Web Application for Elderly Remote Assistance

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University of Pisa

Department of Philosophy and Literature and

Linguistics

Master’s degree in Digital Humanities

Thesis:

Web Application for Personalized

Elderly Remote Assistance

Supervisor: Prof.Fabio Patern`o

Candidate: parvaneh parvin

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Acknowledgment

I would like to express my gratitude to my supervisor Prof.Fabio Paterno for the useful comments, remarks and engagement through the learn-ing process of this master the-sis. Furthermore I would like to thank the participants in my survey, who have willingly shared their precious time dur-ing the process of interview-ing. Finally, I must express my very profound gratitude to my loved ones, who have sup-ported me throughout entire process, both by keeping me harmonious and helping me putting pieces together. I will be grateful forever for your love.

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Summary

With today’s technology, elderly users could be supported in living inde-pendently in their own homes for a prolonged period of time. Commercially available products enable remote monitoring of the state of the user, en-hance social networks, and even support elderly citizens in their everyday routines that in one hand can assist older adults to continue living at home with safety and independence and on the other hand make the work of caregivers more easier.

Keywords. Elderly people, Remote care, Assistive technology, User inter-face, Personalization

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Chapter 1 Intoduction

1.1 Introduction

As people become older, they depend more heavily upon outside support for health assessment, caregivers and medical care. With the growing age a person may encounter with different impairments physically and mentally, such as vision problems, cognitive problems (dementia) etc. Few of them may be lighter and healable but some of them may be severe and are not curable. In those situations an older adult needs a care taker most of the time in order to avoid any unfavorable situation to occur. Due to the busy schedule and adverse circumstances, it may not be possible for a care taker to be available with elderly all the time. To combat these difficult situations, the concept of remote health care has come into existence and serves as a help not only for elderly but also for care taker as well as it absorbs lot of responsibilities of a care taker.

Today, remote healthcare is available to relax the life of a caretaker by providing a help to look after an older inhabitant up to a great extent and helps people age in place by continuously providing key information to caregivers.

Many elderly people indicate they would prefer to live independently in their own homes as long as possible [Aarts et al., 2008]. In many cases, how-ever, support is needed to continue their everyday living routines. Whereas support is nowadays typically given by both professional and informal care-givers, support could in part be taken over and augmented by new technol-ogy. This assistive technology is expected to play an increasingly important role in the coming years [Tscheligi et al., 2009].Although when making an inventory of products that support independent living of elderly users, there are plenty of technological solutions available on the market.

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art products range from low level sensor networks[MuRata, ] to activity-awareness services [Innoviting, ].

The increasing aging population will also result in many challenges for society and the health care system. [AH IS¸ILAK, 2010]

1. Increase in diseases: Increase in diseases: There will be an increase in age related diseases, such as the Alzheimer’s disease or Parkinson’s disease for which we currently have no cure. ;

2. Increase in health care costs: The proportion of income spent on health in virtually all developed countries has progressively increased. For example in the UK, 4.1% of GDP was spent on the NHS in 1950/51; in 2008, this figure was 8%.Therefore, the current model of health care is going to become strained as the aging population increases in the next decades. [John, 2011]

3. Shortage of caregivers: There will be a shortage of professionals trained to work with the aging population, which means more family mem-bers have to take the role of informal caregivers. Caring for dependent individuals at home will result in many complications for the infor-mal caregivers, such as higher levels of emotional distress and physical health problems. ;

4. Dependency: With an increase in age-related diseases, there will also be a rise in individuals unable to live independently. As the population ages, it becomes a question of how are we going to pay for the quality care for the elderly and how are we going to deliver quality care to our aging population. ;

5. Larger impact on society: Economist believe that as a society, we will be unable to build, staff, and pay for the older individuals to live in assisted living or skilled nursing facilities. It is also estimated that annual loss to employers of various working family care givers is about 33billion(2100 per employee) for absenteeism, workplace disruptions, and reduced work status [Robotics, 2012]. Given the fact that 89% of the older adults prefer to stay in the comfort of their own homes, and given the costs of nursing home care [for Disease Control et al., 2007] , it is imperative to develop technologies that help older adults to age in place.;

By considering all aspects mentioned above, we reach the conclusion that remote health care technologies can be used in a variety of ways, and for a

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variety of purposes. It can support people in carrying out everyday tasks and activities, enhance a person’s safety, and monitor their health.

Generally assistive technology can help people who have problems with:

1.2 Motivation

The motivation for developing remote healthcare systems comes from many reasons, but most prominent are convenience, security and safety of elderly, help disable people, saving both caregivers and senior times and make elderly life easier.

Disabled people are more likely to be exposed to daily life problems than other healthy people, for example Alzheimer diseased people can forget to take their medicines. With the help of technology, assistant projects can be developed to overcome their difficulties. The environment can also be monitored by the remote health care system to ensure safety and alert people when there is some dangerous situation [AH IS¸ILAK, 2010]. The system can allow the user to control many features or customize and personalize them. Our motivation for this work also focuses on the creation of a Remote Care solution that will fill the gap we realize in web applications for remote healthcare: there are many home automation solutions on the market, but none of them effectively provides a complete and integrated solution to remote healthcare application that connect to different types of assistive technologies. By this way we can provide an additional level of comfort for the user, without requiring technical assistance, with a simple user interface for both elderly and their caregivers. In addition having customizable fea-tures allow the application to be personalized to better suit the particular contexts of individual users with abilities that change over time.

1.3 Goals

The application developed in this thesis is mostly designed to reduce the costs of professional caregivers and their times. By this application family members can easily monitor their loved ones and help them without being there.

Our solution shows how to provide remote access to physical status in-formation such as (heart rate, body temperature and every each personal medical information and document) and to their home situation, with in-formation concerning their movements and activities for increasing safety and reducing risk. In addition, giving possibility to the caretaker for

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sonalizing the remote care options on the base of senior condition is another goal to achieve in this thesis.

Based on experience data from previous studies on assistive technology efforts in the remote healthcare sector, we realize that the use of remote homecare web applications can be cost-effective and easy to use.

Another objective of this thesis is to identify design criteria for remote personalization tools that require minimal mental and physical efforts by older adults to operate them.

1.4 Thesis structure

In this thesis I have therefore dealt with aspects of usability and acces-sibility in relation to a web application for elderly remote monitoring. The remote assistive technology, why we need it and why it should be provide with some example in real world will be addressed in chapter 2. In chapter 3 we have state of art with some example of previous work.

The design and prototyping issues are addressed in more detail in chap-ters 4 and 5, inside which I collected all information pertaining to the con-text, the choice of tools and the website structure with all details, tasks related to caregivers and seniors and the various stages of design with the technologies used to implement the system.

