SMART HOME DATA VISUALIZATION FOR PROACTIVE HEALTH MONITORING OF COMMUNITY DWELLING OLDER ADULTS

Abstract The role of Ambient Assistive Living and smart home technologies, which utilize unobtrusive sensors to detect changes in health, is becoming increasingly important in the delivery of healthcare services to older adults. However, these technologies must be designed to meaningfully incorporate into clinicians’ decision making. Research has shown when clinicians are engaged in the design process of smart home systems, the accuracy and efficacy of the systems are improved. We present the process undertaken by a team of nurse researchers and computer science engineers to design clinically meaningful behavior markers derived from smart home sensor data that can be used by nurses to proactively identify changes in patient status. During the first phase of design, nurse researchers qualitatively analyzed time series from smart home sensors installed in the homes of community dwelling older adults and identified patterns in these data related to significant health changes. From this analysis, we assembled a candidate list of 15 sensor-based behavior metrics, such as percent time spent in each room or frequency of bathroom use. During the second phase of design, we will build on lessons we learned from participatory design to create behavior markers and visualizations that are inspired by clinical experience. These include visualizing behavior change over time, highlighting behavioral anomalies at multiple time scales, and calculating markers that are not directly observable such as time spent out of home. Lessons learned from clinicians using the data visualizations to proactively screen for health changes in near real time will also be discussed.

adults, a new web-based cognitive training platform that simulates real-life multitasking demands.Research Design and Methods: A community-based sample of 24 cognitively healthy participants aged between 60 and 75 (M = 69.12,SD = 3.83) underwent an online 5-session training protocol.Each session lasted 40 minutes and occurred twice a week at participant's homes.Game performance was recorded, and participants completed questionnaires at baseline and after the intervention.
Results: Feasibility metrics showed overall high recruitment (82.7%), adherence and retention rates (100%).Acceptability was considered good based on participant`s quantitative and qualitative responses.On average, participants rated the game as interesting, enjoyable and did not report difficulties in accessing the game online or in understanding the instructions.Moreover, participants showed a learning curve across sessions, improvement in most game outcomes and benefits from the emphasis change approach.Discussion and Implications: The findings provide preliminary support for the feasibility and acceptability of the Breakfast Task training platform with community-dwelling older adults and demonstrate potential cognitive benefits.Results suggest the value of further research investigating the Breakfast Task features and dose-response relationship, as well as its efficacy in older adults via larger randomized controlled trials.The role of Ambient Assistive Living and smart home technologies, which utilize unobtrusive sensors to detect changes in health, is becoming increasingly important in the delivery of healthcare services to older adults.However, these technologies must be designed to meaningfully incorporate into clinicians' decision making.Research has shown when clinicians are engaged in the design process of smart home systems, the accuracy and efficacy of the systems are improved.We present the process undertaken by a team of nurse researchers and computer science engineers to design clinically meaningful behavior markers derived from smart home sensor data that can be used by nurses to proactively identify changes in patient status.During the first phase of design, nurse researchers qualitatively analyzed time series from smart home sensors installed in the homes of community dwelling older adults and identified patterns in these data related to significant health changes.From this analysis, we assembled a candidate list of 15 sensor-based behavior metrics, such as percent time spent in each room or frequency of bathroom use.During the second phase of design, we will build on lessons we learned from participatory design to create behavior markers and visualizations that are inspired by clinical experience.These include visualizing behavior change over time, highlighting behavioral anomalies at multiple time scales, and calculating markers that are not directly observable such as time spent out of home.

SMART HOME DATA VISUALIZATION FOR PROACTIVE HEALTH MONITORING OF COMMUNITY DWELLING OLDER ADULTS
R PROACTIVE HEALTH MONITORING OF COMMUNITY DWELLING OLDER ADULTS

Lessons learned from clinicians using the data visual Lessons learned from clinicians using the data visualizations to proactively screen for health changes in near real time will also be discussed.
zations to proactively screen for health changes in near real time will also be discussed.


