Feasibility of a wireless health monitoring system for prevention and health assessment of elderly people

The work presented in this paper comprises the methodology and results of a pilot study on the feasibility of a wireless health monitoring system designed under main EU challenges for the promotion of healthy and active ageing. The system is focused on health assessment, prevention and lifestyle promotion of elderly people. Over a hundred participants including elderly users and caregivers tested the system in four pilot sites across Europe. Tests covered several scenarios in senior centers and real home environments, including performance and usability assessment. Results indicated strong satisfactoriness on usability, usefulness and user friendliness, and the acceptable level of reliability obtained supports future investigation on the same direction for further improvement and transfer of conclusions to the real world in the healthcare delivery.

Evolution and treatment of vitamin B12 deficiency as a risk factor for (cognitive and functional) neurodegenerative diseases in institutionalized elderly = Evolución y tratamiento de la deficiencia de vitamina B12 como factor de riesgo de enfermedades neurodegenerativas (cognitivas y funcionales) en las personas mayores institucionalizadas.

Prevalence of vitamin B12 deficiency is very common in elderly people and can reach values as high as 40.5% of the population. It can be the result of the interaction among several factors. Vitamin B12 deficiencies have been associated with neurological, cognitive deterioration, haematological abnormalities and cardiovascular diseases that have an important influence on the health of the elderly and their quality of life. It is necessary to approach the problems arisen from the lack of data relative to them. The main objective of this thesis was to analyse the evolution of vitamin B12 status and related parameters, lipid and haematological profiles and their relationship to health risk factors, and to functional and cognitive status over one year and to determine the effect of an oral supplementation of 500 μg of cyanocobalamin for a short period of 28 days. An additional objective was to analyze the possible effects of medicine intakes on vitamin B status. Three studies were performed: a) a one year longitudinal follow-up with four measure points; b) an intervention study providing an oral liquid supplement of 500 μg of cyanocobalamin for a 28 days period; and c) analysis of the possible effect of medication intake on vitamin B status using the ATC classification of medicines. The participants for these studies were recruited from nursing homes for the elderly in the Region of Madrid. Sixty elders (mean age 84 _ 7y, 19 men and 41 women) were recruited for Study I and 64 elders (mean age 82 _ 7y, 24 men and 40 women) for Study II. For Study III, baseline data from the initially recruited participants of the first two studies were used. An informed consent was obtained from all participants or their mentors. The studies were approved by the Ethical Committee of the University of Granada. Blood samples were obtained at each examination date and were analyzed for serum cobalamin, holoTC, serum and RBC folate and total homocysteine according to laboratory standard procedures. The haematological parameters analyzed were haematocrit, haemoglobin and MCV. For the lipid profile TG, total cholesterol, LDL- and HDLcholesterol were analyzed. Anthropometric measures (BMI, skinfolds [triceps and subscapular], waist girth and waist to hip ratio), functional tests (hand grip, arm and leg strength tests, static balance) and MMSE were obtained or administered by trained personal. The vitamin B12 supplement of Study II was administered with breakfast and the medication intake was taken from the residents’ anamnesis. Data were analyzed by parametric and non-parametric statistics depending on the obtained data. Comparisons were done using the appropriate ANOVAs or non-parametric tests. Pearsons’ partial correlations with the variable “time” as control were used to define the association of the analyzed parameters. XIII The results showed that: A) Over one year, in relationship to vitamin B status, serum cobalamin decreased, serum folate and mean corpuscular volumen increased significantly and total homocysteine concentrations were stable. Regarding blood lipid profile, triglycerides increased and HDL-cholesterol decreased significantly. Regarding selected anthropometric measurements, waist circumference increased significantly. No significant changes were observed for the rest of parameters. B) Prevalence of hyperhomocysteinemia was high in the elderly studied, ranging from 60% to 90 % over the year depending on the cut-off used for the classification. LDL-cholesterol values were high, especially among women, and showed a tendency to increase over the year. Results of the balance test showed a deficiency and a tendency to decrease; this indicates that the population studied is at high risk for falls. Lower extremity muscular function was deficient and showed a tendency to decrease. A highly significant relationship was observed between the skinfold of the triceps and blood lipid profile. C) Low cobalamin concentrations correlated significantly with low MMSE scores in the elderly studied. No correlations were observed between vitamin B12 status and functional parameters. D) Regarding vitamin B12 status, holo-transcobalamin seems to be more sensitive for diagnosis; 5-10% of the elderly had a deficiency using serum cobalamin as a criterion, and 45-52% had a deficiency when using serum holotranscobalamin as a criterion. E) 500 μg of cyanocobalamin administered orally during 28 days significantly improved vitamin B12 status and significantly decreased total homocysteine concentrations in institutionalized elderly. No effect of the intervention was observed on functional and cognitive parameters. F) The relative change (%) of improvement of vitamin B12 status was higher when using serum holo-transcobalamin as a criterion than serum cobalamin. G) Antiaenemic drug intake normalized cobalamin, urologic drugs and corticosteroids serum folate, and psychoanaleptics holo-transcobalamin levels. Drugs treating pulmonary obstruction increased total homocysteine concentration significantly. H) The daily mean drug intake was 5.1. Fiftynine percent of the elderly took medication belonging to 5 or more different ATC groups. The most prevalent were psycholeptic (53%), antiacid (53%) and antithrombotic (47%) drugs.

