What components are important for diagnosis-technology combinations as needs for elderly in context of Smart Assisted Living?

What components are important for diagnosis-technology

combinations as needs for elderly in context of

Smart Assisted Living?

SUBMITTED IN PARTIAL FULLFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE

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IA

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TERKENBURG

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NFORMATION

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TUDIES

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ENTERED

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ULTIMEDIA

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ACULTY OF

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CIENCE

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NIVERSITY OF

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MSTERDAM

August 28, 2015

1st _{Supervisor 2}nd _Supervisor

Dr. Frank Nack Dr. Catholijn Jonker

What components are important for diagnosis-technology

combinations as needs for elderly in context of

Smart Assisted Living?

Lia Sterkenburg

University of Amsterdam

Lia.sterkenburg@gmail.com

ABSTRACT

This paper presents research on requirements for Smart Assisted Living (SAL), so that elderly with a specific diagnosis can be supported in their aim to live longer in their own home. Based on a thorough investigation of the field and interviews with people from different target groups, we developed a list of requirements for the development of module-based technologies to serve the needs based on the specific diagnosis, phase of the disease and social demographic situation of the elderly. We are aware that the limited qualitative data does not allow a generalization of our findings but the modular components have the potential to form the basis for future overall SAL solutions, especially when more input is available from the target groups for diagnosed elderly.

1. INTRODUCTION

According to the United Nations department of Economic and Social affairs the world’s population is ageing. Both the percentage of elderly (in relation to this research defined as people of 55 years and older) as part of the total population and the average age has and will be increasing (1950 – 2050) [1]. The increasing population of elderly requests a growing demand on the need for care, and demands changes for the future health care system, states Dall et al [2]. Peek et al [3] add to this that the majority of elderly prefer to live independently for as long as they possibly can, even when their health is declining. Policy makers also favor ageing in place, to enhance the quality of life of elderly and to reduce the workload of caregivers [4].

One of the promising solutions to promote and prolong the abilities of people living independently at home in their old age is Smart Assisted Living (SAL) [3]. This solution comes from the domain of gerontechnology [5], which matches technological interventions, like sensors, to domains of human activity, like health and Activities of Daily Living (ADL’s) [6, 7].

The goal of this research is to combine SAL solutions for the elderly with a specific diagnosis, so that their need for better quality of life through prolonged living at home can be supported. To reach this goal we look at the problem from 3 different points of view: what is the disease space we are confronted with, what is the influence of the demographics on the impact of diseases within the disease space, and how are Diagnosis-Technology combinations related to

current SAL solutions in the context of daily routines of patients with diagnosed diseases.

In this report main concepts and outline of already established SAL solutions will first be defined. To gain a better understanding of the needs elderly with diagnosis for certain diseases have in relation to their daily activities we did extensive research, involving a literature study, interviews with elderly, caregivers and other target groups, and a SAL solutions review to come to concluding diagnosis specific requirements for SAL solutions based on user needs. We conclude the report with an outline of future work.

This research was done in collaboration with Almende B.V. [8], who is involved in the Salig++ project [9] that has the objective to develop ICT-based solutions to enable and sustain elderly to continue managing their daily activities in their home. The project is currently in the phase of collecting user requirements for future overall SAL solutions with combined functionalities instead of offering small SAL solutions with limited purposes.

2. RELATED WORK

Künemund and Tanschus [5] refer to Smart Assisted Living as the design and use of technologies that promotes aging in place, defined as "the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level" (Centers for Disease Control and Prevention, 2009, p. 1).

This rather broad definition and the review in this area determined a large facet of aspects (Appendix I), that contribute to SAL , namely:

1. Context awareness [10];

2. Ubiquitous computing and wearables [11, 13, 18]; 3. Embedded sensors [12, 14, 17, 21];

4. Embedded infrared sensors [15, 16, 17, 19]; 5. Fully automated biomedical devices [19]; 6. Electrical appliances fitted with sensors [20]; 7. Cameras and microphones [21];

8. RFID systems [21].

Reflecting on this review and current aspects of SAL solutions also showed current problems worth taking into account for the research question.

