address those challenges. Care Net [4] and MAPS [2] are systems that attempt to create a socio-technical environment supporting customization, personalization and effective collaboration between both seniors and caregivers through the use of Meta Design and Distributed Intelligence approaches.

The Care Net Display [4] consists of an interactive picture frame that surrounds the digital photograph of the senior with relevant information about their daily lives. This digital frame provides caregivers updates throughout the day about the senior’s activities, calendar, mood and medication tracking. This technology is still widely used and accepted due to its unique characteristics being the focus on seniors, not only from a health perspective but an emotional perspective as well. It ensures that the whole caregiver network is updated instantaneously, which improves on having a single designated member to share all relevant information and news – hence everyone has equal access to crucial information. Caregivers are updated instantaneously which helps satisfy their roles of monitoring the day to day lives of their beloved elder but at the same time seniors have no knowledge on the type of information caregivers receive. User studies in [4] present increased acceptance by seniors of this technology due to the increased level of independence and autonomy afforded to the functioning of their lives. However, they reported loss of privacy and control over the information shared about them. Care Net system provides automatic updating from monitoring seniors without the need of caregivers initiating any actions or tasks nor seniors providing information about themselves [4].

The second proposed system known as the Memory Aiding Prompting System (MAPS) [2] creates an environment that allows caregivers to create scripts for seniors that enables them to carry out task independently. This would satisfy the independence requirements of seniors and give caregiver full control and awareness of the normal functioning of the elderly life [2, 10]. MAPS was designed to help seniors achieve more independence through a distributed intelligence approach. This allows the limited internal scripts created by caregivers to be complemented by more powerful external scripts from professional caregivers [2]. Hence, MAPS is integrated with the capability for personalization and customization to tailor the settings in regards to the specificities and particular capabilities of the senior. In addition, MAPS is contextually aware of the current situation through the use of a panic button, which can help when immediate help is needed and help recover from any errors introduced by the system. A participatory design study during the development of MAPS revealed that such a feature is essential for caregivers who are anxious about not being able to intervene in situations where seniors need immediate help and support [2, 10].

The systems and research approaches presented here illustrate that technology interventions can improve the management of information that is essential to both older adults and caregivers. However, as we have highlighted in our analysis, this is not without disadvantage, mainly in the form of seniors’ potential loss of control and privacy. The following section discusses a proposed approach to address these shortcomings.

2 Proposed Solution

Although there has been much research and commercial activity in the last two decades on technology for knowledge acquisition and sharing, little of this has considered seniors and their sense of independence and control as the primary target. In addition, few have considered how design must take into consideration deteriorating cognitive abilities and alleviating care giving burden. Moreover, where research has targeted older adults, it has predominately studied them as consumers of content, knowledge and care, rarely focusing on their capacity to manage and even contribute to knowledge creation (e.g. such as in the case of an older adults caring for a spouse and customizing health information for his/her). As such, what is needed is a more integrated approach to acquiring, managing, and sharing increasingly-complex information.

Our research project aims to focus on the digital independence afforded by collaborative platforms to help support better quality of life for both seniors and caregivers. Seniors struggle in finding accurate sources of information and with understanding the medical terminology discussed in medical articles. We hypothesize that a digital platform that allows collaboration while maintaining seniors’ control over the flow of information may address such challenges. We envision that this can be achieved through the use of semi-automated information and collaboration tools such as summarizing, annotating, and the placement of virtual sticky notes. The use of the natural language component together with the visual representation of sticky notes will help assist the knowledge acquisition task. This framework will be assessed and validated through the creation of a mobile based multi-modal interface that helps older adults increase their digital independence with respect to information-centric tasks.

We are currently witnessing an increase research focus in developing formal requirements that will inform the development of assistive technologies for seniors [6]. Methods such as automatic speech processing and gesture processing are expected to enhance the intelligence of mobile assistive interfaces by increasing the ability to support older adults’ information acquisition tasks. Furthermore, collaborative digital artifact creation has been employed in many design projects such as the Post Card Memories application proposed in [5]. Based on the promising results of such prior work, we aim to contribute a unique research direction to this space, which relies on combining speech and natural language technology and integrating them into assistive interfaces that make use of annotation techniques and sticky notes to better meet seniors’ information and knowledge needs.

3 Proposed Methodology and Evaluation

We plan to evaluate the proposed framework in four phases. The first phase (pre-deployment stage) consists of one-on-one sessions with older adults and caregivers using contextual inquiry to gain further understanding of how older adults seek new information relevant to their health. The second phase (pre-development) is conducted as a participatory design workshop that will bring in the seniors in the early prototyping and development stage. The third stage (development stage) consists of the development of the tool that will integrate natural language processing techniques such as summarization and annotations together in an elder-centric collaborative mobile tool. This tool will be designed to enable seniors to easily seek and research health-related information online. Furthermore, through crowdsourcing and collaborations among the caregiver circle, the collaborative platform will provide discussions and annotations that will allow older adults to better assess the reliability and trustworthiness of each information source they find. The final stage is carried out as a usability evaluation of the tool together with an extensive qualitative interview to gain further insight into future developments.

4 Conclusion

Accessing new information, continuing to learn and be engaged in the society is always a priority for seniors, but with limited eyesight and dexterity, simple tasks such comprehending health information could be a great struggle. This leads to the need of caregivers to assist them. However, with family members often serving as caregivers (and often from a distance), the potential for immediate assistance can be a struggle, leaving socially- and physically-isolated older adults without much needed support. At the same time, seniors need to maintain their privacy and independence with respect to managing their health. Intelligent assistive technologies based on mobile, collaborative and multimodal interfaces (speech, natural language and gestures) offer the potential to fill this gap and provide seniors support for accessing and comprehending critical information while staying connected to their family and beloved ones. The goal of our project is to facilitate older adults’ digital independence by addressing the challenges faced by them when seeking health information while maintaining an optimal balance between privacy and support. For this, we will propose a theoretical framework for better collaboration between seniors and caregivers. We hypothesize that such a framework will enhance older adults’ independent living, encourage social participation with their care network, and reduce the burden and stress caregivers face. The framework will be practically implemented as a collaborative, natural and interactive annotation tool. This will support and connect seniors and family caregivers during the management of health-related information.