El fitness como factor determinante en el riesgo de discapacidad, su relación con la composición corporal y el estado cognitivo en población mayor institucionalizada y de vida independiente = Fitness as a determinant factor in the risk of disability, and its relationship to body composition and cognitive status in institutionalized elderly population and independent living

La condición física, o como mejor se la conoce hoy en día el “fitness”, es una variable que está cobrando gran protagonismo, especialmente desde la perspectiva de la salud. La mejora de la calidad de vida que se ha experimentado en los últimos años en las sociedades desarrolladas, conlleva un aumento de la esperanza de vida, lo que hace que cada vez más personas vivan más años. Este rápido crecimiento de la población mayor de 60 años hace que, un grupo poblacional prácticamente olvidado desde el punto de vista de la investigación científica en el campo de la actividad física y del deporte, cobre gran relevancia, con el fin de poder ayudar a alcanzar el dicho “no se trata de aportar años a la vida sino vida a lo años”. La presente memoria de Tesis Doctoral tiene como principal objetivo valorar los niveles de fitness en población mayor española, además de analizar la relación existente entre el fitness, sus condicionantes y otros aspectos de la salud, tales como la composición corporal y el estado cognitivo. Entendemos que para poder establecer futuras políticas de salud pública en relación a la actividad física y el envejecimiento activo es necesario conocer cuáles son los niveles de partida de la población mayor en España y sus condicionantes. El trabajo está basado en los datos del estudio multicéntrico EXERNET (Estudio Multi-céntrico para la Evaluación de los Niveles de Condición Física y su relación con Estilos de Vida Saludables en población mayor española no institucionalizada), así como en los datos de dos estudios, llevados a cabo en población mayor institucionalizada. Se han analizado un total de 3136 mayores de vida independiente, procedentes de 6 comunidades autónomas, y 153 mayores institucionalizados en residencias de la Comunidad de Madrid. Los principales resultados de esta tesis son los siguientes: a) Fueron establecidos los valores de referencia, así como las curvas de percentiles, para cada uno de los test de fitness, de acuerdo a la edad y al sexo, en población mayor española de vida independiente y no institucionalizada. b) Los varones obtuvieron mejores niveles de fitness que las mujeres, excepto en los test de flexibilidad; existe una tendencia a disminuir la condición física en ambos sexos a medida que la edad aumenta. c) Niveles bajos de fitness funcional fueron asociados con un aumento en la percepción de problemas. d) El nivel mínimo de fitness funcional a partir del cual los mayores perciben problemas en sus actividades de la vida diaria (AVD) es similar en ambos sexos. e) Niveles elevados de fitness fueron asociados con un menor riesgo de sufrir obesidad sarcopénica y con una mejor salud percibida en los mayores. f) Las personas mayores con obesidad sarcopénica tienen menor capacidad funcional que las personas mayores sanas. g) Niveles elevados de fuerza fueron asociados con un mejor estado cognitivo siendo el estado cognitivo la variable que más influye en el deterioro de la fuerza, incluso más que el sexo y la edad. ABSTRACT Fitness is a variable that is gaining in prominence, especially from the health perspective. Improvement of life quality that has been experienced in the last few years in developed countries, leads to an expanded life expectancy, increasing the numbers of people living longer. This population consisting of people of over 60 years, an almost forgotten population group from the point of view of scientific research in the field of physical activity and sport, is becoming increasingly important, with the main aim of helping to achieve the saying “do not only add years to life, but also add life to years”. The principal aim of the current thesis was to assess physical fitness levels in Spanish elderly people, of over 65 years, analyzing relationship between physical fitness, its determinants, and other aspects of health such as body composition and cognitive status. In order to establish further public health policies in relation to physical activity and active ageing it is necessary to identify the starting physical fitness levels of the Spanish population and their determinants. The work is based on data from the EXERNET multi-center study ("Multi-center Study for the Evaluation of Fitness levels and their relationship to Healthy Lifestyles in noninstitutionalized Spanish elderly"), and on data from two studies conducted in institutionalized elderly people: a total of 3136 non-institutionalized elderly, from 6 Regions of Spain, and 153 institutionalized elderly in nursing homes of Madrid. The main outcomes of this thesis are: a) sex- and age-specific physical fitness normative values and percentile curves for independent and non-institutionalized Spanish elderly were established. b) Greater physical fitness was present in the elderly men than in women, except for the flexibility test, and a trend toward decreased physical fitness in both sexes as their age increased. c) Lower levels of functional fitness were associated with increased perceived problems. d) The minimum functional fitness level at which older adults perceive problems in their ADLs, is similar for both sexes e) Higher levels of physical fitness were associated with a reduced risk of suffering sarcopenic obesity and better perceived health among the elderly. f) The elderly with sarcopenic obesity have lower physical functioning than healthy counterparts. g) Higher strength values were associated with better cognitive status with cognitive status being the most influencing variable in strength deterioration even more than sex and age.