First, the shortage of research on user needs leads to a technology-push, causing user disappointment. Involving (more) users will lead to a demand-pull approach where users share their needs, which will give better demands for products and services. [22,23].

Second, the literature review proves a shortage on diagnosis-based research on chronic diseases. Also, the studies performed on chronic diseases are mostly done without control groups [24].

A third limitation appears to be the users lack of technological knowledge, concerning all parties involved. This includes getting the users consent, especially from (future) mentally incompetent users.

The forth problem seems that most current SAL systems only cover partial solutions. This points out the absence of overall systems including general decay of the user and development of the diagnosed disease.

3. RESEARCH QUESTION

Based on the literature review and the foregoing motivation on related work, we came to the following research question: What components are important for diagnosis-technology combinations as needs for elderly in context of Smart Assisted Living? From this question we derived three subtopics:

• Which diseases are part of the disease space? • What is the demographic impact of the diseases

within the disease space?

• What are Diagnosis-technology combinations?

4. APPROACH

The overall approach applied to address the research question is a user-centered, qualitative investigation in form of a case study. Thus, the final recommendations will be based on a detailed investigation of the idiosyncratic needs of the various stakeholders already identified in established work and limitations: diagnosed elderly, their partners, and caregivers. As the

Figure 1. ADL - Disease space mapping

field is broad, finding out what needs elderly with a specific diagnosis have is the main focus. The disease space in general is rather large, so determining a set of most relevant diseases is the first step. In view of this space we then outline demographic and social aspects that influence the decision-making on identifying the target groups for our case evaluations and provide insights into the type of technologies that need to be considered for the case study.

In this section we define the attributes of the different facets of the 3 main research question topics. In the remaining sections we provide the description of the case study findings, their evaluations and the final recommendation list that answers the research question.

4.1 Subtopics

4.1.1

For contextualizing the disease space both basic and instrumental Activities of Daily Living (ADL’s) of elderly [8, 9] to the impairments they experience in an early stage of a disease were taking into account. With the knowledge and input from the literature review we made a mapping (Figure 1).

The highest scoring medical conditions after mapping ADL’s to impairments led to the following top four:

• Neurological conditions (i.e. Parkinson’s disease); • Cognitive conditions (i.e. Alzheimer);

• Heart diseases (i.e. heart attack, seizure); • Depression and stress related conditions.

These four medical conditions are defined as the focus of the disease space within the range of this research.

4.1.2

Worldwide there has always been a difference between the number of ageing men and women. Over the years the gender gap between men and women is narrowing, especially in the West (25), women still get older compared to men. Research has showed that women suffer higher rates of chronic diseases and men face more life-threatening conditions at younger ages [26]. This results in a sex ratio of 2:1 [1], meaning that for every man involved there would need to be two women involved in the case study. Studies have also shown that Alzheimer occurs more often with women and Parkinson occurs more with men [27, 28].

Other studies show results that chronic stress and related conditions could cause heart diseases, which can trigger brain conditions from both neurological and cognitive origin [29].

The problems that elderly develop in decision-making can have disastrous consequences for their well-being and can cause health issues [30]. Therefor it is important take the disease space, as well as knowledge and problems from current SAL solutions into account when designing an overall, user-centered system for all future users.

Recent work has also reported that age, health status, racial/ethnic status, education, and gender are generally associated with patient satisfaction with health care [31]. As the goal of our research is to improve quality of life for the elderly with a specific diagnosis through prolonged living at home by offering them an SAL solutions based on their needs, we should not only investigate needs, but also current demographic and social aspect, like:

• Age en gender;

• Are they diagnosed (disease space)? • Do they live independently?

• Do they live alone (have partner or not)? • Do they have children?

