Report of The International Society for Gerontechnology's 7th World Conference Vancouver, Canada May 27-30, 2010

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Report of

The Internationa
l Society for
Gerontechnology's

7th World Conference

Vancouver, Canada

May 27
-
30, 2010



Prepared by:


Peter Kwok, Project Manager, Information
Technology

R
e
source Centre Limited


Scarlett Tsang,
Unit Manager
,
The Providence
Garden for Rehab
,

Sheng Kung Hui Welfare Council


Cain Ng
,
Social Work Supervisor
,
Chi Lin
Elderly
Services








Page

2


Introduction


The International Society for Gerontechnology's

7th World Conference

Vancouver, Canada, May 27
-
30, 2010


Internationally recognized experts in gerontechology share
d

their knowledge and experience
through lectures, symposia, workshops, papers and posters. Topics addressed include
d

rehabilitation enginee
ring, robotics, telemonitoring, telecare, ICT, biomechanics and
ergonomics, assistive technology, inclusive design and usability, smart homes and smart
fabrics, sensor technology, and cognitive aging and computer games.


In addition to a strong scientific
program the Conference feature
d

an exhibition and trade
show, an exciting social program, and pre
-

and post
-
conference special interest events.


The main theme of the conference
was

"
Technologies for Health, Quality
-
of
-
Life and
Aging
-
in
-
Place
".

The 2010 I
SG conference
brought

together two crucial themes. Firstly,
old people, given the right help and support, would prefer to continue living in their familiar
homes and neighborhoods for as long as possible. The use of technology, ranging from
simple assisti
ve devices to complex information and communication systems, has
considerable potential for enhancing the lives of many older people and helping them to
age
-
in
-
place.


Secondly, much of the research and development within the field of ageing and technology

has focused on issues of safety and security. While these remain important, equal
consideration needs to be given to how technology can positively enhance the everyday lives
of older people by supporting independent living, social participation and improv
ing health
and well
-
being. These considerations need to be contextualized within the realities of global
population ageing. The impact of ageing baby
-
boomers will present enormous challenges to
health and economic institutions in coming decades. It is a re
ality that demands creative
responses and the opportunities afforded by new technology are an important part of this
response.


The aim of the conference
was

to bring together researchers from around the world, who
were

working in the area of gerontechnolo
gy, to present the results to their research and
assess the implications for the development of practical solutions to the needs of older people,
family carers and care professionals. In particular, the aim
was

to explore how technology
can:


Page

3




Enhance qual
ity of life and well
-
being



Preserve autonomy and feelings of security



Improve the efficiency and effectiveness of health services


Over 350 participants from all corners of the globe shared their knowledge and experience in
28 invited and submitted symposi
a, 18 paper sessions in which over 80 papers covering all
aspects of technology and aging
were

presented, and 7 poster sessions with over 100 posters
covering aides for dementia patients and their carers, housing and institutional design issues,
health man
agement, using technology in everyday life and user aspects of gerontechnology.
The program also feature
d

expert round tables, an exhibition, a GerontechnoPlatform,
demonstrating state of the
-
art
-
products, site visits, a Master Class for students and an e
xciting
social program.





Page

4


(b) Evaluation of the Event Program (content / scope of the papers presented)


Topic:

Changing practices: Home and community based care technologies for
independent living

By
:

Mr. Eric Dishman, Intel Fellow, Digital Health
Group, Director, Health
Innovation and Policy, Intel Corporation


In the plenary session, Mr. Eric Dishman

of Intel Corporation discussed about the business
case and investment of resources in technology for aging. There is little argument that the
population of the world is aging rapidly, nevertheless, Dishman pointed out that the society,
especially the gove
rnment authorities, do not invest wisely on gerontechnology.
He
questioned the attendance on the society's continuing, and even increasing investment in
institutional care. Although home
-
based and community
-
based care are believed to be more
sustainable, a
nd more important is that, it is more beneficial than institutional care to senior
citizens, the investment of resources does not manifest such importance.


