ISA: An Integrated Environment for the Digital Inclusion of Elderly
People
Bernhard Kohn
1a
, Klaus Dittrich
1
, Carmina Coronel
1b
, Martin Litzenberger
1c
,
Birgit Unger-Hrdlicka
2
and Karoline Reither
2
1
AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1220 Vienna, Austria
2
myneva Austria GmbH, Hietzinger Kai 133,1130 Wien, Austria
birgit.unger-hrdlicka@myneva.eu, karoline.reither@myneva.eu
Keywords: Active Assisted Living Technology.
Abstract: Elderly people are increasingly discouraged from using mobile digital devices due to the large number of
applications. In this paper, we present ISA, an integrated system that is intended to simplify the inclusion of
older people in the digital world, by a joint organisation of a digital calendar by care organisation, cared for
person and informal carer. On a tablet computer daily routine such as home care, taking medication, but also
appointments, meetings with friends or relatives can be easily managed by an integrated calendar. In addition,
functions such as video telephony and photo albums are offered for better social interaction with friends and
relatives. A pilot operation was carried out to check whether the system would be helpful in daily activities
or in reducing the burden of informal carers. 12 pairs of participants, each consisting of the person to be cared
for and the informal carer, were recruited for a study. They filled out questionnaires on activities of daily life
and the caregiver burden before and after the test. Evaluation of the questionnaires showed no significant
change of status regarding the activities of daily living or the caregiver burden.
1 INTRODUCTION
Participation of the elderly in the digital world is
becoming more and more important as some basic
services are only available through smartphones with
internet connection. In the near future, registration for
social events or even personal services, such as
booking an appointment at the hairdresser, will only
be possible via digital tools, such as web forms or
smartphone apps. On one hand, existing digital
technologies still pose a huge barrier for some elderly
to participate in daily life and to organize their own
agenda. On the other, care persons are facing an
increasing burden to support the elderly in the use of
the digital technologies or, in many cases, even
having to completely take over these tasks for them.
Existing systems or software often pose a problem
of being not optimized for a use by elderly people or
not having the possibility to use the system by carer
and cared for person cooperatively in a consistent
a
https://orcid.org/0000-0002-3177-3159
b
https://orcid.org/0000-0001-6304-0243
c
https://orcid.org/0000-0002-2101-2188
manner. For example, although a digital calendar may
be shareable among different people across different
platforms, the necessary workflows for a cooperative
usage by a caregiver and elderly are usually not
supported. While the design of user interfaces
optimized for use by elderly are already under
investigation for some time (Iancu & Iancu, 2017;
Kurniawan, 2008; Zhu et al., 2008), cases of
successful implementation and adoption of assistive
solutions are still rare (Haan et al., 2021; Martinez-
Martin & Costa, 2021) and they concentrate more on
the compensation of cognitive deficiencies than on
the support of organizing general daily activities and
fostering digital inclusion.
Baric et al. report on the "RemindMe" system
(Baric et al., 2019) that combines an interactive
digital calendar for the carer with short text message
(SMS) reminders sent to the elderly users. The widely
known SMS service has been chosen, instead of a
smart phone GUI or app, to simplify the interaction
344
Kohn, B., Dittrich, K., Coronel, C., Litzenberger, M., Unger-Hrdlicka, B. and Reither, K.
ISA: An Integrated Environment for the Digital Inclusion of Elderly People.
DOI: 10.5220/0011137300003188
In Proceedings of the 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2022), pages 344-350
ISBN: 978-989-758-566-1; ISSN: 2184-4984
Copyright
c
2022 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
for the elderly. A study with 20 subjects has been
conducted. Project Freewalker (Litzenberger et al.,
2021) piloted a GNSS based assistive technology that
combined a GNSS dongle with smartphone apps for
caregiver and user, to protect from wandering and
getting lost. Through creation of appointments
defined in a shared calendar, maintained either by the
carer or cared-for person, the application generates
optimized and safe travel directions for the cared-for
persons
In this paper we report on the concept and
software of the ISA project, developed in the
framework of a research project, to test and validate a
system based on a collaborative and maintained
electronic calendar to organize all aspects of the daily
schedule for care and support of an elderly person in
close cooperation with the care person. ISA
implements an intelligent web-based system intended
to assist working individuals in their care and support
duties and the data gathered by the system will be
permanently available to the caring individual. A
tablet installed with the application is placed in the
home of the cared-for person. The application
equipped with an optimized user-interface reminds
and notifies regarding activities, not only such as
eating, drinking, grooming, housework, but also
outside activities such as shopping, exercising, family
meetings, doctor visits. ISA should thereby enable the
user to lead a more self-organized and self-
empowered life and reduce the burden of the carer,
too. It also displays motivational items such as family
photos. Additionally, the possibility for video calls is
integrated. For personal security, the system also
notifies regarding special adverse weather conditions
like heavy rains or thunderstorm and current weather
information. In contrast to RemindMe, both carer and
cared-for person can maintain the ISA calendar and
organize care appointments. In the future the
possibility of directly integrating various services
(e.g., hairdresser) with the providers is planned. A
first pilot study with ISA, in which the system has
been used by 12 users and their informal carers has
been conducted in Austria over the duration of three
months. To analyse the impact of using ISA on the
reduction of stress for the elderly person and of
caregiver burden of the informal carers a
questionnaire was used before and after the test. For
the elderly persons the questionnaire of the Bayer
Activities of Daily Living (Erzigkeit et al., 2001;
Hindmarch et al., 1998) were used whereas for the
informal carer the Zarid Burden Interview (Zarit et
al., 1980) was chosen to get information how strong
the burden of caring is recognized. Although both
questionnaires are more related for cognitive
impaired persons, they should give an indication if an
influence occurs.