• How often do they get visitors? • How often do caregivers visit them? • What is their affinity with technology?

For the case study it is important that a variety of people with different social, educational, and idiosyncratic are involved, where the questions need to be balanced between general aspects so that the overall technology requirements can be distilled out of the answers but at the same time they need to cover individual aspects (e.g. the questions about related to the diagnosed disease might differ in detail) so that aspects of “modularization” can be investigated.

4.1.3

The term Diagnosis-Technology combinations is based on the idea that SAL solutions serve a certain purpose and (a combination of) SAL solution(s) is suitable for people with a diagnosis. This is why,

parallel to the interviews a mapping (Appendix II) between current SAL technology and a disease space was made. This is what is referred to as diagnosis-technology combinations in the research question. The results from this mapping should form the basis for the component based SAL solutions for elderly with specific needs.

4.2 Target groups

The foregoing analysis on involvement of people for this case study and ideas from the stakeholders Almende B.V. [8] and the SALIG++ project [9], led to the following target groups:

1. Control group without diagnosis, aged 45-55; 2. Control group without diagnosis, elderly; 3. Diagnosed elderly with partner;

4. Partners of elderly with diagnosis; 5. Diagnosed elderly without partner; 6. Informal caregivers (‘mantelzorgers’); 7. Formal caregivers (‘thuiszorg’).

5. CASE STUDY

Now the target groups are known and it is clear who should be involved in this research the next step is to define how to involve these people. The goal of the case study is to gain insight in the specific needs elderly with diagnosis for certain diseases have in the context of daily routines. This chapter focuses the setup and procedure based on the method and the participants involved to achieve this insight.

5.1 Setup and procedure

The overall approach is to conduct individual semi-structured interviews with people from the target groups described in chapter 4 (further explained in Appendix IV). These target groups are also based on the problems and limitations from the related work section. The interviews will result in qualitative data on the personal needs people with and without diagnosis have.

The number of people required for a qualitative research project using the user-centered approach can vary. Results from the work of Baker and Edwards [32] advise to “aim in the broad range of between a dozen and 60, with 30 being the mean”.

Participants were recruited from companies within Almende’s business network, being homecare organizations, local initiatives to prevent loneliness and community centers. To reflect on society as realistic as possible from the findings in chapter 4 on demographic and social impact the aim is to interview women and men according to the 2:1 ratio, find proportionally more female participants with cognitive conditions and more male participants with neurologic conditions.

The setup for conducting the interviews is based on a custom made list of 34, mostly open-ended questions (Appendix III). Every participant will be asked to

answer these questions from their personal view, related to the target group they are in. The interview questions focus on:

• Demographic and social information; • ADL’s, limitations and future perspective; • Diagnosis, impairments and future perspective; • Hobby’s and future perspective;

• Personal needs and future perspective; • Technical solutions, SAL, do’s and don’ts; • Chronic disease amongst relatives and friends. All participants were asked the same questions in the same order. The color-coded interviews, containing rich, qualitative data resulting from the interviews can therefor be compared for analysis of findings.

The main focus is on the specific needs of elderly with specific diagnosis within the defined disease space. The personal needs from people directly around them, being partners or caregivers, are also important. The needs of people from the control groups will give insight in difference in technological knowledge and needs caused by ageing in general.

To conduct the interviews individual appointments are made in the private homes of the participants. Before the interview starts context will be given and the goal of the research will be explained. The interviews will be recorded for transcription and reference using an iPhone, only when the participant gives approval. All interviews are conducted and transcripted in Dutch. After all questions are asked the participants are thanked for their time and information. Also, they will all receive an outline (in Dutch) of the results from this research after they are presented. Participants from target groups 2 & 3 can be present during the interview of their partners, but are be asked not to interfere.