FINDINGS FROM HIGH USERS OF VIDEO TELEHEALTH TO DELIVER OCCUPATIONAL THERAPY SERVICES DURING COVID-19

Megan Gately 1 , Dylan Waller 2 , Emily Metcalf 1 , and Lauren Moo 1 , 1. VA Bedford Health Care System,Bedford,Massachusetts,United States,2. VA Portland Health Care

FINDINGS FROM HIGH USERS OF VIDEO TELEHEALTH TO DELIVER OCCUPATIONAL THERAPY SERVICES DURING COVID-19
Megan Gately 1 , Dylan Waller 2 , Emily Metcalf 1 , and Lauren Moo 1 , 1. VA Bedford Health Care System,Bedford,Massachusetts,United States,2. VA Portland Health Care System,Portland,Oregon,United States Occupational therapy (OT) helps older adults improve their ability to perform day-to-day tasks.Veterans Health Administration (VHA) is the single largest employer of occupational therapy (OT) practitioners in the United States and a forerunner in telehealth.As a result of COVID, OT video visits increased by nearly 2000% from 2019 to 2020.To ascertain barriers and facilitators to this shift in care delivery, we conducted interviews between January and April 2021 with OT practitioners (N=27) who were high users of VA Video Connect (VVC), VHA's videoconferencing software.OT participants were from rural and urban settings, and had completed an average of 536 VVC appointments each in 2020.Participants used VVC to deliver a variety of OT services, including mental health groups and home safety interventions.Facilitators to VVC included, a) Patient characteristics, such as positive perceptions of VVC and technological skill, b) OT clinician characteristics, like flexibility, level of experience, and desire to increase patient access to care, and, c) VHA's telehealth infrastructure.Barriers included, a) Patients' lack of familiarity or skills with technology, particularly older patients, b) challenges translating traditionally hands-on care to video, and c) unreliable internet connectivity, particularly for rural patients.This study broadens our understanding of video telehealth service delivery for care which has historically been delivered in brick-and-mortar settings.Understanding challenges and enablers to video telehealth highlights opportunities to increase access to those who face barriers, such as older, rural patients.Denver,Colorado,United States,3. VA Eastern Colorado Geriatric Research Education and Clinical Center,Denver,Colorado,United States,4. Department of Veterans Affairs,Madison,Wisconsin,United States The Veterans Administration (VA) established pathways to provide VA-issued tablets and increased access to internet for Veterans without these resources.Veterans aged above 65, experience barriers with telemedicine such as access and usability.We sought to improve the usability and experience of telemedicine for rural, older Veterans receiving a VA-issued tablet by modifying materials and qualitatively evaluating their experience with set-up and preparing for their first appointment, guided by user-centered design.We conducted a rapid exploratory evaluation, to understand Veteran and care partner experiences setting up VA-issued tablets and logging into their first appointment using standard 9-page instructions.We interviewed telehealth technicians, and providers to better understand patient barriers from their perspective.Using insights from interviews and evidence-informed guidelines on educational materials for older adults, we created a two-page guidance.A group of Veterans and care partners reviewed the materials and provided feedback.Received feedback provided 17 suggestions, 8 of which were utilized, including enlarging graphics, clarifying abbreviations (or wording), consolidating the instructions further and emphasizing pertinent information further.Modified materials reduced standard written instructions from nine pages to two.Feedback suggests that updated materials are helpful, aesthetically pleasing and preferred over current materials.Utilizing user-centered design methods, addressed barriers experienced by older, rural Veterans with initial telemedicine device and appointment set-up.Veterans, care partners, providers, and telehealth technicians perceived materials adapted for older adults as supportive of video device usability, helping to alleviate barriers that prevent Veterans from initiating telemedicine.Background: With the increased implementation of interactive technologies for assessment and rehabilitation, it would be optimal to exhibit the reliability of physical assessment measures via tele-assessment.Aim: To determine the test-retest and intra-rater reliability of physical function outcome measures routinely used in the balance and gait rehabilitation using real-time online tele-assessment.
System,Portland,Oregon,United States Occupational therapy (OT) helps older adults improve their ability to perform day-to-day tasks.Veterans Health Administration (VHA) is the single largest employer of occupational therapy (OT) practitioners in the United States and a forerunner in telehealth.As a result of COVID, OT video visits increased by nearly 2000% from 2019 to 2020.To ascertain barriers and facilitators to this shift in care delivery, we conducted interviews between January and April 2021 with OT practitioners (N=27) who were high users of VA Video Connect (VVC), VHA's videoconferencing software.OT participants were from rural and urban settings, and had completed an average of 536 VVC appointments each in 2020.Participants used VVC to deliver a variety of OT services, including mental health groups and home safety interventions.Facilitators to VVC included, a) Patient characteristics, such as positive perceptions of VVC and technological skill, b) OT clinician characteristics, like flexibility, level of experience, and desire to increase patient access to care, and, c) VHA's telehealth infrastructure.Barriers included, a) Patients' lack of familiarity or skills with technology, particularly older patients, b) challenges translating traditionally hands-on care to video, and c) unreliable internet connectivity, particularly for rural patients.This study broadens our understanding of video telehealth service delivery for care which has historically been delivered in brick-and-mortar settings.Understanding challenges and enablers to video telehealth highlights opportunities to increase access to those who face barriers, such as older, rural patients.Denver,Colorado,United States,3. VA Eastern Colorado Geriatric Research Education and Clinical Center,Denver,Colorado,United States,4. Department of Veterans Affairs,Madison,Wisconsin,United States The Veterans Administration (VA) established pathways to provide VA-issued tablets and increased access to internet for Veterans without these resources.Veterans aged above 65, experience barriers with telemedicine such as access and usability.We sought to improve the usability and experience of telemedicine for rural, older Veterans receiving a VA-issued tablet by modifying materials and qualitatively evaluating their experience with set-up and preparing for their first appointment, guided by user-centered design.We conducted a rapid exploratory evaluation, to understand Veteran and care partner experiences setting up VA-issued tablets and logging into their first appointment using standard 9-page instructions.We interviewed telehealth technicians, a