Chapter 6 shows the results and techniques used in a final user testing, in which we further tested and refined, on a sample of 20 participants, the effectiveness of the guidelines for the development of our interfaces for elderly and caregivers; Consideration will be given to the conclusions of this research, together with possible future developments in chapter 7.

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Chapter 2 Assistive technology and older

adults

Assistive technologies are of special interest, as the average age of the population increases fast. Average life expectancy in the EU is one of the highest in the world and is continuing to rise. In 2000, it was 74.7 years for men and 81.1 years for women; in 2050, according to Eurostat base sce-nario, it will be 79.7 and 85.1 years respectively. The share of the total European population older than 65 is expected to increase from 16.1% in 2000 to 22% by 2025 and 27.5% by 2050. At the same time, the percentages with disabilities increase with age. Data shows that half of senior 65+ have a disability. [Cortes et al., 2007] One side effect of this rapidly expanding

Figure 2.1: Table of population age 65 and above.

older adult population is a significant increase in caregiving responsibilities

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being performed by family and friends. These demographic trends highlight the need for innovative support systems for family members and their care-givers. [for Healthcare Research et al., 2008] Because older adults with or without disabilities want to remain living in their homes. Special tools and applications, can keep people living in their homes. These tools and home modifications aid in improving independence, safety, and quality of life.

2.1 Remote assistive technology

New developments in assistive technology are likely to make an impor-tant contribution to the care of elderly people in institutions and at home. Video monitoring, remote health monitoring, electronic sensors and equip-ment such as fall detectors, pill reminder, bed alerts, and temperature and heat alarms can improve older people’s safety, security and ability to cope at home. Care at home is often preferable to patients and is usually less expen-sive for care providers than institutional alternatives. [Aanesen et al., 2011]

2.1.1 What is assistive technology?

Assistive technology “refers to a broad range of devices, services, strate-gies, and practices that are conceived and applied to ameliorate the prob-lems faced by individuals who have disabilities” [Cook and Hussey, 2002]. Assistive technology can make life easier for persons of all ages who may need help carrying out their daily activities through home modification and adap-tation. Section 508 of the Federal Rehabilitation Act defines AT devices as any item, piece of equipment, or product system—whether acquired com-mercially, modified, or customized— that is used to increase, maintain, or improve functional capabilities of individuals with disabilities[Assistive-tech, ]

Many organizations that support people with disabilities also define as-sistive technology broadly to include any device or piece of equipment that helps individuals with disabilities to function more independently. More commonly, the term assistive technology denotes some kind of electronic or computerized device that helps people with disabilities to function more easily and independently. [medicinenet, ]

2.1.2 What are types of assistive technology devices

for older adults?

The devices are classified according to the problem they seek to solve and their monitoring mode. By monitoring mode we mean that some

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plications are event-driven while others require periodic or continuous mon-itoring.

Device Types

The classification evaluates assistive technology device types, of which we have focused on:

• Ambient

Ambient, in the assisted living sense, may be described as the provi-sion of an unobtrusive service or device. Ambient components allow the AP to feel confident that they will be aided in the event of an emergency.

• Smart Sensor

Sensors have become more advanced in the past few years. Sensor nodes, such as those presented in [Akyildiz et al., 2002] may be de-scribed as being “fitted with an onboard processor”.

In [Teixeira et al., 2006] they describe camera sensors which are used in conjunction with Address-Event Representation (AER) imagers — these measure a scene as opposed to taking pictures.

• Audio

Audio data may be retrieved through the installation of microphones throughout the home. Currently applications for microphones involve recognizing fall detection.

• GPS

Global positioning system (GPS) is used as a navigational aid — it is utilized in the Opportunity Knocks system in the form of GPS chip embedded in a mobile phone; it works by learning its user’s stan-dard routes and as a result is very useful for those with cognitive decline [Pollack, 2002].

• RFID

RFID tags may be used to track objects as well as monitoring daily patterns such as eating and taking medication or some sensors for motion tracker. The PROACT system allows tasks to be observed

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• Smart Camera

Smart cameras such as those described in [Williams et al., 2006] may be used in fall detection, location and object tracking. Solutions are available which ensure that privacy is maintained — often a significant concern when image data is captured.

• Phone/Video Unit

Phones and video units are of major importance in keeping in con-tact with distant friends and relatives. Services such as Skype enable phone and video call communication at a low cost. Mobile phones may also be used in location-tracking, using services such as Place-Lab [LaMarca et al., 2005].

• Robotics

Robotic assistance in the form of robot suits used as mobility aids, as well as robots such as Twendy-One [Iwata and Sugano, 2009] for day-to-day support, help to maintain independence, ensuring that people are facilitated in their homes and carry out tasks which may otherwise be impossible without external assistance.

• Software

Sensors require software to interpret their results and ensure that the correct response is executed. Apart from software used with previ-ously mentioned devices, there are other software systems that are very useful for an aging in place situation. Reminder systems bring a new lease of life for those with cognitive decline, ensuring that they remember vital tasks such as eating and taking medicine. Automin-der [Pollack, 2002], acts as a plan management system ensuring that all critical tasks are carried out and that dependencies are maintained. And finally as we describe later in this thesis our software with capa-bility of having all application mentioned above in one software with ability of personalization of some of these assistive technologies.

2.1.3 What are the benefits of assistive technology?

Assistive technology for some people can bring benefits that help them to live well with the condition.[Assistive-tech, ]

Assistive technology can:

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• Improve confidence and quality of life for a person with dementia • Help manage potential risks in and around the home

• Support elderly to live at home for longer • Help with memory and recall

• Support a person with dementia to maintain some abilities

• Provide reassurance to caregivers and help them to feel less stressed.

2.1.4 Personalization of assistive technology

Just as there is no such thing as the average person [Norman, 1993], there is no typical disability. Many disorders are best described as a spec-trum with varying degrees to which a person is affected. There is great variability within each category of disability: cognitive, sensory, and phys-ical. Each person’s abilities and disabilities combine in a multidimen-sional fashion, which creates a truly unique condition or a “universe-of-one”. [Kintsch and DePaula, 2002] .Therefore, not only must designers un-derstand the disabilities they attempt to support, but also they must under-stand the settings in which their design will be used. Thus the “one-size-fits-all” design approach is impossible and personalization becomes necessary.