iCarer Project: Intelligent Care Guidance and Learning Services Platform for Informal Carers of the Elderly

The increasing ageing population is demanding new care approaches to maintain the quality of life of elderly people. Informal carers are becoming crucial agents in the care and support of elderly people, which can lead to those carers suffering from additional stress due to competing priorities with employment or due to lack of knowledge about elderly people?s care needs. Thus, support and stress relief in carers should be a key issue in the home-care process of these older adults. Considering this context, this work presents the iCarer project aimed at developing a personalized and adaptive platform to offer informal carers support by means of monitoring their activities of daily care and psychological state, as well as providing an orientation to help them improve the care provided. Additionally, iCarer will provide e-Learning services and an informal carers learning network. As a result, carers will be able to expand their knowledge, supported by the experience provided by expert counsellors and fellow carers. Additionally, the coordination between formal and informal carers will be improved, offering the informal carers flexibility to organize and combine their assistance and social activities.

An iPhone-based application for promoting type 2 diabetic patients self- management towards healthy lifestyle habits

— In 2000, according to the World Health Organization, at least 171 million people, 2.8% of the population worldwide, suffered from diabetes. The Centres for Disease Control has defined it as an epidemic disease. Its incidence is increasing rapidly, and it is estimated that by 2030 this number will almost double. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. Diabetes is a chronic condition that occurs when pancreas does not assure enough insulin secretion or when the body does not consume the insulin produced. Insulin is a hormone that regulates blood sugar. The effect of uncontrolled diabetes is the hyperglycaemia (blood sugar), which eventually seriously damage many organs and systems, especially the nerves and blood vessels. Diabetes type 2 (most common type of diabetes) is highly correlated with elderly people, obesity or overweight. Promoting a healthy lifestyle helps patients to improve their quality of life and in many cases to avoid complications related to the disease. This paper is intended to describe an iPhone-based application for self-management of type 2 diabetic patients, which allow them improving their lifestyle through healthy diet, physical activity and education

AALUMO: a user model ontology for ambient assisted living services supported in next-generation networks

Ambient Assisted Living (AAL) services are emerging as context-awareness solutions to support elderly people?s autonomy. The context-aware paradigm makes applications more user-adaptive. In this way, context and user models expressed in ontologies are employed by applications to describe user and environment characteristics. The rapid advance of technology allows creating context server to relieve applications of context reasoning techniques. Specifically, the Next Generation Networks (NGN) provides by means of the presence service a framework to manage the current user's state as well as the user's profile information extracted from Internet and mobile context. This paper propose a user modeling ontology for AAL services which can be deployed in a NGN environment with the aim at adapting their functionalities to the elderly's context information and state.