5.2 Participants

It was hard to get access to the target groups for people with diagnosis and their partners for the interviews. Because of the limited timeframe it was not possible to establish a relation with elderly, relatives and organizations. Several attempts of contacting different organizations resulted in knowing that vulnerable people are protected by their relatives and care giving organizations for good reason, which is understandable and is mostly concerning their dignity and privacy. To be able to conduct at least some interviews, even though resulting in a small sample, people from our own network were contacted.

Within the given timeframe 17 participants were found. All participants (12 females and 5 males) were all Dutch and aged between 46 and 81. All of them were individually interviewed using the described semi-structured interviewing method [33, 34]. Table 1 gives an overview of the personal information of the participants. Additionally, appendix V provides a list of all interviewees.

Table 1 Personal information participants. Participant Age Gender Target

group

Diagnosis

Jan van der Horst 58 Male 2 - Jantien Slob 49 Female 1 Scoliosis Stella Noordzij 50 Female 5 Heart disease Marie-Louise

Nales

57 Female 7 -

Wim Nales 51 Male 1 -

Thea Weltevrede 53 Female 7 - Brigit Westbroek 56 Female 7 - Piet Nales 81 Male 3 Alzheimer’s

disease Jannie Nales 76 Female 4 - Delian Noordzij 46 Female 1 Osteoarthritis Jan Geert van

Hall

51 Male 6 Meniere, poly neuropathy Ron Braber 50 Male 3 Parkinson’s disease Corrie Braber 53 Female 4 - Lenny Rouss 55 Female 6 - Marian

Emmerich

64 Female 4 -

Ria Doornbusch 47 Female 6 Fibromyalgia Ina Schram 78 Female 5 Depression

Table 2 shows an overview of how these 17 participants are distributed over the different target groups, their gender and all diagnosis resulting from the interviews. Appendix VII contains the full transcripts of the interviews.

Table 2 Participants per target group. Target

group people No. of Male Female Diagnosis

1 3 1 2 Scoliosis, Osteoarthritis 2 1 1 - - 3 2 2 - Alzheimer, Parkinson 4 3 - 3 - 5 2 - 2 Heart disease, Depression 6 3 1 2 Fibromyalgia, Meniere, polyneuropathy 7 3 - 3 -

Out of all 17 participants, 8 indicated they are formally diagnosed with a chronic disease. Of these, 4 had a diagnosis for one of the diseases within the range of the disease space as defined for this research. From all participants, 9 expressed their affinity with technology in general as average, 5 estimated their affinity with technology as high and 3 of the participants said they have no or low affinity with technology. Of all 17 participants, 10 expressed confidence in SAL solutions in relation to their personal future. Table 3 gives an overview of how these 10 participants are divided over the target groups and the additional remarks they had.

Table 3 Confidence in SAL for personal future. Target group No. of people Remarks

1 3 Privacy, mental ability, use when needed, need for control, prefer human contact. 2 1 Prefer human contact. 3 1 In for everything that helps to prevent the

need to move to a healthcare facility. 4 2 We are in this together, so let us use the

solutions available to help us. 5 1 Privacy concerns, human help is preferred.

6 0 -

7 1 As long as I can and am able to control it. The 7 participants reluctant to have SAL solutions in their home include the oldest 3 participants, aged above 65. They are spread over target groups 3, 4 and 5. They stated they are unwilling to use technology in general and do not want to change their daily routine. Of the remaining 4 participants reluctant to use SAL solutions 1 is a formal caregiver (target group 6) and 3 are informal caregivers (target group 7). These 4 participants stated the false sense of security, loss of sense of dignity as human, change of daily routine, the need for useful alternatives and their personal unwillingness as arguments why they do not want to use SAL solutions in their home.