The term personalization refers to the potential to adapt features of a device or technology to a user’s needs and requirements. Health-monitoring applications and devices can be considered personalized in the sense of be-ing adaptive to the specific needs of a user or user group. Personalization may also refer to being adjusted to a particular individual, or adapted to the needs of an individual [Kim, 2002]. Personalization relies heavily on preinstalled or alternately accessible data to which a system can match the specific parameters of a user. This is often found in web-based environ-ments, which collect information while the user interacts with the applica-tion [Eirinaki and Vazirgiannis, 2003]

The personalization of the assistive technology can be included under the term of application modifications which are efforts made to adapt the application for remote assistant to the changing capabilities of the older adult. This kind of personalization restore a balance between environmen-tal demands (physical, cognitive, and social) and individual capabilities with application functionality. In our case based on the user, the system main-tains a profile that specifies the user information, retrieve personal data from the medical devices and stores the information, monitors the status of

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the household appliances and the rules for the medical data and household appliances measurements that defined by caregiver before, and executes ac-tions based on the rules defined for each service and related measurements that were collected.

The behavior of the system is often determined by a specific set of rules. Thus, personalization according to the person’s needs and preferences in-cludes a configuration of the given rule system that conducted by caregiver and as a result, personalization processes require no technical knowledge and skills such as specific notations or programming languages.

2.2 Remote healthcare:

Remote care usually refers to a system or devices that remotely monitor people living in their own home, enabling them to access support or response services when necessary. The various pieces of technology are connected over the internet. Remote care systems can include alarms, sensors and movement detectors, and reminders, fall detector, and etc.

Remote care systems are often used to support independence and per-sonal safety. They may help to reduce the risks associated with living alone, and can be useful for people living with dementia. Remote care can provide assistance to the person to help them to do things (e.g. a phone call to remind them to take their medication). It can also alert others of danger-ous situations (e.g. if they were to have a fall or leave the gas on). Sensors around the home can be linked to a nominated person or clinic. The system monitors a person’s activities and can trigger an alarm to the person or clinic call center if a problem occurs. [Society, 2015]

Remote care in our application comes in various forms and be used for a range of situations:

• Fall detector

data registered by the accelerometer. The adoption of automatic fall detection mechanisms can noticeably reduce the response time of the medical staff or caregivers when a fall takes place by sending an alert with their location to them.

• Medication reminders

An automatic pill reminder can be linked to a caregiver or clinic. If the medication isn’t taken at a set time, an alert is raised and the person is contacted to remind them to take their medication.

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• Floods

Sensors can be fitted on skirting boards or floors in the kitchen or bathroom. If taps have been left running and cause a flood, the sys-tem will raise the alarm. In addition it checks the sys-temperature and humidity threshold for more security. Sensors will send a warning signal if the temperature is very low, very high, or changes suddenly. This can be useful in the kitchen - for example, to detect a pan that has boiled dry. It can also detect if the temperature in a room is low enough to pose a risk of hypothermia.

• Movement tracker: – Absence from a bed

A sensor is placed on a bed or in bed room. If a person gets up and doesn’t return within a preset time, or if they don’t get up in the morning, an alarm is raised.

– Getting up in the night

Sensors placed by the bed can be used to activate an alarm when the person gets up in the night and leave the room for a long time - for example, to alert someone to help them get to the toilet. Similarly, lights with movement sensors can switch on if a person gets out of bed or enters a room.

– Leaving the home

A system may be set up to trigger a response if the front door is opened, perhaps during specified times (e.g. at night), or if a person does not return within a specified time.

– Devices to monitor daily activity

These are unobtrusive movement sensors that can oversee a per-son’s activity in their home over a period of time. They can sometimes help relatives or caregivers or clinics get a better idea of a person’s activity during the day and night. An alert can eas-ily be set to tell the person monitoring if something unexpected happens, such as a person leaving their home in the middle of the night.

• Heart Analysis

by placing your finger on infrared light-emitting-diode (IR LED) and a photo diode, it’s measuring your heart beat and convert it to the pulse.

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• Body temperature:

This sensor allows you to measure body temperature. It is of great medical importance to measure body temperature. The reason is that a number of diseases are accompanied by characteristic changes in body temperature. Likewise, the course of certain diseases can be monitored by measuring body temperature, and the efficiency of a treatment initiated can be evaluated by the physician.

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Chapter 3 State Of Art

Many studies have been conducted in different countries to define the needs of elderly concerning a Remote health care system able to help them in their daily life .These studies concern systems that provide support in three main areas: Health monitoring, Security and Comfort. Health-oriented sys-tems are those that monitor the status of the person (e.g. weight, heart rate, activity) via physiological sensors, movement detector, videos, etc.; Security oriented systems provide distress or hazardous situation detection, for instance, fall detection, smoke detection, intrusion detection, etc.; and Comfort-oriented systems based on classical home automation allowing peo-ple to manage home appliance in an easy way.[Portet et al., 2013a]

The classification of the state of art devised in the thesis relates to applications helping caregivers to support elders who are resident in their homes. Our ultimate aim was to design a remote healthcare application that would assist caregivers in supporting older people with possibility of personalization of these assistive supports.

A.F. Newell et al. present together a number of proposals to improve design methods for older and disable people and the concept of universal usability[Newell and Gregor, 2002]. Or in another research done by Con-solvo et al. they represent results from a field experiment that investigated the effectiveness of mobile displays as a means for improving awareness of daily life (self-monitoring of physical activity).The result of this experiment using metaphoric interface UBiFit system, shows that use of everyday mo-bile devices as awareness displays help elderly to maintain their physical activity. [Consolvo et al., 2008]

Zhao et al. present a novel approach to helping elders reach their goals with IT products by working collaboratively with helpers. In this approach, the elder uses an interface with a small number of triggers, where each trigger is a single button (or card) that can execute a procedure. The helper

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uses a customization interface to link triggers to procedures that accomplish frequently-recurring high-level goals with IT products. Customization can be done either locally or remotely. [Zhao et al., 2015]

Becker et al. present an initial test of a novel system named “Buddy” assistive technology, which combines PocketPC and Web technologies to support family caregivers. Buddy expands a safety net for dementia pa-tients and family caregivers who choose home vs. institutional care. Pock-etBuddy can be used to record patient behaviors and the emotional well-being of the caregiver, document daily activities and events, and schedule appointments and personal events, among other features. Through a series of interviews and laboratory tests they have developed and refined the pro-prietary interface which maximizes the usability of the pocket computer by older adults.[Becker and Webbe, 2008]

This paper [Maciuszek et al., 2005] operate as resources for supporting our older generations when they can no longer age in place. The assistive technologies presented in this paper wish to prolong this aging in place which may not be possible if these assistive technologies are not utilized. Requirements differ significantly in an aging in place situation – as the first level support team is not as accessible – assistive technologies must therefore be designed to be used by the assisted persons’ AP as opposed to their caregiver.

