Using Smart Home Technology and Health-Promoting Exercise

Abstract

Falls have a very high prevalence in older adults (aged 65 and older) and are probable causes of decreased physical activities, function, and quality of life, as well as increased depression and nursing home placement. Home exercise is an effective way to reduce fall risk factors, but there is often low adherence. The use of smart home technology with health-promoting exercise can be a new method for occupational therapists to reduce fall risks through encouraging an active lifestyle.

The Internet home-based group exercise was great. I got stronger. I have a sense of accomplishment. Now that the program is over, what’s next to motivate me to do home-exercise?Participant

Appendices

The Case Study of Rita: Use of Smart Home Technology to Promote a Healthy and Active Lifestyle

Keywords

Mobility, physical strength, smart home technology

Introduction

The theme of this case study concerns the use of smart home technology by older adults to maintain independence through adopting a healthy and active lifestyle.

The student’s tasks include the following:

• Understanding how home improvement solutions should be planned.

• Finding information on studies using smart home technology.

• Describing the current status of smart homes for older adults.

• Identifying key factors to maintain older adults’ independence.

• Synthesizing the information into a report.

As a starting point, students should use the following references to gather background information. Important references are as follows:

• 1. Christenson M, Lorentzen L (2011) Proposing solutions. In: Christenson M, Chase C (eds) Occupational therapy and home modification. The American Occupation Theory Association, Inc., Bethesda, MD

• 2. Morris ME, Adair B, Miller K, Ozanne E, Hansen R, Pearce AJ, Santamaria N et al (2013) Using smart-home technologies to assist older people to live well at home. Home technology for mobility exercising. J Aging Sci 1(101):1–9

• 3. Center for Disease Control and Prevention (2013) 2013 Report: the state of aging and health in America. http://www.cdc.gov/aging/

• 4. National Institute on Aging & World Health Organization (2011) Global health and aging. http://www.who.int/ageing/publications/global_health.pdf

• 5. Tomita M, Russ L, Sridhar R, Naughton B (2010) Smart home with healthcare technologies for community-dwelling older adults. Smart home systems, pp 139–158, IN-TECH, Vienna

Overview of the Content

Major Goals of the Actual Intervention

The major goals of using smart home technology are (1) maximization of independence, (2) prevention of reduced physical strength, (3) promotion of a healthy and active lifestyle, and (4) improvement in the frequency of regular exercise.

Learning Objectives

By the end of studying this chapter, the learner will Be able to:

• Identify common home environmental problems and make recommendations for improvement.

• Understand the process of using smart home technology to promote health and an active lifestyle.

• Use information from the literature and clinical reasoning to develop an intervention plan for the specific case study and similar clinical situations.

The Background History of Clinical Case Study

Personal Information

Rita (pseudonym) is a 90-year-old woman. Her present height is 147 cm (about 4′11″) and her weight is 54 kg (about 119 lbs). She is a widow and lives alone in a senior town house she owns in the suburbs. She communicates with her family over long distance using online Skype once a week. She still drives a car to go to a nearby church 7 days a week.

Medical Information Including Prognoses

Rita is relatively healthy with a few physical conditions, including thyroid symptoms, minor chronic obstructive pulmonary disease, and osteoarthritis in her knees, as well as scoliosis. Rita takes four medications, one of which is to improve her cognition . She had a left hip replacement 3 years ago. Her blood pressure and cholesterol levels are within normal limits. She reported she is very satisfied with her life. A month ago, Rita had a fall in her attached garage and hit her head. She was unconscious for several minutes, but got up and drove to church. She did not have any recollection of these events. Noticing her disheveled appearance and blood on her face, church members took her to the emergency room of a nearby hospital. Rita stayed in the hospital for 3 days for tests, but no abnormality was detected. Her primary care physician encouraged her to begin the exercise program slowly.

Occupational Therapy Interventions

Rita’s home environment needed change in increase safety to exercise. An OT completed a home assessment and recommended a number of home modifications and environmental interventions, and provided needed smart home technology for the preventing exercise program .

Home modifications were (a) to clear clutter in the garage, especially the path from the driver side of Rita’s car to the entrance door into her kitchen; (b) to secure the loose railing leading up the steps to the door from the garage; (c) to automate the lighting in the garage ceiling was automated, using X10 technology and providing a remote control; (d) to install a motion sensor LED night light to the lower side of the garage wall and the hallway; (e) to use a simple version of the automation system (MT13 MiniTimer); and (f) to add a timed schedule to (1) turn a porch light on at dusk and off at 6:30 a.m., (2) turn off the basement light at night, (3) sound a medication alert time using an alarm clock, and (4) start brewing coffee at 7:15 a.m.

Rita participated in the web conference exercise program during the 6 months. She joined the chat room before anyone else, talked with an OT about her health, and asked about exercise procedures and computer operation. She missed 5 out of 72 sessions because she visited her family out of state for her 90th birthday. When she traveled within the state, she carried the laptop and joined the session. As the progressive exercise advanced, she used ankle weights and shoeboxes for exercise as required. The OT decided not to recommend the use of a TheraBand^® because it required postural stability.

Positive effects were noted for lower extremity strength, grip strength, level of physical activity, fear of falling, functional independence, and completion of IADL tasks. Now the study is over, a friend reported that Rita misses the exercise session. It seems home exercise was a just the right amount of activity that she needed to maintain her independence, physically and cognitively.

The Student’s Report

The following guiding questions have been identified in developing possible solutions to Rita. These questions were generated from the references found in the literature search:

• 1. What are the major concepts used in the case?

• 2. What assessments can be used for home evaluations?

• 3. What is the research-based evidence on the impact of physical activity on function?

• 4. What assessments can be used to measure Rita’s function and performance?

• 5. What home modifications could be made by the OT to promote safety and fall prevention?

• 6. What is needed for Rita to participate in the online exercise program?

• 7. What are some long-term goals for Rita?

• 8. What could the OT do to help Rita maintain her exercise program?