Support for Activities of Daily Living

Technological innovations designed to assist elders with activities of daily living help them function safely and effectively in their homes.

Michael Moran, Social Work Today

The demographics of aging are quite clear: Greater numbers of people are living longer lives. And not surprisingly, older adults generally want to remain in their own homes or age in place. But doing so requires addressing issues related to independence and injury or illness prevention.

Various technological advances have facilitated the prospects of aging in place. These gadgets, products, and innovations increase the likelihood that older adults can remain right where they want to be: in their homes.

Vital but Unobtrusive
The use of technology to help people age in place can be divided into three broad areas: monitoring, assisting with daily living activities, and injury or illness prevention.

Monitoring involves the use of technology to keep caregivers or family members apprised of the older adults’ status. It may be as simple as calling an elder on the telephone to check on the individual. Telephones with adjustable volume control have been available for many years. Speakerphones and lightweight headsets are helpful for individuals who have difficulty holding a phone while talking.

Many videophone products offer the added advantage of being able to see in addition to hearing the older adult. Observing an elder performing a simple task such as sitting down or standing up can provide information about strength and balance. Additionally, if an individual has changed or stopped routine grooming or other self-care habits, it is more apparent via video.

Personal emergency response systems help elders contact family or friends or summon emergency assistance. Benefits to older adults using a personal alarm system include obtaining faster assistance in an emergency, lengthening the time they are able to remain in their homes, enhancing their sense of security, decreasing anxiety about falling, and increasing confidence in performing everyday activities. Family and friends also benefit from relative peace of mind.

More extensive monitoring systems are also available, including the use of floor- (typically carpet) and wall-mounted sensors to detect movement—or a lack of it—as well as video cameras to relay images of elders at home. For instance, sensors may track an individual’s movements throughout the home. If an elder walks to the bathroom but does not return following a predetermined length of time, an alert can be sent to various caregivers. Another example of monitoring involves tracking whether an elder has opened a refrigerator door, with the assumption that the door remaining unopened is associated with the individual failing to eat properly.

Additionally, environmental factors such as home temperature can be monitored. Caregivers can be alerted if the temperature deviates from a predetermined range. The acceptability of home monitoring technology among community-dwelling older adults and baby boomers has been investigated. Reports indicate that various technologies are acceptable if they allow older adults to remain in their own homes and age in place.
However, ethical issues pertaining to privacy must be addressed on an individual basis.

Keeping in Touch
Technological assistance with activities of daily living can take many forms. As with monitoring, simple technology can solve certain problems. For instance, a telephone with an adjustable volume control enhances verbal communication.

Targeting injury prevention and illness among older adults presents another practical use of technology. Telemonitoring is defined as the use of IT to monitor patients at a distance. Much has been written about the advantages of telemedicine, including reduced hospital admissions and decreased length of stay when admissions occur. Specific applications of health-related monitoring via technology include motor and cognitive function, monitoring gait to predict or identify falls, wound care, diabetes, vital signs such as blood pressure, and an in-bed monitoring system to help prevent falls and detect infusion fluid leaks as well as urinary incontinence.

Although it’s not typically categorized as an illness, loneliness is a problem for many older adults living alone. Technology helps elders feel more connected to those outside their homes. Videophones enabling elders to both see and hear family and friends can be a tremendous asset. Computer networks such as the Internet offer many opportunities for elders aging in place to communicate with others. One service specifically designed for people aged 50 and older is called SeniorNet. It offers computer training at more than 200 learning centers across the country. Some of the learning centers offer social activities as well. SeniorNet also hosts a variety of online discussions as well as enrichment topics such as books and culture.

Demris and Hensel authored an article in 2008 for the Yearbook of Medical Informatics covering all three areas of aging-in-place technologies. In it, they explored the concept of a smart home, defined as a residence wired with technological features that monitor the well-being and activities of residents to improve overall quality of life, increase independence, and prevent emergencies.

Housekeeping Aids
Many items are available to ease the stress and strain of performing housework. For elders with limitations in upper extremity use or the ability to use only one hand, trash containers that open automatically are useful. Robotic vacuum cleaners and floor washers can turn chores that are difficult or impossible to perform into a nonissue. And a vacuum dustbin reduces the need to bend over to use a dustpan.

Two chores that older adults may wish to avoid or are unable to manage are lawn care and cleaning up after pets. Robotic lawn mowers, capable of handling up to a 1-acre area, can present a viable option for some individuals. Long-handled scoopers ease the burden of cleaning a litter box.

Leisure Activities
One leisure activity many older adults enjoy is watching television programs and movies. However, in light of reduced hearing and vision as well as arthritic changes in the hands, operating and using a television can be difficult.

Technology is available in the form of a product called TV Ears. It’s one example of a sound amplification system that permits older adults to increase volume without disturbing others. Screen enlargers magnify images, enlarging the effective size of the picture. And voice-activated remote controls offer a solution to elders with upper extremity mobility limitations.