Many systems have been proposed that use these methodologies to assist the elderly. For example, passive infrared (PIR) sensors have been used in home for the estimation of amount and type of daily activity and in hospital for classification of patient movements [Innoviting, ]. Other recent applica-tions of pervasive healthcare and wireless sensor networks for supporting elder healthcare for aging in place include multimodal sensing and com-puter vision [Perry et al., 2004], while systems for supporting independence in assisted living are described in [Lymberopoulos et al., 2008]

Kang et al. present a wrist-worn integrated health monitoring device who collects data of six bio-signals measuring, which includes fall detection, electrocardiogram (ECG), blood pressure, pulse oximetry (SpO2), respira-tion rate, and body surface temperature measuring [Kang et al., 2006]. This solution provides information concerning current person condition, such as vital bio-signals and location information. The developed system provides rapid and appropriate directions in emergency situations and alerts the user or caregiver to manage changes in health condition.

Huang et al. present a wearing system with four sensors, ECG, three-axis accelerometer, temperature, and tight-switch, applied for remote monitor-ing system in home-care [Huang et al., 2008]. The ECG, measured with

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wearable electrodes using steel textile to generate the real-time heart-rate estimator. The heart-rate estimation is calculated to the movable textile electrodes in motion of user, performing a sophisticated work. The tight switch sensor and FIR (Filter Impulse Response) filter technology are ap-plied here to get the best heart-rate accuracy. The other biosensors can detect falls and body-temperature changes. Moreover, the device has low-power consumption to transmit detected bio-information from these four sensors and transmission turns it highly suitable for applications to remote healthcare and wellness.

Horta et al. presented a solution for fall detection in elderly people [Horta et al., 2013]. Falls can origin injuries that may cause a great depen-dence and even death in extreme cases. This system aims to prevent falls and advice the patient or even give instructions to treat an abnormal condi-tion to reduce the risk of falling. Thus, this fall prevencondi-tion system works in real time and the algorithms analyses bio-signals to thereby warn the user. Monitoring and processing data from sensors is performed by a smartphone that, in danger situations, can send eMails or SMSs (short message system) to a caregiver.

Technological developments have yielded devices that can measure activ-ity using accelerometers. Accelerometry is composed of measure of acceler-ation of the body or parts of the body. It is one of the most extensively-used methods implemented for measuring physical activities to monitor activity patterns.

Mathie et al. used an integrated approach of waist-mounted accelerom-etry. A fall is detected when the negative acceleration is suddenly increased due to the change in orientation from upright to lying position.[Mathie et al., 2004]

A barometric pressure sensor was introduced by Bianchi et al. as a sur-rogate measure for altitude to improve upon existing accelerometer-based fall event detection techniques. The acceleration and air pressure data are recorded using a wearable device attached to the subject’s waist and ana-lyzed offline. A heuristically trained decision tree classifier is used to label suspected falls.[Bianchi et al., 2010]

Estudillo-Valderrama et al. analyzed results related to a fall detection system through data acquisition from multiple biomedical sensors, then pro-cessed the data with a personal server. The hardware and software design issues are clearly discussed when processing of bio-signals is involved during analysis.[Estudillo-Valderrama et al., 2009]

A wearable airbag was incorporated by Tamura et al. for fall detection by triggering airbag inflation when acceleration and angular velocity

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olds are exceeded. The system design consists of an accelerometer and a gyro sensor. Such a fall detection system can be very useful, especially at construction sites etc., for reducing fall related injuries.[Tamura et al., 2009] In addition to all these researches there are some application available in markets for smartphone [assistireland, 2016] like iFall (Android) that uses the phone’s accelerometer (measures force and acceleration) and tries to detect when a fall has occurred. If a fall is detected, the user is issued a prompt which gives them a chance to clear if it is a false alert. If the alert times out without a user response, their emergency contact is called. Fall Alert (Android) that triggers an alarm if you fall, sending an automatic SMS or phone call to your designated number. GPS coordinates will be attached in the SMS message. It is also possible to activate the function by pressing the ’Panic’ button in the application and Fall Detection (iOS) that uses the phone accelerometer to detect if you have a fall. If a fall is detected an email or text message is sent to your designated recipients, providing your GPS location and street address.

In the case of medication reminder as we know the inability to take medications in the correct dose at the correct times may have negative and possibly even life-threatening effects. Numerous pill organizers are available to help the general public remember to take medications in correct dosages at the right times. More sophisticated products have been designed to help persons with memory and other cognitive impairments to comply with pre-scribed medication regimes. Some of these reminder devices are lightweight (under 3 ounces); are battery powered; and can be worn on the wrist, placed around the neck, or carried in a pocket. They can be set to give an alarm at pre-set times when medications should be taken and to display the name of the medication on the face of the device. [O’Keeffe et al., 2010]

Also there are plenty of pill reminders and health related mobile apps. A review of the top 500 medical apps available in Italian app stores conducted in 2012 [Stawarz et al., 2014] identifies 58 “health diaries”, which includes “medication scheduling apps”. However, no further information about these apps is provided. Another review from 2013 [Dayer et al., 2013]describes over 160 medication adherence apps available for different types of smart-phones, and although medication reminders were included, the focus was on intentional non-adherence and evaluating the apps from a pharmacist’s per-spective. There is also some application for smartphone like Pill Reminder (iOS) that alerts you when you need to take your medicine or refill a pre-scription. The app has a range of audible alert sounds including an extra loud reminder which may be useful if someone has hearing difficulties. The app has a built-in database of medicines so you can also access information

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like dosage and side effects for your medication. It lets you add photos of your medication so it is easy to recognize even if the writing on the packets is small. The app also keeps a history of when medications are taken or missed.

Some researchers have proposed their own solutions. For example, Silva et al. designed a medication reminder app that allowed users to enter multi-ple medications, showed due times and taking instructions, and highlighted overdue doses. The app did not differ much from commercial apps, and since its focus was on reminders, routine support was not available. How-ever, the authors created a set of functional requirements that address a number of accessibility issues, including automated reminders with differ-ent modalities (visual and auditory alerts) and the snooze option to prevdiffer-ent missing doses, which could be considered when designing a reminder system that takes routines into the account.[Silva et al., 2009]

De Oliveira et al. took a different approach: to help people develop routines, they designed an app that encouraged continuous use by adding a competitive element to medication-taking. Users were awarded adherence scores, which were then shared with their peers and displayed on a leader board. The game did not provide reminders and users had to remember by themselves, although the focus was on winning the game and taking the medication at a specific time rather than simply taking it every day. As a result, routines were not sufficiently well defined and users needed their own timer-based reminders.[De Oliveira et al., 2010]

Despite the efforts to achieve effective solution, most of the aforemen-tioned commercial products reveal some kind of deficiency that hinders the efficiency of the remote healthcare applications. Firstly, most of them presents one remote care solution for only one specific aspect. Besides, they mostly offer closed solutions that cannot be easily personalized, customized or adapted to the particular conditions of the user or the application.

