In-home Use of Home-based Sensor Technology for Monitoring Mobility in Community-Dwelling Korean American Older Adults
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The growing population of older adults faces many health challenges, including mobility limitation. Mobility limitation leads to reduced participation in physical and social activities and threatens quality of life and well-being. However, the current understanding of mobility and the ability to assess mobility limitation in older adults are often restricted to a limited set of variables measured sporadically. An alternative approach is to bring monitoring through sensor-based technology into the home setting. This monitoring could be performed continuously with less intrusion on the daily lives of residents and reduced reliance on self-reporting and memory recall of past events. Recent developments in sensor technologies have shown that they could provide the key to early detection of mobility limitation and prompt intervention to prevent adverse health events due to mobility limitation. Despite demonstrated successes of sensor technologies, no attempts have been made to explore mobility and activity patterns of Asian American older adults. Also, there still remains a challenge in increasing acceptance and usage of these technologies among older adults, particularly in those from racial and ethnic minority groups, or who have lower income or poor literacy. The dissertation includes three papers that covered two areas, 1) mobility limitation in community-dwelling older adults and 2) home-based sensor technologies for continuously monitoring older adults' mobility and activity levels. The first paper is a systematic review of instruments to measure mobility limitation among community-dwelling older adults. A search of PubMed, CINAHL, and psycINFO databases identified studies that were published from 1990 to 2012 and included the topics of definitions of mobility limitation, empirical constructs of elderly mobility and types of mobility measurement tools (either self-report or performance-based). A total of 103 articles were included in this systematic review. The review provides a broader overview of what types of mobility measures are commonly used and included a thought discussion of the inconsistencies in mobility measurement, which limit the comparison across studies. The second paper seeks to understand perceptions of home-based monitoring technologies in the context of culture among older Korean immigrants and older adults living in Korea. This study is a qualitative analysis of three focus groups and four individual interviews (N = 21) and focuses on cross-national differences in perceptions and intention to use of home-based monitoring technologies among the Korean ethnic group. We identified several cultural and contextual factors affected the acceptability of home-based monitoring technologies among participants, such as weakened filial tradition, immigration, cultural norms around the living situation of an older adult, health insurance system, and national policy initiatives for technology adoption for older adults. Results of the study indicates the need for considering cultural differences to better understand the complexity embedded in the construction of perceptions of and preferences for home-based monitoring technologies among older adults from various ethnic groups. The third paper is a feasibility study to test an integrated home-based monitoring system that utilizes innovative sensor technologies to assess aspects of Korean American older adults' daily activities with an emphasis on mobility. An exploratory multiple case-study methodology was used. The sensor system was deployed in four homes of Korean American older adults (N = 6). Study procedures included 1) data collection from the sensors, 2) administration of self-report instruments to measure mobility and health, and 3) individual interviews at midpoint and study completion. Sequence plots for every area of the home show variable natural fluctuation in activity trends. Most participants did not have any decrease or increase, but one participant's overall activity in each area was increased after her granddaughter's visit. Participants had different 24-hour occupancy patterns in the bathroom, bedroom, kitchen, and living room. Interview data indicated that the home-based sensor system was acceptable for all participants. However, some participants reported privacy concerns related to a motion sensor in the bathroom at an initial stage. Results from these papers suggest that sensor technologies could lead to understanding of aging, allowing for identification of patterns in elder mobility. Despite some challenges related to sensor deployment and data analysis, continuous sensor-based monitoring of activity patterns in the home will provide a useful tool to detect deviations from normal activity and mobility patterns that could be an early sign of functional decline. Finally, findings from the dissertation indicate that technology applications could be successfully performed in the minority population of older adults. Future efforts are necessary to develop linguistically and culturally appropriate technology-based interventions to prevent functional limitation and enhance healthy aging among older adults from racial and ethnic minority groups.
- Nursing - Seattle