Technology for Adaptive Aging (2004) / Chapter Skim
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9 The Impact of Technology on Living Environments for Older Adults
9 The Impact of Technology on Living Environments for Older Adults
Pages 230-252
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In this chapter we discuss the most common types of housing available for older adults, focusing specifically on independent living, assisted living, and nursing homes. We provide definitions for each of these different living environments and discuss factors that influence housing options.
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There are three main types of living environments for aging adults that we discuss: independent living (e.g., private housing) , assisted living, and nursing homes.
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Prior to the development of ALH, nursing homes were the only option for older adults who needed healthcare services that could not be provided at home. In contrast to assisted living facilities, nursing homes are a more medical environment, characterized by minimal personal au
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Nursing homes were considered to be a longterm care facility; that is, older adults who were too physically frail, too cognitively impaired, or too socially isolated to remain at home moved into a nursing home, and most lived there until death. Admission to a nursing home was often feared and avoided for many reasons, including the connotation of these facilities as "the last stop" before death, the poor quality of care provided in them (Institute of Medicine, 1986)
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Indeed, over the past decade or so, continuing care retirement communities have been developed to capitalize on this continuum of care model. These retirement communities typically have independent living apartments or houses, assisted living facilities, and a nursing home on the same grounds.
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FUNCTIONAL STATUS AND INDEPENDENCE Functional status is one very important determinant of a living environment. Functional status is an index of individuals' ability to perform self-care tasks in two general domains: activities of daily living (ADLs)
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In addition to functional status, there are other factors that influence transitions from independent living to assisted living to nursing home. These include acute illness (such as stroke)
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We first provide a categorization of the technologies based on the needs served. The categories of technology we consider are · assistive devices that compensate for motor, sensory, or cognitive difficulties; · monitor and response systems, both for emergency response to crisis situations and for early warning for less critical and emerging problems; and · social communication aids.
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From page 238... ...
Other abilities remain largely intact, such as recall of rehearsed material, vocabulary and reading, and ability to focus on a single source of information. Technological support for cognitive aging, often referred to as cognitive orthotics, is a very promising direction for research, evidenced by a recent survey on assistive technology for cognition by LoPresti, Mihailidis, and Kirsch (in press)
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Some cognitive orthotics research focuses on support for extreme cognitive dysfunction, such as Alzheimer's disease or severe dementia. For example, within the Gloucester Smart House consortium (http://www.
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As Table 9-1 shows, many cognitive orthotics are designed to support prospective memory, that is, remembering tasks that need to be performed and carrying out these tasks at the appropriate time (Ellis, 1996)
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The capture of information can be for instantaneous purposes only (e.g., a "GrannyCam" usually transmits images over the Internet to be viewed in real time only) or over a period of time for trend analysis, as you would expect for vital signs in a telemedicine application or in medication monitoring for compliance in a home or assisted living environment.
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From page 244... ...
Although monitoring technology is not used in these cases to treat the condition of an individual, early detection can increase the effectiveness of medical intervention and counseling for the afflicted. Cognitive orthotics discussed above rely on context-sensitive reminders, and these often require a way to monitor a person's environment and activities (LoPresti et al., in press)
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The digital family portrait shows a history of one month's activity, providing an aesthetically acceptable communication aid aimed directly at supporting awareness for a distant adult child. This use of technology will try to approximate the subtle peace of mind that comes from physical proximity.
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In a nursing home setting, in which the supervision and assistance is more critical, medication and general medical monitoring are also important to help caregiving staff provide prompt and efficient care and to maximize frail elders' remaining skills, functioning, and quality of life. The need for social communication is important across all living environments, although the type, availability, and ability to use various technologies may vary across settings.
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The vast majority of elderly Americans live at home, often with the assistance of family, friends, and professional home-care services to assist them as their functional abilities decline. Over the past decade, assisted living facilities have been developed and have proven to provide a desirable living environment for those who require some assistance in functional ADLs and more monitoring and security.
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From page 248... ...
Using technology, older adults may be able to delay or avoid moving from their home to alternative living environments and may maximize their ability to live independently. Specifically, technology applied across living environments can provide cognitive assistance, monitoring, and social communication, thus optimizing "home" for many older adults as they age.
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. The use of nursing home and assisted living facilities among privately insured and non-privately insured disabled elders.
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. State assisted living policy, 1998.
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. Assisted living: Quality of care and consumer protection issues.
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From page 252... ...
. Aware Home Research Initiative at Georgia Institute of Technology (http://www.awarehome.gatech.edu)
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