In this thesis we propose a web application which includes most im-portant features for remote assistive technology devices (e.g. Fall detector, Flood detector, Pill reminder, etc. . . ) and an integrated user interface that supports all these features with possibility of personalized them. We fo-cus on an application including various aspects concerning monitoring and alerting elderly and their caregivers in emergency situation. We conducted a review of existing apps in the remote assistance area to understand what functionality they offer, what type of approach they had for personalization and to what extent they support routine behavior.

Moreover, the review of the state of art has been useful to understand what kind of data are gathered through sensors. For example in case of

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fall detector most of them used TBD (threshold-base-detection) or PRM (pattern-recognition-method) as their algorithm for detecting fall and with employed sensors built in tri-axial accelerometer .So as an output from this sensor we have change in axis, latitude, longitude and in addition we need timestamp and location of fall.

Another factor that we considered was personalization of fall detector by

adjusting device sensibility base on senior ability [Sposaro and Tyson, 2009],[assistireland, 2016], or defining notification mode, which makes application more useful and more

easy to use.

In existing medication reminders I found some common aspects that we included in building our application such as: multiple modality for sending reminders (visual and auditory alerts) [Silva et al., 2009] or as mentioned in Pill Reminder (iOS), accessing to medicine information like dosage and instructions.

In the case of Ambient Assisted Living, AAL system with a user inter-face, the user interface should be kept as simple as possible. For exam-ple, the possibility of error should be limited, cognitive overload should be avoided by limiting possible options, the dialogs should be linear, and par-allel tasks should be avoided [Newell and Gregor, 2002]. Also, metaphor in-terfaces might be more intuitive for the elderly. An example of a metaphoric interface is the “UbiFit Garden” [Consolvo et al., 2008]. that uses the metaphor of a garden that blooms throughout the week with different types of flowers representing activities that are important to a well-balanced rou-tine. Another interesting point in [Zhao et al., 2015] was using template to give caregiver simple customization interfaces with pre-defined procedures for common applications that require average computer skills to operate. We look forward to use this method in future for developing our app. there-fore, regarding the study carried out through this article, we decided to distinct roles for elders and helpers .in addition elders should have a simple interface with small number of triggers and helpers have a simple interface for defining and modifying procedures even remotely.

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Chapter 4 The design of the tool

Assisted living services will be used in different situations and for dif-ferent purposes. A single central interface will not suffice; for example, a television-based interface when assisting elderly in the bathroom will result in higher cost, since the user has to take more effort using the interface. Alternatively, users might select the optimal interface based on the situa-tion. This could range from a static TV-screen to a mobile tangible device. Uniform interaction styles create a coherent interaction experience, and will enhance the usability of the different devices. [Vastenburg et al., 2008]

Design tools are objects, media, or computer programs, which can be used to design. They may influence the process of production, expression and perception of design ideas [Portet et al., 2013b]and therefore need to be applied skillfully. Acceptability of assisted living products and services can be improved by a design vision targeted at creating short-term bene-fit, leveraging known interaction metaphors, and leveraging existing social networks.

As the first step in the design of the system, we have performed a thor-ough analysis of senior essential needs at home. The results of the analysis pointed out the information management in this application is a critical task. The patient’s self-monitoring activity generates a very large amount of data: on the average, three measurements are collected on each day, just for Flood detector.

From the organizational point of view, the management of senior sit-uation is a distributed and collaborative activity, since the decision are performed in a cooperative fashion by the caregiver and the patient him-self. It is an activity involving a large number of specialized tasks (e.g. data collection and analysis), that are carried out by our application itself and there are also few number of non-specialized tasks that carried out by caregivers and elderly.

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4.1 Guidelines for designing elderly

applica-tions

By whatever definition of older we might use, the number of older peo-ple throughout the world is surging. The general characteristics of older adults—along with demographic and technological trends—merit particular consideration when designing the user interfaces that they will use. As Alan Newell said: “design for older adults and you design for almost everyone else”. Here we are speaking in terms of accessibility rather than usability and for some part we referred to the Web Content Accessibility Guidelines (WCAG) 2.0. But the WCAG guidelines may not be sufficient to accom-modate such conditions as the aging eye’s need for increased brightness and contrast.

Many older people have age-related impairments that can affect how they use the Web, such as declining [Arch, 2008]:

• vision

including reduced contrast sensitivity, color perception, and near-focus, making it difficult to read web pages

• physical ability

including reduced dexterity and fine motor control, making it difficult to use a mouse and click small targets

• hearing

including difficulty hearing higher-pitched sounds and separating sounds, making it difficult to hear podcasts and other audio, especially when there is background music

• cognitive ability

including reduced short-term memory, difficulty concentrating, and being easily distracted, making it difficult to follow navigation and complete online tasks

Changes in vision that occur with age can make it more difficult to read a computer screen. These include reductions in the amount of light that reaches the retina, loss of contrast sensitivity, and loss of the ability to detect fine details. Therefore, I used following guidelines to improve readability of online text. [Checklist, 2002]

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• Text:

Considering Typing issue the standard Size for elderly should be be-tween 12 point or 14 point type size for body text and medium or bold face type weigh. In addition proper use of capital and Lowercase Letters means use all capital letters and italics in headlines only. For more clearness we used double space for all body text. In case of justification, there are three ways to justify type: left, full, or center justified. We used Left justified text that is optimal for older adults. • Color / Background/ Button/ Image:

As we said before vision problem occur with age make difficulty for elderly, so we should use appropriate Colors and Backgrounds to help them for having a better view, therefore we avoided put yellow and blue and green in close prox-imity. These colors and juxtapositions are difficult for some older adults to discriminate and subsequently we used dark type or graphics against a light background, or white lettering on a black or dark-colored background. In the following we used large buttons that do not require precise mouse movements for activation. And for the images we tried to use text-relevant images only or provide text alternatives such as open-captioning. For elderly we should consider some navigational features like ease of navigation and we should carefully label links.

• Navigation:

The organization of the web site is simple and straightforward. We used explicit step-by-step navigation procedures whenever possible to ensure that both old people and their caregivers understand what follows and obviously incorporate button such as Previous Page to allow the reader to review or move backward with a single mouse clicks to access information.