The paper concentrates on the technical
description of the software component of ISA and on
the first results of the pilot study and is organised as
follows: The following section gives an overview
over the system features and the system architecture.
In Section 3 the pilot is explained and how the
questionnaire was carried out. The paper closes with
Section 4, the conclusion.
Figure 1: Overview of the features of the ISA system.
ISA: An Integrated Environment for the Digital Inclusion of Elderly People
345
2 ISA SYSTEM
2.1 Features
In Figure 1 a schematic overview of all system
features is shown. The basis of the ISA system is the
calendar. Using the calendar, it’s possible to plan
daily activities. The entry point for the cared for
person is the day view (see Figure 2 top) of the
system. He or she can add special reminders for daily
activities like medication or drinking times, meeting
appointments with friends or relatives (see Figure 2
bottom). Each appointment added to the calendar can
be given a category, one of: appointment out of house,
medication, video call, event or other (see Figure 3
top). For appointments of the category out of house
the user will get a reminder with additional
information regarding the actual weather situation, so
she is reminded to dress accordingly (see Figure 3
bottom). Additionally, the cared-for person can add
video calls (see Figure 4 top) as appointments and
invite the informal carer or other contacts to join. A
photo album (Figure 4 bottom) can be used to share
pictures of family or other events. This should help,
especially in times of the COVID-19 pandemic, to
keep personal contact with family and friends. All
these possibilities are offered by an application for an
android tablet. The user interface is specially
designed for an easy and intuitive use.
Figure 2: Top) overview of appointments, bottom) add new
appointment.
Figure 3: Top) available categories for appointments,
bottom) reminder with weather information
For the informal carer a web portal is offered to
access the calendar, contact list, and photo albums.
The cared for person can grant rights to the informal
carer via an access list, so that the cared for person
maintains control on the data to be shared. If access
right is granted, the informal carer can access and add
pictures to the photo album, add additional contacts
to contact list and view and add appointments.
The ISA systems also offers an API to directly
interface to care organisations, so that home care
appointments can be sent automatically to the
calendar. This feature allows the cared-for persons to
know at which time the home care person will visit
them. In case that a home care appointment is late, the
cared for person can be informed by the care
organisation through the table application (see Figure
5). Additionally, the cared for person or the informal
carer may also cancel appointments if the cared for
person is unable to attend due to unforeseen situations
like doctors’ appointments or hospitalisations.
Additionally, a so-called logic engine is integrated
into the system. The purpose of the logic engine is
twofold. On one hand, it automatically checks if a
new added appointment conflict with an existing one.
This is necessary, as the home care appointments
typically are only available for the next four weeks.
The logic engine derives over this four-week period
when home care appointments are made and hints the
user about potential conflicts. On the other hand, it
analyses the daily activities, especially the medication
intake and home care appointments. If the logic
engine detects unusual behaviour of the cared for
person in her daily routines, it sends a message to the
ICT4AWE 2022 - 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health
346
Figure 4: Top) video call, bottom) photo album.
informal carer to inform her about the observation.
This can give the informal carer an early chance to
contact the cared for person to ask if anything is
wrong. Of course, the cared for person can activate or
deactivate this feature on their own will.
Figure 5: Notification that a care appointment is shifted.
2.2 System Architecture
In Figure 6 the overview of the system architecture is
shown. It consists of three server applications. The
basis of the system is the ISA server, which stores all
the user and calendar data, and provides the web
portal for the informal carer. For the tablet app it
serves a web API to give access to all needed
information. The tablet app can also be notified when
reminders or messages should be shown by this mean.
The second server application is the logic engine.
It is served by a separate server. The decision to
separate the logic engine from the ISA base was to
ease the parallel development of the two components.
