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FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY

FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY TUE, EINDHOVEN, NL November 13-14 2007 TECHNOLOGY FOR EXTENDED HEALTH. James L. Fozard, Ph.D. School of Aging Studies University of South Florida Tampa, FL 33260

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FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY

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  1. FIRST INTERNATIONAL SOCIETY FOR GERONTECHNOLOGY MASTERCLASS IN GERONTECHNOLOGY TUE, EINDHOVEN, NL November 13-14 2007 TECHNOLOGY FOR EXTENDED HEALTH James L. Fozard, Ph.D. School of Aging Studies University of South Florida Tampa, FL 33260 For electronic copy of slides, send me an e-mail request at fozard@tampabay.rr.com

  2. Extended Health—What’s that??What is technology’s role in it?? • Extended health links the WHO definition of health to the opportunities and challenges of aging. WHO definition of health includes: • Physical, • Mental, and • Social well being • Technology’s roles include: • Preventing or delaying age related limitations in functioning • Compensating for age related declines in functioning • Care and support for elderly with illnesses and limitations in function • Enhancing quality of life for all 3 applications

  3. Achieving Extended Health requires us to change how we think about aging • Negative stereotypes about old age and aging are detrimental to the well being and personal fulfillment of young and old alike • Agism is apparent in many jokes: • Pervasive negative stereotypes about aging • Poor parental training about aging to the young • Poor appreciation of individual differences

  4. Let’s change our way of thinking about aging—starting here • Pervasive negative stereotypes about aging • If I knew I was going to live this long, I would have taken better care of myself • One senior to another: “When does old age begin?” Answer: “Later” • Young adult’s most serious life decision? Answer: “ When to begin middle age”

  5. Let’s change our way of thinking about aging—continuing here • Poor parental training of the young about aging • Dennis the Menace to his father’s friend: “What age are you in the middle of?” • Child to grandmother: “If I’m only young once, how many times do I have to be old?”

  6. Let’s change our way of thinking about aging-continuing here • Poor appreciation of individual differences • Old man answers question about his age: “What age do you mean--My anatomical, physiological, psychological, or chronological? • This gentleman is both smart and wise, smart because of the critical distinctions and wise because chronological age is at the end of the list • When asked what his doctor thought about his lifestyle choices at age 100+, George Burns replied, “I don’t know, my doctor’s dead.”

  7. Technology can help education and training activities related to aging • Create simulations to educate people for aging in various situations (BJ Fogg) • Cause and effect simulations (social skills) • Environmental simulations (treat phobias) • Object simulations (drunk driver) • Simulations of aging for young people can reduce negative attitudes toward aging

  8. Virtual simulations of aging and healthy lifestyles • Since the 1970s, many simulations of age related sensory and mobility limitations have been devised to educate the young • Clouded lenses, ear plugs, gloves, weighted shoes etc. • Limitation is lack of linkage of these devices and preventive and compensatory interventions • Virtual reality simulations can improve education by linking simulations of limitations to effects of compensatory and preventive measures

  9. Gerontechnology Contributes in many Ways to aging and health • Education about and training for aging • Enhancement of quality of life • Prevention or delaying of age-associated losses in sensory-perceptual and motor systems • Technology to lower impact of long-term exposure to environmental hazards and maintain cardiovascular health and strength • Compensation for age-associated losses • Care for elderly persons with functional limitations

  10. High speed networking expands scope of gerontechnologies • Telemedicine and communication applications using video over Internet • Mobile-Health Toolkit wirelessly measures blood pressure, blood glucose, etc. and relays information to patient records • Ultra-wideband radio allows for precise location of persons within a home and communication among appliances Common feature of examples is, “…enhanced communication between people and people, people and machines and among machines that themselves are networked.” • Kearns WD, Fozard JL High-speed networking and embedded gerontechnologies. Gerontechnology 2007;6:135-146

  11. Preventing or delaying age-related limitations in functioning • Technology can contribute to motivating people of any age adopt healthy life styles that prevent or delay limitations in functioning • Diet, weight control, exercise, substance abuse • Idea rests on the capacity of technology for monitoring physiological functioning and changes in location of one or more persons

  12. Prevention to delay age declines in cardiovascular and strength • Effects of cardiovascuclar training on preventing heart disease and stroke as well as facilitating rehabilitation are well known • Positive effects of strength training on preventing age related decline in physical functioning, personal mobility, and physical frailty are being demonstrated continuously in new research • Technology can help promote motivation for exercise and in setting targets for exercise

  13. Background: Old Adults perform ADLs closer to max strength than young adults Hortobagyi T, Mizelle C, Beam S, DaVita P. J. Gerontology:Medical Sciences, 2003, 58A,453-460.