• Layout:

One of the important accept that should be consider is consistent layout that means use a standard page design and the same symbols and icons throughout. Use the same set of navigation buttons in the same place on each page to move from one web page or section of the web site to another and label each page in the same location with the name of the web site. We tried to use pull down menus sparingly because it’s not appropriate for the elderly and for ease of use we applied manual scrolling and incorporate specific scrolling icons on each page.

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4.2 The structure of the application

The structure of the application has therefore been modeled on the char-acteristics that we have just outlined. So that it can be easily accepted both by health care professionals in a medical setting and by unskilled patients and caregivers at home [Figure 4.1]. The result is a model focus around two main components: a Patient unit and a caregiver unit.

The application can be located on a personal computer or cellphone or TV at the patient’s home, while for the caregiver resides on a workstation in the health care center or on a personal device of the unprofessional caregiver. The patient section is able to periodically get updated during which the patient’s self-monitoring data are uploaded to the database. The following sections will describe in more detail with the services and functionality that are provided for these two sections in the current prototype of the application.

Figure 4.1: Index page consist of 2 parts: Caregiver and Senior

4.2.1 The Senior and Caregiver sections

Reasoning The senior section should assist the patient in the day-to-day life, by sending reminders, alerts and suggestions. This is done by using a simple forms whose parameters are set by the caretakers in caregiver section. Furthermore the senior section gives to the patient, the ability to monitor clinical and house state in a quick way with helps of charts and reports. This application using a rule-based techniques, the system

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generates a set of alerts, reminders and modifications to the protocol that the patient is following.

Data analysis

Our application employs a variety of programming codes for data anal-ysis to extract the largest possible amount of knowledge from the available data. The main purpose of the analysis is to point out possible problems associated with the patient’s clinical state and even his home in order to detect situations that require an immediate intervention.

Database

The application must collect and store the data coming from all the users. Here we have two types of data: First, the measurements that are usu-ally obtained through sensors, and can subsequently be sent to the database, but in our case because we have no real sensors we insert manually some hypothetically data in database. Second, the personal information and ana-graphic data that is needed in order to perform long-term analysis of the clinical state of a patient which gathered through different forms. The data must be manually input by the patient or his/her caregiver.

If we want to take a closer look at the senior section, as you can see in Figure 4.2 on the first page, patient has a quick access to the “To do list”, besides, he can immediately monitor his house and medical situation through charts and reports, further, he can set his profile, add documents, set events in calendar, receive alerts and notification by application at the top-right corner of the page which is shown by envelope icon. As you see there is no need for the patient to do anything, he just receives alerts and should react upon them by pushing a button. All the essential works do via caregiver and the application itself. The caregiver section will be explained in detail in section 4.6.

4.3 Tasks carried by Users and App

Caregiver’s tasks

• Associate an alarm or reminder to a task, which means the phone pings when it’s time to address a task to caregivers.

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Figure 4.2: Senior main page

• Understand that customization is not a one-shot deal and may need to continue throughout the technology’s life.

• Organizing and giving medication.

• Access to the task list, so can enter and organize tasks. • Monitoring symptoms and lifestyle

• Setup the journals (create account, enter patient information, set re-minders)

• planning schedule event

• Add family member and Maintain contact list

• Get notified by text, email or phone call when something is out of the ordinary and respond accordingly

• Monitor abnormal activities • Maintain patient record

• Organize list of medications held in the medication reminder app (which is associated to the pill alarm)

• Doctor’s appointments and reminders

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• Name and contact details of person identified to be contacted in case of emergencies, accessible with an easy click on the medication reminder app

• Train to use device like a help menu or a video with all information for using the device

Elderly tasks:

• Train to use End Application that should be done through caregiver • Act upon alerts and reminders

• Push help button for asking help in emergency situation • Call caregiver for assistant

App task Detecting by sensors:

• Detection and tracking of people using sensory system • Movement tracking

• Flood detecting and sending alerts • Heat/temperature analyzing

• Sending hypothermia alert (the condition of having an abnormally low body temperature, typically one that is dangerously low)

• Fall detecting and contacting caregiver

4.4 Rules regarding

reminders/alarms/com-pensatory strategies

As we mentioned before, this application using a rule-based techniques for generating a set of alerts, reminders and modifications. Below you can see some rules regarding reminders/alarms/compensatory strategies:

• Trigger Environment + User: behaviour – Action: prompt message If ¡ elderly spends longer than XX minutes in a certain area that carries a potential risk like the bathroom or kitchen ¿ and ¡it is overnight¿ do ¡ send to the elderly a multimodal prompt for the elderly to react (e.g. by using speech)

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• Trigger Environment + User: behaviour – Action: alarm message If ¡ the system detects that there is no response from the elderly¿ do ¡send an alarm/notification to care-giver informing him of the event and background information about the person’s current state (loca-tion, time, since how much time the situation persists¿

• Trigger: User: activity + Environment + Action: alarm message ¡If an elderly person has left the bed too long time during a certain period of time (such as night time) or has been on the bed for too long time¿ do ¡send an alarm to the caregiver through smartphone (SMS)¿ • Trigger - User: behaviour + Environment: time – Action: reminder

message

If ¡user has not yet taken medicine¿ and ¡time for taking medicine is quickly approaching¿ do ¡ send a reminder appropriate for the current elderly context (e.g.: environment noisy use smartphone’s vibration)¿

4.5 Personalization and customization the user

interface for web-based remote care

There are variety of customizations of the user interface at different times during the creation and use of an application. Mainly there are 2 type of customization [Kintsch and DePaula, 2002]:

1. Static customizations that are performed by a developer or system integrator prior to the deployment of an application:

Like choice of language, appearance, page text, and layout. It may also include customizations that limit or augment the fundamental behavior of the application interface and the types of tools and com-ponents that are made available to the user.

2. Dynamic customizations that occur at run-time based on user prefer-ences. For example one kind of customization is alert customization [Islam et al., 2011] We have 2 kinds of alert in our application:

(a) Device alert (b) Caregiver alert

Since Device Alerts is related to the basic functionality of the implantable system, they cannot be customized or turned off. In contrast, the Caregiver

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Alerts are related to the patient’s condition and thus should be customized per patient. The customization can be done at any time in the Application. The application allows you to customize care of your patients. Besides the system provides flexibility and customization to optimize the management of your patients. We assume that a number of sensors are placed in the house to collect data regarding temperature, humidity, light, sound, movements, etc. Data from the sensors are sent to a server connected to the internet. An authorized user can log on to the website at any time, from any place and using a PC, laptop or smartphone. The application displays status of home appliances/devices, doors, windows and values of selected ambient pa-rameters graphically in different part of the application[Burns et al., 2008] and the clinical status of the user.