The communication between the ISA server and the
logic engine is realized by several dedicated
endpoints. For each change of the calendar (e.g.,
adding, changing, or deleting an appointment) the
ISA server asks for approval by the logic engine. By
this design the logic engine receives the complete
information of active appointments and can check, if
there is any conflict with any existing appointments
for a given user. Additionally, the logic engine
records each reminder of appointments. By this the
logic engine can check several corner cases,
- Is a home care appointment cancelled?
- Is the cancellation time under a certain time
range, where it may cost a cancellation fee?
- Is there an overlap within a time range, where
usually a home care appointment takes place?
- Is there an overlap with another appointment?
Depending on the results of this analysis next step
will be executed. E.g., if the cancellation of a home
care appointment within the next 24 hours is detected,
the user will be notified, that the cancelation may cost
a cancelation fee. If a conflict of appointments is
Figure 6: ISA System architecture: ISA Server, Logic
Engine and weather service.
ISA: An Integrated Environment for the Digital Inclusion of Elderly People
347
detected, the user will be reminded, that another
appointment is planned at the same time, and if she
would like to proceed or choose a different time.
An additional task of the logic engine is to detect
unusual behaviour. Unusual behaviour can be
assumed, for example, if a cared for person frequently
cancels home care appointments, or if reminders for
medications aren’t acknowledged. In the case of the
not acknowledged reminder the logic engine triggers
the ISA server to send a message to the user. If the
acknowledgement is not given by a user several times
a week, a message to the informal carer is send, to
notify about the situation. Of course, such a strict
monitoring must be explicitly approved by the cared
for person and the general aim is not to enforce strict
monitoring. The aim of this function is to give the
informal carer a hint, that there might be something
not in order and that they could ask sensitively about
medications or cancelled home care appointments.
The logic engine can be configured to follow different
workflows, depending on the care organisation the
user is registered with. The workflows allow to
configure which type of messages should be send,
like SMS, emails or by other message applications.
By this different connection methods and different
type of users can be defined according to the needs of
the care organisation.
The third server application is the weather service.
By the separation of the weather service from the
other components, the local weather provider could
be easily exchanged. The weather service provides
two different services. Each user using the ISA
system will be registered by the place he is living
(over the area code) at the weather service. In regular
time intervals (every 10 mins) the weather service
asks an external weather information provider if there
is any local warning for extreme weather situations
like heavy rain, strong wind, thunderstorms and other
similar situations. If there is warning, each user living
in the affected area will be notified by the tablet about
it. Additionally, it provides a web endpoint for the
ISA server, so that any reminder on an out of house
appointment will be accompanied with weather
information. This gives the user an indication on what
appropriate clothes to wear.
3 PILOT STUDY
The ISA system was piloted in a field trial from
October 2021 till the end of December 2021. The
pilot was accompanied by a set of questionnaires to
get a measure if the usage may help to reduce the
daily stress of the cared-for persons and for the
informal carers.
For the pilot a care organisation (Vienna Red
Cross) and one research project partner searched for
candidate pilot participants of cared for persons and
informal carers. Due to the Covid pandemic the
response of potential study participants was
moderate. In total 12 candidates were involved in the
pilot study. The cared for persons have an average age
of 74 years ranging from 64 to 95 years. The group
consists of 5 women and 7 men. The informal carers
had an average of 39 years ranging from 29 to 64
years, consisting of 7 women and 5 men.
All of them answered the questionnaire before the
beginning of the pilot and within three weeks after the
end of the pilot.
3.1 Questionnaires
As questionnaire for the cared-for persons the Bayer
Activities of Daily Living (Bayer ADL) was chosen.
The questions were in German language and
consisted of 25 questions regarding different daily
activities. Each question could be assigned a value
between 1 and 10, and 'does not apply' was also a
possible answer. Higher values meant more difficulty
executing the activity. At the end, all answered values
are summed up to give an overall score and a mean
value for all answered questions is calculated.
Depending on the mean value the Global
Deterioration Scale (GDS) for the person has be
assigned (Erzigkeit et al., 2001).
The Zarid Burden Interview (ZBI) questionnaire
was chosen for the informal carer. This questionnaire
has the intention to score the burden of a partner of a
cognitive impaired person in home care. Although no
cognitive impaired person was involved in the pilot,
this questionnaire was assumed to be the best
approach to score the burden the informal carer is
experiencing. The Zarid Burden Interview consists of
22 questions in German language. Each question
could be assigned a value between 0 and 4. Higher
values meant higher burden. The total sum of the
values gives the overall score. Scores between 0 and
20 indicates no or little burden, 21-40 mild to
moderate burden, 41-60 moderate to severe burden,
61-88 severe burden.