Entornos de ayuda a la vida independiente de personas mayores sobre servicios de redes de próxima generación

El progresivo envejecimiento de la población está produciendo una elevada demanda de servicios socio‐asistenciales por parte de las personas mayores para mantener su vida independiente y el consiguiente “envejecimiento activo”. La iniciativa Ambient Assisted Living (AAL) promueve el “envejecimiento activo” a través de las Tecnologías de la Información y las Comunicaciones (TIC) y es en ella donde se centrará el trabajo de esta tesis doctoral. Una característica fundamental de los servicios AAL es su adaptación y personalización a las características y preferencias del usuario y su contexto. Así, el paradigma “context awareness” presenta una gran relevancia en la provisión de servicios AAL y en el soporte a la vida independiente de las personas mayores. Concretamente, la utilización de ontologías permite crear modelos de usuarios y contexto que pueden ser utilizadas para los mecanismos de razonamiento incluidos en los servicios context‐aware. Por otra parte, los usuarios actualmente precisan acceder a un conjunto de servicios desde cualquier red de acceso y desde cualquier dispositivo. Las redes de próxima generación (Next Generation Networks‐NGN) lo hacen posible pues ofrecen una convergencia dispositivo‐red‐servicio. La tecnología IMS (IP Multimedia Subsystem) es una arquitectura que implementa el paradigma NGN y ofrece una serie de servicios de red genéricos llamados servicios habilitadores o enablers que pueden ser reutilizados en cualquier aplicación, soportando mecanismos de interoperabilidad entre aplicaciones y permitiendo un desarrollo robusto, rápido y sencillo. Además, los servicios enablers permiten mecanismos de gestión de la información de usuario para realizar una provisión adaptada del servicio en función de la información del estado del usuario. El objetivo de esta tesis doctoral se centra en establecer un marco de convergencia entre estos dos campos diseñando y desarrollando un conjunto de servicios enablers soportados en una arquitectura IMS implementada para soportar la provisión de aplicaciones AAL bajo el paradigma context‐awareness y la triple convergencia reddispositivo‐ servicio cubriendo así las necesidades y requisitos de las personas mayores. Entre las aportaciones de la presente tesis se destaca la realización de un modelo de plataforma servicios AAL, denominado Residencia Virtual Asistiva, para su provisión en el domicilio de la persona mayor, así como la propuesta de implementación de sus servicios a través de servicios enablers. Por otra parte se define una ontología destinada a modelar servicios AAL así como sus usuarios (personas mayores) para lograr una provisión personalizada y adaptada de servicios AAL. Esta ontología se ha implementado a través del servicio de presencia de la arquitectura IMS para poder crear perfiles de usuario y así poder realizar dicha provisión personalizada. Además, se desarrolla una aplicación de teleconsulta, como ejemplo de servicio AAL, que utiliza una serie de servicios enablers desarrollados para ofrecer funcionalidades avanzadas a la aplicación. Bajo el paradigma contex‐awareness se ha desarrollado y evaluado técnicamente un servicio enabler para ofrecer soporte a la movilidad y a la independencia de las personas mayores con deterioro cognitivo que sufren episodios de desorientación espacial. ABSTRACT The progressive ageing of the population is making elderly people demand sociohealthcare services to maintain an independent living and therefore an “active ageing”. The initiative Ambient Assisted Living (AAL), on which the current PhD thesis is focused, promotes the “active ageing” by means of Information and Communication Technologies (ICT). Essential features of AAL services are the adaptation and personalization to the user’s characteristics and preferences as well as user’s context. Thus, the “context‐awareness” paradigm implies a great importance in the AAL service provision and the elderly independent living support. In particular, the usage of ontologies allows creating user and contexts models to be employed in the reasoning mechanism of context‐aware services. On the other hand, users currently require accessing to a set of services from anywhere and any device. Next‐Generation Networks (NGN) support this need by offering a service‐network‐device convergence. The IP Multimedia Subsystem (IMS) technology is an architecture that implements the NGN paradigm and offers a generic network services know as service enabler which can be reused by any application supporting application interoperability mechanism as well as allowing a simple, fast and robust application development. Furthermore, the service enablers offer user’s information management procedures to achieve and adapt service provision considering the user’s status. The objective of this PhD thesis is focused on establishing a convergence framework between these two previous fields by designing and developing a group of service enablers that will be deployed in an IMS architecture. The enablers developed will support the AAL applications provision from the context‐awareness paradigm and service‐network‐device convergence in order to cover the elderly people’s requirements and needs. Among the contributions achieved in this PhD thesis, the definition of an AAL platform service model, named as “Assited Virtual Nursing Home”, for being deployed in the older adult home is emphasised. In addition, a proposal of service enablers to support the AAL service defined in the model is made. Otherwise, an ontology is defined to model AAL services as well as their users with the aim at achieve a personalized and adapted AAL service. This ontology has been implemented by means of the IMS service presence in order to create users profiles to be used in the personalized AAL services. As an example of AAL service, a teleconsulting application has been developed to employ a group of service enablers developed using a set of advanced functionalities. Considering the context‐paradigm, a service enabler has been developed and technologically evaluated to support the mobility and independence of elderly people with mild cognitive impairment who suffers spatial disorientation episodes.