The system interacts with the user through an interface having iconic representations of appliances/devices, doors, windows, rooms etc. It re-quires minimal typed input from the user and is easy to learn and use. It is accessible from any phone or computer connected to the internet. Be-sides, fixed thresholds can be set up to check for an emergency situation (according to gathered data) and generate an alarm. The authorized users can also be immediately notified and can take measures before it is too late. The further detail on how and through which forms, user can do alert personalization is explained in section 4.6.

4.5.1 Service personalization for users:

In summery when a new user should be registered

• A personal data form with the user’s personal data fields should be completed.

– The major information that is needed for each user is: user fiscal code, username, password, name, surname, date of birth, sex, phone number and address.

– The type of group that the user belongs should be selected. Types of groups: Caregiver or Senior.

The user information is stored

• Afterward, the user associated with some services.

• The actions (alerts, alarms) that should be made in case of rule vio-lation should be also defined by caregiver.

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The system gives the capability to the user to view all the details and the information related to him (personal information regarding the user, the services associated with the user, the measurements that have been taken, actions that have taken place, etc.). Also, allows the caregivers to manage the user accounts and change any personal information and rule definitions that are stored. On definition of the rules, alerts should be activated in case of violation of rules.

To describe in more detail the developed modules and their interaction, a flowchart is provided for the user monitoring service personalization. The

Figure 4.3: Senior monitoring service personalization

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user, rules are defined and, in case of violation, activation of alerts is defined as well. When a measurement is performed using a device, the personalized measurement is retrieved. If the retrieved measurement violates the rules, the proper alarm services are activated and the notification alerts are sent. Also, the user records are updated accordingly by changing the alarm rules. A set of fundamental rules were defined by default.

4.6 The detailed description of the

applica-tion funcapplica-tionality:

In detail user can access to the website using direct URL: http://parvin.zeus.ir/. After that, the main page appears with two big buttons, one for caregiver

and one for senior. By clicking on caregiver button you enter to login page, if you are a new user, you should first do the registration [Figure 4.4] and then do the login [Figure 4.5], you remain login since you decide to log out from the website. When you are in the caregiver page as you see in Fig-ure 4.6,you have access to the patient list. Obviously, each caregiver can have multi patients, and so after selecting his patient, he has access to all applications and equipment of the device and through them you can have access to senior medical information and monitor house situation through different applications.

Figure 4.4: Registration form

As I mentioned before our device consists of 6 different applications list below that I’ll explain their functionality in detail one by one:

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Figure 4.5: Signin form

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4.6#1 36 1. Fall detector 2. Flood detector 3. Movement tracker 4. Pill reminder 5. Heart analysis 6. Body temperature

4.6.1 Fall detector:

This application is able to detect falls using the information collected by some of the mobile or implant sensors such as the accelerometer. It can be configured to issue an alert message to a predefined contact of caregiver after a fall detection, reporting the time and place where the accident occurred, using the device’s geolocation tools. This information, which may be sent to the selected contact via SMS and email that is set in manage rules section by a caregiver, can be vital in emergencies. Another options that can be customize by caregiver is the sensibility of the system that consists of 3 part:

• slow sensibility

It’s the ideal mode for situation with irregularities in the field and activities like jogging

• medium sensibility

It’s a standard mode for when user is not performing any specific activity

• high sensibility

When we need that App is especially attentive to possible falls as se-niors. In turn, we also have four different ways to notify our emergency contact that we have suffered a fall.

• Call notification

Faster and direct mode of notification. The app will automatically make a call to our contact.

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• SMS notification

An alternative if we believe that our contact cannot attend our call at that time, we send a user location with custom text notification. • E-mail

The best option if we know that our emergency contact will be in a place without telephone coverage.

• Application

There is an envelope icon at the top corner of the page that all the alerts place there.

In Figure 4.7 you can see all the customization available for this application.

Figure 4.7: Main page of Fall detector with all customizable options

In addition there is a chart that user can monitor all fall event in current year for reporting to the physician. Figure 4.8 shows the graph of the fallen situation in a current year; the data were retrieved from the database, and were then plotted by a Js chart.

4.6.2 Flood detector

This application consists of 3 parts that checks temperature, humidity and water leak. The functionality of the application is like, once water is detected, the sensor sets off the alarm—likely a loud, audible sound and/or blinking light. If the detector is connected to a home security monitoring system, the monitoring service is alerted and will immediately contact the

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Figure 4.8: Graph of the fallen situation

homeowner or if the owner don’t respond to the alert, in our case through the App, SMS or call we alert the caregiver or family member. For temperature and humidity we give some possibility to caregivers to set the threshold for each part of the house that exist a sensor. They can set the threshold for both temperature and humidity separately and based on their setting, our application diagnose if it’s out of threshold or not. If something goes wrong first we send an alert to the senior. Or senior react upon the alert and push the button that says everything is under control or in other case after some minutes (depend on how much time caregiver set for reacting upon triggers in manage rule [Figure 4.9]. We send an alert to the caregiver and announce the situation . The most important part is Manage Rules, is that caregiver can sets all the rules need for sending and receiving alerts to senior and himself including reacting time , how many time alert should be send , notification mode and custom text messages for sending an alert. As you see in Figure 4.10 in the first page of the Flood detector, user can see list of all sensors exist in the house include the active and inactive one. In this page user has the ability to add, delete, active or deactivate each sensor he desires. Then by click on each sensor he can see all the details including temperature and humidity chart, sensor status which include current temperature and humidity readings and active events of current day. Caregiver can also set the threshold in this page for this specific sensor .By setting thresholds user can be notified of important changes in temperature and humidity [Figure 4.11]. In addition you can have an overview on senior home by Event section. This section displays your current status and history of events like a temperature above your threshold setting [Figure 4.12]. In other word here

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4.6#1 39

Figure 4.9: From for setting alert rules

you can see when and where all Humidity, Water Leak, and Temperature events occurred.

Figure 4.10: main page of Flood detector that shows all sensors

4.6.3 Movement tracker:

The application monitors movements while keeping track of which room the user is in at home that helps predict serious changes in health. This application enables care staff to monitor more residents and spend more time helping those with higher need.

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Figure 4.11: Show sensor detail with all charts and possibility of setting the threshold

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is the usage of logging tools for remote usability analysis and then present the recorded data to experts in such a way to support detection of possible problems. In the design of such automated tools, an important issue is the choice of meaningful visual representations in order to support the caregiver and even experts’ analysis. So we considered some tools for monitoring patient situation.