6. ANALYSIS AND EVALUATION

6.1 Results - Interview findings

Because of the small amount of participants, especially in the target groups for diagnosed people and their partners, it is not possible to state findings from the interviews as strong qualitative evidence. However, there is a trend visible from the findings gathered from the interview. The findings will be given accordingly to the order the questions were asked

Several participants stated difficulties with different types of physical daily activities, like cleaning the house and basic maintenance. This became clear from the set of questions on their Activities of Daily Living, current impairments and future perspective. These Activities of Daily living are influenced directly and the most. To visualize how particular activities are related to roles/activities table 4 shows the influenced Activities of Daily Living the interviewees mentioned in the order of the groups sorted by importance. The main focus for this research is on the elderly with diagnosis within the range of the disease space, therefor mentioned in table 4 as group 1. The interviewees in this group get their column, to express the impairments they experience caused by their diagnosis. Next are the interviewed partners and caregivers (target groups 6 and 7), who are mentioned in table 4 as group 2 and 3. The influenced ADL’s marked in red take place outside the house and are therefor outside the scope of this research.

ADL

Group 1 Group 2 Group 3 Ron (Parkinson) Piet (Alzheimer) Stella (Heart disease) Ina (Depression) Preparing meals X Feeding X

Personal care / hygiene X Toileting

Bathing

Shopping X X X

Putting on clothes X Maintaining continence

Selecting proper clothes

Low energy / concentration loss X X X X Managing medications X

Managing finances X

Housework / maintenance X X X X X X

Transport (car / public) X X X X X

Using phone / comm. Devices X X X Walking /in home transfers X X X

Feeling of being safe (self) X

Feeling of being safe (by others) X X

Combining the results in table 4 and the Diagnosis-Technology combinations in Appendix II led to an overview of overview of combinations of SAL solutions suitable to fit the current specific needs of the diagnosed interviewees as stated in group 1 of table 4. Figure 2 shows this overview of SAL components per diagnosis as part of the disease space. A full overview of Diagnosis-Technology Combinations (DTC’s) is given in appendix VIII.

Secondly and also made clear by the visualization in figure 2, functional mobility inside the house and transportation by car or public transport i.e. to go shopping and visit others also becomes (partially) hard to everybody in group 1. Interviewees Ron (1), Corrie, and Marian (2), Jan Geert and Ria (3) speak of their social live and sense of freedom being limited by this. The interviewees in group 2 and 3 do not experience problems related to in-home mobility. Physical limitations also score high when it comes to the sense of independence. Mental impairments like concentration problems and low energy was mentioned by all 4 participants in groups 1 and therefor is another influence.

All 17 participants understood the concept of Smart Assisted Living and its possibilities, although some needed explanation of the concept in general. This was revealed by their answers on interview question 26 “Do you know what Smart Assisted Living is?” The 14 participants aged below 65 were not reluctant in the way of having SAL solutions in their homes to help them with their Activities of Daily Living and extend their ability to live in their trusted home and environment. The overall view on collected SAL

Cognitive conditions

Ubiquitous computing, Wearable devices, portables, for: Using phone / communication devices

Low energy / concentration problems Feeling of being safe (by others)

Walking / in home transfers

Stationary devices like sensors, actuators, for: Feeling of being safe (by others)

Walking / in home transfers Housework / maintenance

Intelligent systems for context awareness & decision support, for:

Feeling of being safe (by others)

Figure 2. SAL components per diagnosis as part of the disease space.

solutions from the interviews resulted in more questions concerning privacy, control over an overall system and the preference of face-to-face contacts for care and social relations on the other hand. During their interviews, formal caregivers Marie-Louise, Thea and Brigit expressed their wish to receive education to be able to work with overall SAL systems. Also informal caregiver Lenny and partner of a diagnosed elderly Marian expressed the need for education to prepare the elderly of the future on the possibilities to make use of Smart Assisted Living and to increase to acceptance of SAL solutions as change in their daily routine and home environment when future elderly need it.