Navigating the Kitchen
Many products exist to streamline older adults’ effectiveness in the kitchen. Hamilton Beach manufactures models of talking microwave ovens. They can be programmed in English or Spanish and are particularly useful for individuals with vision limitations.

Save on Security Systems Inc. offers a device called a stove guard, which uses motion detection technology to turn off a stove when no one is near it for a specific period of time. HearMore.com offers talking kitchen scales using a variety of languages.

The General Electric Company is designing ovens with easier-to-open doors. A collaborative effort between the German company Bosch and Siemens AG introduced a glass cooktop (induction cooktop) to help prevent foods from boiling over.

In addition to stoves, dishwashers are also being improved. General Electric offers a model that allows for an entire bottle of detergent to be added rather than just a small amount for each load.

Universal Design Products Inc. produces a device called a cabinet lift system that lowers upper wall cabinets to counter height. Work surfaces, such as a counter, can be adjusted to optimal height simply by pushing a button. Another device lifts heavy kitchen appliances, such as a mixer or a food processor, by raising a panel from the bottom of the kitchen floor or wall cabinet to the desired working height.

Laundry Made Easy
The Whirlpool Corporation has tested many of its products with older adults who have a variety of limitations and disabilities. Based on that testing, the company offers pedestals that raise the heights of washing machines and clothes dryers to make it easier for elders with decreased mobility or reduced strength to independently do their laundry. Whirlpool also makes machines with larger knobs that make more than the normal amount of noise when turned. The larger size can help elders with arthritic hands, while the increased noise helps individuals with hearing limitations adjust the machine properly.

Additionally, a combination washing/drying machine (one machine does both) eliminates the need to transfer heavy, wet clothes from a washer to a separate dryer. Also, laundry detergent packets offer an alternative to lifting and pouring detergent from heavy containers.

Bathroom Enhancements
Two bathroom fixtures, the toilet and the bathtub, are available in many shapes, sizes, and configurations. Elevated toilets or regular toilets with raised seats have been available for some time. Recently, a new product called a universal toilet became available and is designed for virtually anyone to use. An interesting component is the dual-function backboard and chest board. If an older adult transfers onto the toilet moving forward, the backboard becomes a chest board, offering support. The design also incorporates a sink. It requires approximately one quarter of the space of a standard disabled toilet and conserves water by recycling the used water in the attached sink.

Bathtubs offer a variety of options that lend themselves to aging in place. Walk-in bathtubs come in many makes and models. An existing bathtub can be replaced with a tub that has a cut out (with or without a door), allowing an elder to enter the tub without climbing over the tub wall. While this may be beneficial for some individuals, others do not want to replace an existing bathtub. In such a situation, a tub bench allows elders to sit down and swing their legs over the tub wall. However, it doesn’t easily facilitate entering the tub water.

One solution to this problem is a seat lift device called the Deepest. The seat lift is “smart” in that the controller will not allow the seat to lower its occupant unless there is sufficient remaining charge in the battery to return the lift to its full height. The seat lift uses a scissors mechanism, allowing users to lower themselves into the tub water.

Bedroom Safety and Comfort
For older adults trying to gain restful sleep, a comfortable temperature is important. A variety of sheets, blankets, and other covers can provide warmth. However, their bulk and weight can sometimes impair rolling over and getting in and out of the bed. For warmth, one solution is a mattress pad warmer, which can be purchased with dual controls to accommodate individual preferences.

Sometimes, though, heat is not the problem. There are times when the ambient temperature is too high, interfering with sleep. One solution is to run an air conditioner, but noise and expense may be prohibitive. Like the mattress warmer, a product is available that both heats and cools a bed. A ChiliPad regulates temperature between 65˚F and 100˚F.

Tracking Medication Use
Of course, taking medications is not limited to any particular part of the home. But older adults must remember to take their medications for them to be beneficial. Some elders have difficulty remembering repetitive tasks, and with medications, they can forget to take a pill or they may forget they’ve already taken a dose and then take another.
Medication reminder systems are available to help avoid such problems. These systems fall into the following categories:

• With passive organizers, pills are placed in some sort of container, usually labeled by day, and may also be sorted by time of day (e.g., morning, noon, night).

• Active organizers are similar to passive organizers, as they include a reminder mechanism, such as a ringing bell or buzzer, when it’s time to take a dose. The reminder mechanism may be part of the organizer or it may be a device such as a watch that vibrates at a time medication is to be taken.

• Commercial medication reminder services place a telephone call to a home and/or mobile phone or send e-mail messages.

• Software for personal data assistants reminds older adults to take medications.

Final Thoughts
Although we’ve identified some of the useful technologies for aging in place, this is by no means an exhaustive treatment of various issues and problems. However, it presents numerous sources of information that can benefit older adults and their caregivers. The coming years are likely to witness a huge increase in the types of technological advances designed to facilitate a generation of baby boomers determined to age in place.

— Michael Moran, PT, DPT, ScD, is a tenured professor of physical therapy at Misericordia University in Dallas, PA, who focuses on specialized efforts to help elders remain in their homes.

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