Cognitive reserve is associated with the functional organization of brain networks in healthy aging: a MEG study

The proportion of elderly people in the population has increased rapidly in the last century and consequently "healthy aging" is expected to become a critical area of research in neuroscience. Evidence reveals how healthy aging depends on three main behavioral factors: social lifestyle, cognitive activity and physical activity. In this study, we focused on the role of cognitive activity, concentrating specifically on educational and occupational attainment factors, which were considered two of the main pillars of cognitive reserve. 21 subjects with similar rates of social lifestyle, physical and cognitive activity were selected from a sample of 55 healthy adults. These subjects were divided into two groups according to their level of cognitive reserve; one group comprised subjects with high cognitive reserve (9 members) and the other contained those with low cognitive reserve (12 members). To evaluate the cortical brain connectivity network, all participants were recorded by Magnetoencephalography (MEG) while they performed a memory task (modified version of the Sternberg¿s Task). We then applied two algorithms (Phase Locking Value & Phase-Lag Index) to study the dynamics of functional connectivity. In response to the same task, the subjects with lower cognitive reserve presented higher functional connectivity than those with higher cognitive reserve. These results may indicate that participants with low cognitive reserve needed a greater 'effort' than those with high cognitive reserve to achieve the same level of cognitive performance. Therefore, we conclude that cognitive reserve contributes to the modulation of the functional connectivity patterns of the aging brain.

Integration of multisensor hybrid reasoners to support personal autonomy in the smart home.

The deployment of the Ambient Intelligence (AmI) paradigm requires designing and integrating user-centered smart environments to assist people in their daily life activities. This research paper details an integration and validation of multiple heterogeneous sensors with hybrid reasoners that support decision making in order to monitor personal and environmental data at a smart home in a private way. The results innovate on knowledge-based platforms, distributed sensors, connected objects, accessibility and authentication methods to promote independent living for elderly people. TALISMAN+, the AmI framework deployed, integrates four subsystems in the smart home: (i) a mobile biomedical telemonitoring platform to provide elderly patients with continuous disease management; (ii) an integration middleware that allows context capture from heterogeneous sensors to program environment¿s reaction; (iii) a vision system for intelligent monitoring of daily activities in the home; and (iv) an ontologies-based integrated reasoning platform to trigger local actions and manage private information in the smart home. The framework was integrated in two real running environments, the UPM Accessible Digital Home and MetalTIC house, and successfully validated by five experts in home care, elderly people and personal autonomy.

Design and technical evaluation of an enhanced location-awareness service enabler for spatial disorientation management of elderly with mild cognitive impairment

The progressive ageing of population has turned the mild cognitive impairment (MCI) into a prevalent disease suffered by elderly. Consequently, the spatial disorientation has become a significant problem for older people and their caregivers. The ambient-assisted living applications are offering location-based services for empowering elderly to go outside and encouraging a greater independence. Therefore, this paper describes the design and technical evaluation of a location-awareness service enabler aimed at supporting and managing probable wandering situations of a person with MCI. Through the presence capabilities of the IP multimedia subsystem (IMS) architecture, the service will alert patient's contacts if a hazardous situation is detected depending on his location. Furthermore, information about the older person's security areas has been included in the user profile managed by IMS. In doing so, the service enabler introduced contribute to “context-awareness” paradigm allowing the adaptation and personalization of services depending on user's context and specific conditions or preferences.