  14. Walking, going up and down stairs and rising from chair requires relatively higher percentage of maximum reserve capacity in older than younger adults--True for cardiovascular and muscle function Study measured relative effort to perform these tasks by assessing maximal leg strength on a machine and by the force used when going up or down stairs or standing up from a chair. Force was measured by special recording plate embedded in the floor or steps Participants were healthy women in two age groups mean ages 22 and 74 years. Purpose/Methods

  15. Relative effort (%) of maximum strength required to perform ADLs

  16. Long-Term Consequences of Age Differences in Strength • Midlife strength predicts functioning 25 years later • Grip strength measured at age 45 to 68 in Japanese-American men. 25 years later speed of walking, ability to stand up from chair, and self-reports of difficulty lifting 10 lbs, doing housework, etc were measured. • Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999;281:558-560

  17. Proprioception, Balance and Movement: Prevention 3 • Grip strength divided into thirds: <37, 37-42, >42kg; outcome measures included • Walking speed<0.4m/s (6.2%) • Chair rise without using arms (2.2%) • Difficulty doing housework (18.2%) • Difficulty walking up 10 steps (14.1%) • Rantanen T, Guralnik JM, Masaki K et al Midlife hand grip strength as a predictor of old age disability JAMA 1999;281:558-560

  18. % with Limitations in Strength Groups Measured 25 Yrs Ago Data from Rantanen et al, JAMA 1999;281:559

  19. Effects of strength training on mobility—basic findings • Strength training and physical activity improve muscle mass, control of movement, and balance • Fiaterone MA, Marks EC, Ryan ND et al. High-intensity strength training in nonogernians:Effects of skeletal muscle. J Am Med Ass, 1990;263:3029. • Ivey FM, Tracy BL, Lemmer JT, NessAiver M, SM, Metter EJ, Fozard JL, Hurley BH. The effects of strength training and detraining on muscle quality : Age and gender comparisons J Gerontol:Biol Sci 2000;55A:B152-B157. • Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR, Ettinger WH Physical activity, funtional limitations and disability in older adults J Am Ger Soc 2000;48:1264-1272. • Since 2000, dozens of well designed studies extend these early studies e.g., J. Gerontology: Med Sci 2007;62A;(June);2007; 62A(Aug)

  20. Young Men Young Women Older Men OlderWomen Muscle Quality(MQ) is strength/volume. Strength training of right leg occurred over 9 months; detraining over 31 weeks. From Ivey et al 2000

  21. Strength and Gait Speed • Leg exension strength and leg power correlate with gait speed. The distributions of leg power associated with different speeds may provide the basis for setting goals for strength needed for walking. • Rantanen T, Avela J Leg extension power and walking speed in very old people living independently. J Gerontol Med Sci 1997;52A:M225-M331. • Correlations between power and speed ranged from .4 to.7 in old people • Kwon I, Oldaker S, Schrager MA, Talbot LA, Fozard JL, Metter EJ. Relationship between muscle strength and self-paced gait speed: Age and sex effects. J Gerontol Biol Sci 2001;56B:B398-B404

  22. Cumulative distributions of leg power for 5 groups of walking speed from <1m/s to>2m/s Data from Rantanen andAvela 1997 Cum % Leg power is expressed as Watts/kg Note that the cumulative % of leg power at 1m/s ranged from 1-3 W/kg The cumulative % of leg power at 2m/s ranged from 8-15.5 W/kg