-informed guidelines on educational materials for older adults, we created a two-page guidance.A group
of Veterans and care partners reviewed the materials and provided feedback.Received feedback provided 17 suggestions, 8 of which were utilized, including enlarging graphics, clarifying abbreviations (or wording), consolidating the instructions further and emphasizing pertinent information further.Modified materials reduced standard written instructions from nine pages to two.Feedback suggests that updated materials are helpful, aesthetically pleasing and preferred over current materials.Utilizing user-centered design methods, addressed barriers experienced by older, rural Veterans with initial telemedicine device and appointment set-up.Veterans, care partners, providers, and telehealth technicians perceived materials adapted for older adults as supportive of video device usability, helping to alleviate barriers that prevent Veterans from initiating telemedicine.Background: With the increased implementation of interactive technologies for assessment and rehabilitation, it would be optimal to exhibit the reliability of physical assessment measures via tele-assessment.Aim: To determine the test-retest and intra-rater reliability of physical function outcome measures routinely used in the balance and gait rehabilitation using real-time online tele-assessment.


IMPROVING VIDEO DEVICE USAGE AMONG OLDER RURAL VETERANS WITH USER-CENTERED DESIGN


REMOTE TELEASSESSMENT AND TELEREHABILITATION OF A COMPREHENSIVE EXERCISE TRAINING PROTOCOL FOR OLDER ADULTS

Methods: Community-dwelling healthy older adults (N=30) participated in three experimental tele-assessment sessions.During each session, a real-time online teleassessment was performed on five major domains that evaluate balance and gait function: lower limb strength and endurance (30-second chair stand test), aerobic endurance (2-minute step test), static balance (One-legged stand test), dynamic balance (4-step square test), and gait (Tinetti).

Results: Coefficient of determination (R2) was used to determine the test-

REMOTE TELEASSESSMENT AND TELEREHABILITATION OF A COMPREHENSIVE EXERCISE TRAINING PROTOCOL FOR OLDER ADULTS
Methods: Community-dwelling healthy older adults (N=30) participated in three experimental tele-assessment sessions.During each session, a real-time online teleassessment was performed on five major domains that evaluate balance and gait function: lower limb strength and endurance (30-second chair stand test), aerobic endurance (2-minute step test), static balance (One-legged stand test), dynamic balance (4-step square test), and gait (Tinetti).
 