Two of the interview questions on Technical solutions go into where the interviewees would draw the line concerning technical solutions being part of their house and household and what would absolutely not allow in their houses in relation to technique and technical solutions. If they didn’t know about the possibilities the interviewer stated the example of having camera’s around the house. The results on these questions from the interviews stated clear that camera’s are seen as intrusive and are only welcomed in homes as last solution avoiding moving into care facilities. Privacy concerns such as data storage, independency, dignity and mental competency were mentioned as important barrier to make use of SAL solutions by 10 of all 17 participants, being Jan, Jantien, Stella, Brigit, Delian, Jan Geert, Ron, Corrie, Ria and Ina. Also, interviewees would like to be able to remain in control of a system at all times, including being able to switch of functionalities. Interviewees Wim, Jan Geert, Corrie, Marian and Ina, mentioned this.

Neurologic conditions

Ubiquitous computing, Wearable devices, portables, for: Using phone / communication devices

Low energy / concentration problems Walking / in home transfers

Mobile devices like sensors, actuators, for: Housework / maintenance

Preparing meals and feeding Personal care / hygiene

Stationary devices like sensors, actuators, for: Low energy / concentration problems

Walking / in home transfers Housework / maintenance

Intelligent systems for context awareness & decision support, for:

Low energy / concentration problems Walking / in home transfers

Heart diseases

Ubiquitous computing, Wearable devices, portables, for: Low energy / concentration problems

Walking / in home transfers

Implantable devices, for: Walking / in home transfers

Stationary devices like sensors, actuators, for: Walking / in home transfers

Housework / maintenance

Intelligent systems for context awareness & decision support, for

Low energy / concentration problems Walking / in home transfers

Jan Geert and Ina as well as Delian and Stella expressed the importance to focus on diagnosis specific needs from experience, not from knowledge. They stated they have no doubt technology can already achieve a lot, but they are worried about the human contact. It is not the technology-push that makes SAL solutions a success. They are certain continues inventory of personal needs will create a demand for good overall SAL solutions customized for the user according to their needs.

6.2 Limitations

The strongest limitation influencing this research is caused by not being able to involve more diagnosed elderly, because of strong limitations caused by protection by their relatives and care giving organizations for good reason. This led to a rather small sample of participants, especially within the target groups with diagnosed elderly within the range of the disease space. Also, the amount of participating men compared to the amount of women involved did not meet the 2:1 ratio.

Because of the small population involved in the case study and the limited timeframe there is not enough qualitative evidence to draw conclusions. However, the findings lead to an answer on the research question and interesting possibilities to base future work on.

6.3 Recommendations

Following from the findings and limitations there are some recommendations to state for future research on this topic for care providing organizations like doctors, specialists, hospitals and health care assurance providers. Everybody involved in the future of health care solutions for elderly should understand the importance of the changes coming. The health care assurance providers have to ensure that technologies

Stress related conditions

Ubiquitous computing, Wearable devices, portables, for: Using phone / communication devices

Low energy / concentration problems Feeling of being safe (by others) & (self)

Walking / in home transfers

Stationary devices like sensors, actuators, for: Feeling of being safe (by others) & (self)

Low energy / concentration problems Housework / maintenance

Intelligent systems for context awareness & decision support, for:

Low energy / concentration problems Walking / in home transfers

can be combined and data is safely used and stored. The success of SAL and overall user needs based systems depends on their participation to influence the changing health care market, increase acceptance and use of possible solutions like Smart Assisted Living solutions. The recommendations are ordered by priority.

From the findings it is clear that education of future elderly and caregivers is key and therefor the most important recommendation to affect the acceptance and use of SAL solutions as part of their home situation.

A main result and also limitation for this case study results in the recommendation to built longer-term relations with elderly and care organizations. This is essential for future involvement of (future) users in this type of research for SAL solutions based on user needs of elderly with specific diagnosis. Establishing and maintaining relations with elderly in general, but diagnosed elderly specific will lead to valuable knowledge and input that will make these solutions to a real success. This includes the involvement of more users to gain more insight in personal needs coming from diseases, the possible relation with how this influences the Activities of Daily Living and better design of possible modular SAL solutions to help the users to remain in their home environments.