  23. Technology and setting goals for strength training • Prevention requires that we set standards for reserve strength needed for adequate functioning at a later age • Early estimates--we need 40% of our strength at age 25 to function well at age70 • Wearable transducers provide information on quality and required number of maneuvers • New technology development at University of Pisa by Dr. E. Piaggio allows forKinesthetic sensing by use of smart fabrics in gloves, socks and leotards • http://www.piaggio.ccii.unipi.it/kine.htm

  24. Development of health monitoring systems: Early work Health Monitoring in the Home of the Future Infrastructure and Usage Models for Wearable Sensors That Measure Health Data in the Daily Environments of the Users ILKKA KORHONEN, JUHA PÄRKKÄ, AND MARK VAN GILS IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE MAY/JUNE 2003 71

  25. Korhonen et al The sensors are integrated into the everyday life of the users. They should either fit by their look to the individual’s preferences or they should be as unobtrusive as possible. Health monitoring seems a very promising application for the smart home. First of all, there is a clear need to provide tools to support independent living. Automatic processing of the sensor data becomes essential when health monitoring is applied in long-term conditions; i.e., over months or years. While the main application domain of health monitoring is often the home, the research is closely related to the concepts of smart home and home networking

  26. Personal Mobile Hub • Dirk Husemann, Chandra Narayanaswami, Michael Nidd IBM Research Division • hud@zurich.ibm.com, chandras@us.ibm.com, mni@zurich.ibm.com • Proceedings of the Eighth International Symposium on Wearable Computers (ISWC’04) 1530-0811/04 $ 20.00 IEEE • Abstract • As advances are made in wearable computing, there is a • need for a personal mobile hub that can manage • interactions between the wearable devices and act as a • proxy for these devices. • Our personal mobile hub supports multiple wireless protocols, some short range and some wide area so that the power of the internet is available even • to body worn sensors. • We describe custom hardware that we built for this purpose and also the software necessary to make this concept work. • We have tested out thisarchitecture with an end to end application.The workingsystem was demonstrated at the annual IBM Stockholders • meeting in 2004 and is also available for customers to see • at the IBM Industry Solutions Lab in Zurich.

  27. Localization via Ultra-Wideband Radiosation via Ultra-Wideband Radios [A look at positioning aspects of future sensor networks] Sinan Gezici, Zhi Tian, Georgios B. Giannakis,Hisashi Kobayashi, Andreas F. Molisch,H. Vincent Poor, and Zafer Sahinoglu] IEEE SIGNAL PROCESSING MAGAZINE [70] JULY 2005 POSITIONING SYSTEMS CAN BE DIVIDED INTO THREE MAIN CATEGORIES: TIME-OFARRIVAL,DIRECTION-OF-ARRIVAL, AND SIGNAL-STRENGTH BASED SYSTEMS. LOCATING A NODE IN A WIRELESS SYSTEM INVOLVES THE COLLECTION OF LOCATION INFORMATION FROM RADIO SIGNALS TRAVELING BETWEEN THE TARGET NODE AND A NUMBER OF REFERENCE NODES. TIME-BASED POSITIONING TECHNIQUES RELY ON MEASUREMENTS OF TRAVEL TIMES OF SIGNALS BETWEEN NODES

  28. Localization via Ultra-Wideband Radiosation via Ultra-Wideband Radios [A look at positioning aspects of future sensor networks] Sinan Gezici, Zhi Tian, Georgios B. Giannakis,Hisashi Kobayashi, Andreas F. Molisch,H. Vincent Poor, and Zafer Sahinoglu] IEEE SIGNAL PROCESSING MAGAZINE [70] JULY 2005 TIME-BASED POSITIONING TECHNIQUES RELY ON MEASUREMENTS OF TRAVEL TIMES OF SIGNALS BETWEEN NODES UWB TECHNOLOGY PROVIDES AN EXCELLENT MEANS FOR WIRELESS POSITIONING DUE TO ITS HIGH RESOLUTION CAPABILITY IN THE TIME DOMAIN.