• Movement timeline

Since the system monitors residents continuously, caregiver can see and check even later that when and where the patient was all the day, which means detect whether someone is in the kitchen, bathroom, bedroom, or living room at what time and for how long.[Figure 4.13]

Figure 4.13: Timeline for monitoring daily movement

• Virtual home

Another way of looking at the data is through my virtual cottage, this is when the house image changes depending on the sensor conditions. The system monitors and displays the location of each resident in real time and according to that picture will change. [Figure 4.14]

Windows If it is yellow means there is someone there. If it is gray it means no one is there.

Door If its open color is green, if not color is brown.

Kitchen If there is heavy smoke it means there is someone in there By the way, the window at the top is bedroom, right corner at the bottom is living room and finally the left corner at the bottom is bathroom.

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Figure 4.14: Virtual home

• Total report

In this part caregiver can see all the steps taken by senior along with time interval and place of being, for each place we assigned a different color for better understanding.[Figure 4.15]

Figure 4.15: Total report of how many steps has been taken by senior during the day in each place

• Manage alert rules

In this section caregiver can define all the rules for sending the alert to the senior and himself [Figure 4.16] with extra tab that show the

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rules already exist [Figure 4.17] .with considering the minimum steps that should be taken in half an hour (30min) by seniors in each place and with defining a threshold for dangerous time being in that place [Figure 4.16] .which means if someone is lying down in the bedroom, then they are probably sleeping. But if someone is lying down in the bathroom for 3 hours at night, then there is potentially an issue. So we send an alert to the senior first ,if they respond and push the “I’m fine” button we cancel the alarm, if not we send an alert to the caregiver with the custom massage that he defined.

Figure 4.16: manage movement tracker rule for senior

Figure 4.17: Monitor all the rules currently exist

In addition there is a motion chart for each room separately for more detail information [Figure 4.18].

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Figure 4.18: Report of each step in each place

4.6.4 Pill Reminder:

The medication reminder app allows caregivers to note medications be-ing taken, set-up reminders to take pills, capture and set reminders for doc-tor’s appointments, make medical notes, and manage healthcare provider contact details and more. In addition caregivers can personalized medica-tion reminder and set the reminder and alert rules for elderly. Figure 4.19 shows the form used to assign a predefined medicine to the patient. The interface displays a form with all requirement field for each medicine type and each time period during the day. The user can also modify the pa-tient’s total medication requirement and the actual medicine types to be used. These tasks done by caregiver in this part in detail:

• user set-up and reminders to take pills (pill alarm)

• manage list of medications held in the medication cabinet (which is linked to the pill alarm)

• set doctor’s appointments and reminders • manage rules for sending reminders and alerts

On the base of the reminder rules that is set by caregiver we send an alert to senior for reminding him to take his medicine [Figure 4.20] .The senior presses the button “take” when they see the reminder ,if for example care-giver set the reminder for 3 times ,at the third times we send the sound alarm. The App is connected to the senior’s telephone line, so if the senior misses a dose, the App can contact caregiver or another family member.

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Figure 4.19: Add medication Form completed by caregivers

They can then check on the senior to make sure they are getting their medication.

Figure 4.20: Set the alert rules form

4.6.5 Heart analysis:

This part is just a demo and we develop it later. The goal is to de-velop a simple, accurate, and inexpensive system that would use a few pieces of data acquired by the heart rate monitor and process them on a smartphone or other devices to (i) provide detailed test reports about the

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user’s health state; (ii) store report records; (iii) generate emergency calls or SMSs. Remote health control can therefore be achieved without the need for expensive hospital equipment, using only portable consumer devices. [Pierleoni et al., 2014]

How to use the Application:

Lightly place your index finger on the camera lens and flash on the back of your phone, make sure the lens and flash are fully covered. Hold until the measurement is complete.

Measure your resting HR in the morning after waking up. Stay in bed for 2 minutes and run Heart Rate App. If you are doing endurance sport your resting heart rate will decrease over time.

On the history page you will see your past measurements. And you can use the filter to analyze the history of your measurement types.

4.6.6 Body temperature measurement:

Even this part is demo. Just enough to place your finger gently in the fingerprint scanning pad indicated with red color and wait for an analysis. Put your finger gently in the fingerprint scanning pad and wait for an anal-ysis. Your body temperature will show on the screen in the thermometer scale, Digital Thermometer & Text Form.

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Chapter 5 The implementation

5.1 Application requirement

The design of the application has been guided by a set of constraints that we regard as essential for the effectiveness of the thesis. First, the application must support the easy integration of additional components: as new services are developed, possibly in response to feedback from the users, they must be made available without disrupting the functionalities of the rest of the system.

It is important to note that the whole process is completely transparent to the user, who only sees the overall result of the process. Another impor-tant requirement was the ability to obtain a working and reliable prototype in a relatively short time. The number and variety of services needed made it impossible to develop all of them from scratch; therefore, we have tried to rely on widely available and standard solutions where possible. For example we used programming libraries.

The system can be accessed from any location on the network and from any platform in favor of responsive1 _{web design features, without the need}

for specialized interfaces or expensive hardware resources.

For creating this application we used the open source development en-vironment Netbeans2_.

1_{Responsive Web design is the approach that suggests that design and development}

should respond to the user’s behavior and environment based on screen size, platform and orientation.

2_{https://netbeans.org/}

Web Application for Elderly Remote Assistance

University of Pisa

Department of Philosophy and Literature and

Linguistics

Master’s degree in Digital Humanities

Thesis:

Web Application for Personalized

Elderly Remote Assistance

Acknowledgment

Summary

Contents

Chapter 1

Intoduction

1.1

Introduction

1.2

Motivation

1.3

Goals

1.4

Thesis structure

Chapter 2

Assistive technology and older

adults

2.1

Remote assistive technology

2.1.1

What is assistive technology?

2.1.2

What are types of assistive technology devices

for older adults?

2.1.3

What are the benefits of assistive technology?

2.1.4

Personalization of assistive technology

2.2

Remote healthcare:

Chapter 3

State Of Art

Chapter 4

The design of the tool

4.1

Guidelines for designing elderly

applica-tions

4.2

The structure of the application

4.2.1

The Senior and Caregiver sections

4.3

Tasks carried by Users and App

4.4

Rules regarding

reminders/alarms/com-pensatory strategies

4.5

Personalization and customization the user

interface for web-based remote care

4.5.1

Service personalization for users:

4.6

The detailed description of the

applica-tion funcapplica-tionality:

4.6.1

Fall detector:

4.6.2

Flood detector

4.6.3

Movement tracker:

4.6.4

Pill Reminder:

4.6.5

Heart analysis:

4.6.6

Body temperature measurement:

Chapter 5

The implementation

5.1

Application requirement