Another recommendation concerns the development of diseases over time. Longer-term research on this could lead to algorithms checking activities and learning from the progress of decay to keep up with the users personal needs.

Also, combinations of diseases and impairments should be taken into account for future research in this area since this research only focused on one disease related to single impairments instead of combinations of the different factors influencing the ADL’s of diagnosed elderly.

7. CONCLUSION

An ageing population, progressive technological maturity and rising health costs will have implications for the future health care system. An user-centered designed overall Smart Assisted Living solution for elderly could be the answer to this. Answering the research question “What components are important for diagnosis-technology combinations as needs for elderly in context of Smart Assisted Living?” leads to the following conclusion: Good design by continues involvement of more users can result in modular components fitting the users personal situation concerning diagnosis and needs, progress of the specific disease and their role as user, supported by technology. Before going into the modular components first some general conclusions can be drawn to focus on:

• Privacy and confidentiality are most important and cameras are seen as intrusive. Concluding from these findings, ethical and legal issues of Smart Assisted Living, including consent of all users, need to be in place to improve acceptance and use and resolve barriers of use caused by privacy issues.

• Concluding from the finding that physical daily activities are influenced the most, with cleaning and basic maintenance as first impossibilities it is fair to say that the help from humans will also be needed to be able to remain living in a private home. SAL solutions therefor need to be seen as complementary care and not replacing care by formal and informal caregivers.

• From the finding on functional mobility and transportation by car or public transport becoming hard the fair of social isolation arises. This asks for good, fitting solutions to be able to communicate and with this use of communication devices stay in contact with the social network and the world.

• Mental impairments like concentration problems, blackouts and low energy are already stated as current impairments by caused by participants of the case study. From this the conclusion that SAL solutions to help with basic needs and keeping track of activities are already needed can be drawn.

Having stated the conditions that set the boundaries for the success of future overall SAL solutions components per diagnosis as part of the disease space the conclusion can be drawn. Figure 2 already made clear that disease specific SAL solutions can be defined, even based on the small population for the case study.

From the diagnosis-technology combinations made for the disease space as part of this research the conclusion can be drawn that diagnose specific modules of solutions for specific diseases can be designed and offered to users to suit their specific needs. Further research needs to be done on the specific use of the SAL technology to suit the specific user needs best.

8. FUTURE WORK

The future work issues are ranked accordingly to what needs to be done first to what could be done later.

For the success of SAL solutions more data and research is needed on personal needs of people with specific diagnosis, as well as on their partners. Future systems could learn from more research and input data and possibly even be able to adapt to the users changing needs in relation to their specific diagnosis.

To make Smart Assisted Living successful in the future education of care giving organizations and doctors is important. They are the right persons to make people aware of their personal future in term of diseases, ageing in place and technical SAL solutions, starting with the education of people who have diseases amongst relatives. The time and effort spent on creating awareness and learning how to use SAL solutions will lead to more acceptance and use.

This research focused on 1 diagnosis per user. For future research, it is interesting to focus on the question whether combinations of impairments and/or medical conditions have more impact on the activities of daily living of elderly with combined diagnosis and their use of SAL solutions.

From the diagnosis-technology combinations stated it became clear that more research needs to be done on the specific use of the SAL technology to suit the specific user needs best. A lot of technologies can be used for different purposes. Optimizing this could be part of future work. This future work on offering solutions as modules also needs to focus on combinations of diseases and impairments as well as progress of diseases and decay.

9. ACKNOWLEDGEMENTS

The author would like to thank the supervisors, Catholijn Jonker for investing her time to be second reader and be present during the presentation of the results and Frank Nack for coaching and providing valuable feedback. Additionally, the author also would like to thank Andries Stam en Jan Geert van Hall of Almende B.V., all 17 interviewees who invited me in their homes, the anonymous transcriptor of the interviews and two anonymous reviewers for their feedback on this research.

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