Smart-Home Concept for Remote Monitoring of Instrumental Activities of Daily Living (IADL) in Older Adults with Cognitive Impairment: A Proof of Concept and Feasibility Study

Myeounggon Lee, Ram Kinker Mishra, Anmol Momin, Nesreen El-Refaei, Amir Behzad Bagheri, Michele K York, Mark E Kunik, Marc Derhammer, Borna Fatehi, James Lim, Rylee Cole, Gregory Barchard, Ashkan Vaziri, Bijan Najafi, Myeounggon Lee, Ram Kinker Mishra, Anmol Momin, Nesreen El-Refaei, Amir Behzad Bagheri, Michele K York, Mark E Kunik, Marc Derhammer, Borna Fatehi, James Lim, Rylee Cole, Gregory Barchard, Ashkan Vaziri, Bijan Najafi

Abstract

Assessment of instrumental activities of daily living (IADL) is essential for the diagnosis and staging of dementia. However, current IADL assessments are subjective and cannot be administered remotely. We proposed a smart-home design, called IADLSys, for remote monitoring of IADL. IADLSys consists of three major components: (1) wireless physical tags (pTAG) attached to objects of interest, (2) a pendant-sensor to monitor physical activities and detect interaction with pTAGs, and (3) an interactive tablet as a gateway to transfer data to a secured cloud. Four studies, including an exploratory clinical study with five older adults with clinically confirmed cognitive impairment, who used IADLSys for 24 h/7 days, were performed to confirm IADLSys feasibility, acceptability, adherence, and validity of detecting IADLs of interest and physical activity. Exploratory tests in two cases with severe and mild cognitive impairment, respectively, revealed that a case with severe cognitive impairment either overestimated or underestimated the frequency of performed IADLs, whereas self-reporting and objective IADL were comparable for the case with mild cognitive impairment. This feasibility and acceptability study may pave the way to implement the smart-home concept to remotely monitor IADL, which in turn may assist in providing personalized support to people with cognitive impairment, while tracking the decline in both physical and cognitive function.

Keywords: Internet of Things (IOT); activity of daily living; aging; dementia; digital health; life-space; remote patient monitoring; smart home; wearables.

Conflict of interest statement

M.D., B.F., J.L., R.C., G.B. and A.V., co-authors, are with BioSensics LLC, the manufacturer of IADLSys used in this study. However, they only contributed to the technical aspect of this study and were not involved in patient recruitment, data analysis, or interpretation of clinical data. B.N., co-author, is serving as a consultant for BioSensics LLC. However, his consultation is not relevant to the scope of this study. He was also not involved in data analysis from this study. No other potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
IADLSys: a pendant sensor (PAMSys+, left); wireless tag (pTAG, middle); and interaction-tablet PC (right).
Figure 2
Figure 2
Locations of the pTAGs to assess IADL: (a) is describing representative locations for pTAGs; and (b) is an example of the objective IADL assessment.
Figure 3
Figure 3
Data acquisition using the IADLSys.
Figure 4
Figure 4
Flow-chart for the validity test.
Figure 5
Figure 5
Experimental set-up for proximity detection test: (a) was an indoor proximity detection test; and (b) was an outdoor proximity test.
Figure 6
Figure 6
Results of the proximity detection test for the indoor (a) and outdoor (b) environments.
Figure 7
Figure 7
Average of daily physical activities for older adults with clinically confirmed cognitive impairment (n = 5), including the average cumulative postures as durations of sitting, standing, walking, and lying time for 48 h by monitoring pendant sensor (PAMSys+).
Figure 8
Figure 8
Results of acceptability test for IADLSys.
Figure 9
Figure 9
Results of the interaction times for IADLs in the patient with severe cognitive impairment: the objective IADL values provide mean and standard errors for 7 days.
Figure 10
Figure 10
Results of the interaction times for IADLs in the participant with mild cognitive impairment: the objective IADL values provide mean and standard errors for 7 days.

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