3.2 Results
Table 1 summarizes the results for the Bayer ADL
questionnaires. In case of the cared for person only
for 4 persons a change in the score before/after the
pilot is observed, whereas for the other 8 person no
ICT4AWE 2022 - 8th International Conference on Information and Communication Technologies for Ageing Well and e-Health
348
change could be seen. The total sum of the changes
cancels out. To further analyse the results, we select
all those questions from the Bayer ADL related to
subjects which might be impacted by using the
application like keeping appointments and support by
reminders for medication etc. In total 5 questions
could be separated. The results of the score can be
seen in Table 2. In this restricted questionnaire there
is no change in the average value of 10 persons
observed, in 2 persons a change by -2.3% respectively
-16.7% is seen. The increase of scores in Table 1 can
be attributed to questions with subjects that are not
directly related to the app.
Table 1: Results of the Bayer ADL questionnaire. In the
column before/after pilot the average value of all questions
score is shown, the difference is given both in absolute and
in percentage.
Id Before
pilot
After
Pilot
Difference
[abs]
Difference
[%]
1 1.0 1.0 0.0 0.0
2 1.0 1.0 0.0 0.0
3 1.0 1.0 0.0 0.0
4 8.6 8.6 0.0 0.0
5 2.4 2.7 0.3 12.5
6 1.4 1.4 0.0 0.0
7 8.5 8.4 -0.1 -1.2
8 1.0 1.0 0.0 0.0
9 1.0 1.0 0.0 0.0
10 1.8 1.5 -0.3 -16.7
11 2.0 2.1 0.1 5.0
12 1.2 1.2 0.0 0.0
Table 2: Results of the Bayer ADL questionnaire restricted
to questions directly connected to the usage of the app. In
the column before/after pilot the average value of all
questions score is shown, the difference is given both in
absolute and in percentage.
Id Before
pilot
After
Pilot
Difference
[abs]
Difference
[%]
1 1.0 1.0 0.0 0.0
2 1.0 1.0 0.0 0.0
3 1.0 1.0 0.0 0.0
4 8.4 8.4 0.0 0.0
5 1.3 1.3 0.0 0.0
6 1.4 1.4 0.0 0.0
7 8.8 8.6 -0.2 -2.3
8 1.0 1.0 0.0 0.0
9 1.0 1.0 0.0 0.0
10 1.5 1.3 -0.3 -16.7
11 1.2 1.2 0.0 0.0
12 1.0 1.0 0.0 0.0
In Table 3 the results of the Zarid Burden Interview
evaluation are shown. There are only relatively small
changes in the ZBI scores before and after the pilot.
Only in one case the caregiver burden is increased
from one burden level (scores between 0-20) to the
next burden level (21-40), but the absolute change of
the score is only 3, which compared to the burden
range of 20 score points is a relatively small increase.
In total, all 12 informal carers report no or little
burden.
Table 3: Results of the ZBI questionnaire. In the column
before/after pilot the sum of questions scores is given, the
difference is given both in absolute and in percentage.
Id Before
pilot
After
Pilot
Difference
[abs]
1 13 12 -1
2 13 12 -1
3 4 5 1
4 13 14 1
5 0 0 0
6 17 18 1
7 0 0 0
8 12 8 -4
9 1 1 0
10 20 23 3
11 11 7 -4
12 2 7 5
4 CONCLUSIONS
We have presented the ISA system for digital
inclusion of elderly people. The system is capable to
provide services like calendar and appointment
administration, photo albums can be shared with
friends or relatives, also video telephony can be used.
A pilot with 12 participants, pairs of cared for persons
and informal carers, has been conducted and was
accompanied by questionnaires before and after the
pilot (B-ADL for cared for persons, ZBI for informal
carer). The scores of questionnaires are used to
evaluate whether the ISA system is helpful for
facilitating the daily activities of the cared for persons
and if it was able to reduce the caregiver burden.
Evaluation of the questionnaires showed no
significant change of status regarding the activities of
daily living or the caregiver burden. We attribute the
results to a still too high complexity of usage of the
apps and the implemented workflow of jointly
organising a calendar and daily routines. Thus, the
results are somewhat unsatisfactory as they indicate
ISA: An Integrated Environment for the Digital Inclusion of Elderly People
349
that even for a system tailored for digital inclusion of
elderly, the measured acceptance was low.
Future work is to provide the web-based portal as
a mobile app, so that the functionality for the informal
carer is always accessible on the mobile phone.
ACKNOWLEDGEMENTS
This project has received funding in the program
“benefit” by the Austrian Federal Ministry for
Climate Protection, Environment, Energy, Mobility,
Innovation and Technology (BMK).
We would like to thank the Vienna Red Cross for
their contribution in running the pilot.
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