1. Aging-in-place research at ORCATECH: Making sense of the data Tamara L. Hayes Associate Department Head, Biomedical Engineering, OHSU Assistant Professor, Oregon Center for Aging and Technology

2. 2 Percentage of Population Age 65+ in 2005 18 August 2015

3. 3 Percentage of Population Age 65+ in 2015 18 August 2015

4. 4 Percentage of Population Age 65+ in 2025 18 August 2015

5. 5

6. 6 The Looming Health Care Crisis 75% of health care spending is associated with chronic illness Chronic illness impact is driven by aging demographics: –80% of adults over age 65 report having at least one chronic illness; half have at least two –The average cost per health expense is higher for older adults ($6,140) than for younger adults ($2,127) Major causes of disability and impairment in adults over age 65: –Cognitive impairment, mobility disorders, arthritis, heart disease, diabetes, vision loss and hearing loss 18 August 2015

7. 7 What Can Be Done? Focusing treatment on what works Earlier detection to minimize disability, maximize treatment options Prevention before clinical onset 18 August 2015

8. Paradigm Shift Identify meaningful change in real-time, by changing both the timing and place for assessments Bring the locus of assessment into the daily life of the home and community Record events in real-time as they occur Be minimally obtrusive or in the background of daily activity – “ambient assessment” Record continuously 18 August 2015 8

9. Approach: Detecting early changes 9 Early detection Memory changes Baseline3 years6 years Functional measure Functional range Change 18 August 2015

10. 10 18 August 2015 Volunteers… Living in many community settings…

11. Challenges and goals Noisy, sometimes unreliable data –Data must be cleaned, sources of variance understood –“Peripheral” measures must be related to measures of interest 11 18 August 2015

12. Walking speed changes reflect cognitive changes 12 Hayes, et al., Int. Conf. Alz. Disease 2006 Variability in walking speed increases as people develop dementia Slow walkers develop dementia earlier than fast walkers 18 August 2015

13. Problem: accurately measuring walking speed in the home 13 18 August 2015

14. Approach 14 : random variable representing the actual response of sensor i Location of movement triggering sensor i is at Velocity of movement between sensor 1 and sensor 2 is then calculated as: : physical location of sensor i : Location at which sensor i detects motion 18 August 2015

15. Estimating walking speed 15 By assuming that people walk a constant speed on any given pass k through the sensor line we can estimate the distance between locations of firing: Assuming the firing times between the first and last sensors provide the least biased estimate of walking speed, estimate the scaling factor c and determine the actual velocity: Note also that this estimate may be different for motion in opposite directions Note that this is different than the measured distance between the sensors

16. Comparison to actual walking speeds 18 subjects, mean age 84.3 ± 6.4 6 restricted-field motion sensors placed along the ceiling at 0.61m intervals, height 2.6m Subjects each walked their normal walking speed and self-selected “fast” walking speeds and “slow” walking speeds along the line Each subject walked 15 times at each speed in each direction Ground truth measured using the GAITRite® gait mat 16 18 August 2015

17. Comparison of PIR estimated to ground truth 17 Gait mat walking speed (cm/s) PIR estimated walking speed (cm/s) Gait mat walking speed (cm/s) PIR estimated walking speed (cm/s) r=0.99 r=0.93 18 August 2015

18. Comparison to clinical and in-home estimates 18 18 August 2015

19. Comparison to clinical and in-home estimates 19 18 August 2015

20. Comparison to clinical and in-home estimates 20 18 August 2015

21. Challenges and goals Noisy, sometimes unreliable data –Data must be cleaned, sources of variance understood –“Peripheral” measures must be related to measures of interest Data volume –Need to visualize the data to identify patterns –Must select the right timescale for the problem of interest –Manage missing data 21 18 August 2015

22. red = bathroom black = front door pink = kitchen yellow yellow = living room Dealing with the volume of data

23. What do these data mean? red = bathroomblack = front door yellow pink = kitchenyellow = living room

24. Multi-resolutional analysis Discrete wavelet analysis –Decomposition of a time signal into frequency components at multiple time scales –Composed of a wavelet function (a high-pass filter) and a scaling function (a low-pass filter) Calculate total number of sensor firings per 11.25 min period (128 periods per day) 24 18 August 2015 Look at wavelet variance at different intervals

25. Wavelet decomposition reveals periodicity 25 18 August 2015

26. Variance in total activity differentiates MCI from cognitively normal seniors MCI NL Mean age = 88 years Mean in-home motion-activity sensing 315 ± 82 days N = 14 Hayes et al. Alzheimer's & Dementia, 2008; 4(6): 395-405.

27. Challenges and goals Noisy, sometimes unreliable data –Data must be cleaned, sources of variance understood –“Peripheral” measures must be related to measures of interest Data volume –Need to visualize the data to identify patterns –Must select the right timescale for the problem of interest –Manage missing data Heterogeneous data streams –Periodic time series at high sampling rates (load cells, mouse), Event-driven time series at variable sampling rate (PIR sensors) –Data fusion 27 18 August 2015

28. Fusion of information: Medication Adherence Poor medication adherence is one of the major causes of illness and of treatment failure in the USA –More than 3 billion prescriptions are dispensed in the USA annually – 76% of those medications are taken incorrectly Hayes et al. 2006, 2009 Adherence assessed with MedTracker taking a vitamin BID, target times set by seniors Mean Age 83 Assessed continuously x 5 weeks Based on ADAScog: Lower Normal Cognition Group (n =18) vs Higher Cognition Group (n = 20)

29. Adherence data 29

30. 0 10 20 30 40 50 60 70 80 90 100 % adherent Early impaired Median time within 53.4 mins of goal Healthy elderly Median time within 12.0 mins of goal “Normal” Cognitive Function and adherence Early impaired were 4 times more likely to miss taking a pill Healthy group missed their regimen goal by less time overall (t 36 =-3.474, p<0.001) Both groups were more adherent in the morning than in the afternoon Both groups missed meds most because they were out Hayes et al., Journal of Aging and Health, 2009, 21(4), 567-580

31. Adherence as a predictor of MCI 31 Goal: Train a model to recognize MCI and healthy elders from medication adherence parameters MLP Neural Network classifier Leen et al., FICCDAT 2007 Total adherence Features: Regimen adherence -- Total adherence -- STD of adherence to afternoon regimen 74% classification rate

32. Helping people to remember 32 Context aware medication prompting

33. 33 Hayes et al., Telemedicine and e-Health, 2009.

34. Continuing work Activities of daily living Multi-person problem Modeling the relationship between gait and cognition Continuous assessment of sleep Measurement of HR, respiration, weight at night (sleep apnea, CHF) Measures of computer use and game playing Automated coaching (feedback based on sensor data) Visualization and data representation 34 18 August 2015

35. Acknowledgments These studies are funded by NIH grants P30AG024978, P30AG08017, and R01AG024059, by EU, and by Intel ORCATECH faculty, students and staff: Misha Pavel, Jeffrey Kaye, Holly Jimison, Kathy Wild, Linda Boise, Jed Perkins, Zach Beattie, Max Quinn, Daniel Austin, Bill Hatt, Michael Chan, Michael Shapiro, Chow Yu, JonYeargers, Nicole Larimer, Stuart Hagler, Ian Campbell, Thomas Riley, Peter Kearns, Tracy Zitzelberger, Shoshana Maxwell, Molly Bowman, Nic Bookman, Colette Duncan, Sylvia Salazar Special thanks to our volunteers, and to the many staff at ORCATECH who enable the in-home studies 35 18 August 2015