  29. Networking improves coaching in strength training • Motivation is major issue for utilizing strength training—machines can have motivational properties • Networking can improve motivation and quality of feedback from strength training • Reinforcement from sharing information by peers doing similar workouts

  30. Boston Red Sox Deploy Activity-Monitoring Technology FitSense's ActiHealth wireless system seamlessly collects, transports, and presents information on physical activity, weight, body fat, blood pressure, heart rate, peak flow, and blood glucose. SOUTHBOROUGH, MA /BUSINESS WIRE/ -- It's hardly noticeable, but if you look closely enough, the Boston Red Sox players are all wearing something new at spring training. It's a small, wireless, intelligent pedometer called the ActiPed, from Massachusetts-based FitSense Technology. This isn't any ordinary pedometer; in fact, it's an activity monitor that accurately tracks your every step, the calories you burn, how much time you've been active, and how far you went in miles. The ActiHealth network provides physiological information and feedback tools for health and wellness program providers that engage and motivate their members, changing their behaviors and improving health. The network seamlessly collects, transports, and presents information on physical activity, weight, body fat, blood pressure, heart rate, peak flow, and blood glucose, for anyone, anytime, anywhere.

  31. Technology and motivation: Computerized coaching • FitLinxx is a computerized system that attaches directly to existing fitness equipment • FitLinxx “learns” users' programs, “coaches” them individually through their workout for better form, safety and confidence during every exercise, and “tracks” their progress over time. • On strength equipment, FitLinxx appears as an easy-to-read touch-screen display that's attached to the machine. For cardiovascular equipment, each machine's existing console is simply networked to FitLinxx • Users simply tap in their PIN to display their targets - FitLinxx then coaches them on speed, form, heart rate, etc., and tracks the workout session - every rep, set and step. • http://www.fitlinxx.com/Article.htm?ID=976

  32. Kressig, R. W., & Echt, K. V. (2002). Exercise prescribing: computer application in older adults. The Gerontologist, 42(2), 273-7. Abstract: PURPOSE: The purpose of this study was to determine if older adults are capable and willing to interact with a computerized exercise promotion interface and to determine to what extent they accept computer-generated exercise recommendations. DESIGN AND METHODS: Time and requests for assistance were recorded while 34 college-educated volunteers, equal numbers of men and women, ranging in age from 60 to 87, interfaced with a health promotion tool. The computerized exercise promotion tool's ease of use and the acceptability of the exercise recommendations made were rated by the participants. RESULTS: On average, completion of the items on the computer took 33 min and each participant made 3 requests for assistance, of which only 22% were mouse related. The system's ease of use and the exercise prescription acceptability ratings were high and independent of prior experience with computers. IMPLICATIONS: User friendliness of computerized health promotion tools will determine if, and how, health providers integrate these new technologies into daily practice. The participants in the study were able to complete the computerized items within a reasonable amount of time and with minimal assistance from the provider. These data support the potential of interactive technology in health promotion among the expanding older population.

  33. Development of an exercise expert system for older adults Lisa Wynn Boyette, MEd; Adrienne Lloyd, MEd; Stephanie Manuel, MS; James Edward Boyette, MSICS; Katharina V. Echt, PhD Allanta VA Medical Center, Rehab R&D Center, Decatur, GA 30033; Emory University School of Medicine, Division of Geriatric Medicine & Gerontology. Atlanta, GA 30033; Veterans Affairs, Health Eligibility Center, Atlanta, GA 30033 Abstract—The purpose of this study was to develop a cotnputerized exercise expert system (CEES) that creates tailored exereise plans for older adults. A panel of experts was selected in the areas of medicine, exercise physiology, health promotion, exercise psychology, and gerontology. The experts communicated with the principal investigator and the project members by mail, email, telephone, and expert meetings. A two-day workshop was held during the second year for the project metnhers as well as local and national experts to review the CEES. The CEES demonstrated adequate inter-rater reliability (0.80) and criterion validity (0.70). Content validity was achieved by literature review and expert opitiion. The CEES gathers information on the elder's health status, clinical factors, and exercise determinants that characterize specific barriers or incentives to exercise. The software program then develops individualized exercise prescriptions that are customized to older adults.

  34. Summary: Technology and Extended health • Physical, mental and social well being included in the WHO definition of health • The role of technology in extended health is to create what former UN Secretary General Kofi Anan called “enabling environments” that support human endeavors for all regardless of age

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