In the disease model, the notion of health, not necessarily confined to health of our older
populat
ions, was fragmented, if not disintegrated; for instance, the society emphasize on
microscopic / specialist diagnosis but there is relative less focus on the holistic view of health
and the overall quality of life and functioning of the person. Dishman poi
nted out that many
resources, be it cash or manpower resources, were spent to develop precise diagnostic
tools
such as advanced X
-
ray, ultrasound, etc. but there is very limited resources to develop
technology (gerontechnology) for community care. He also
remarked that there was a large
room in interfacing the institutional care with the community/home
-
based care with ICT
solutions. The concept does not include only the exchange of medical records or prescriptions,
more important question to ask it that how

the different systems of the client, e.g. their home,
caregivers, social network, employer, medical practitioners, etc. could be connected.


In addressing the viability and sustainability of care technology,
Dishman pointed out that the
market of care tec
hnology was still considered immature. He revealed to the attendants that
the "
Cost of Care / Day
" was indeed lower in community
-
cased / home
-
based care
, but
the
quality of life

of the clients is much enhanced. He challenged the participants to pay more
ef
forts in building up the evidence
-
base of gerontechnology and to prove the effectiveness
and efficacy of these solutions with controlled trial experiments.

Page

5



At the end of the plenary speech, he also introduced several areas of gerotechnology that
would con
tribute to the better quality of life of the elderly, e.g. GPS and
touch
-
videoconferencing solutions for driving
-
seniors to build up their social network in the
neighbourhood, use of computer games as assessment tools (e.g. Solitaire),

virtual care
platfor
m (to connect medical professionals with clients, and to provide health education
information and reminders to clients), solutions of gait and falls analysis, etc.

He concluded
his remark by suggesting that the way of pay and practice has to be changed, an
d this relies
on the concerted effort of policy makers, medical practitioners and students, care industry,
etc.



Page

6


Topic:

Innovative approached to dealing with population aging

By
:

D
r.
John Beard, Director, Department of Ageing and Life Course, World
Health

Organization


In the second keynote of the day, Beard focused on the issues of ageing faced by the
developing countries.
Unless societies develop innovative ways of responding to the
demographic shirt, the older populations will place a heavy burden on governments of health
care, social services and financial support. However, older people are also a neglected
resource havin
g skills, experience and wisdom that can make a great contribution,
He pointed
out that in the developed society, responses to ageing population

shall

include liberating the
human resources in the aged population, e.g. flexibility in employment, engagement

for
elderly in social decisions, etc. The planning of an longer life vest not only on employment or
retirement planning, but also results in a life planning that was significantly different from the
past, and this applies to all people but not exclusively

for elderly.


Beard noted that this was the context in the developed world. In the developing countries, one
of the major issues about ageing is that the population / countries were
growing old before
getting

rich
. It was forecasted that there will be 1.6

billion older adults living in the
less
-
developed countries

in 20
-
years time, and Beard put forward that the following areas
were approached what could be explore:
-



Employment / Engagement



Disaster Management



Medical treatment



Rehabilitation on
disabilities


In this connection, the technology would be an enabling element in the following areas:
-



Convergence of everyday technology


Technology could connect the older adults and
allow their participation. Health or rehabilitation information could
also be imparted via
information technology. Training and life
-
long learning could also be facilitated by the
application of technology;



Medical technology


What technology can do in this aspect include, screening and
detection of disease / vulnerabilitie
s, treatment and also rehabilitation assistance such as
assistive devices;



Data infrastructure


Data infrastructure include the use of Internet for health care, how
Page

7


records (from medical, social, and other systems) of the clients can be linked and
consoli
dated to present the overall understanding on the health and quality of life of
clients.


In concluding his speech, he urged the participants to pay close attention to the developing
world;
he also

asked the
participants to look at ageing as a process of d
evelopment instead of
applying a problem paradigm. He believed that the ageing issue would bring not only
problems, but also opportunities for the society to advance.



Page

8


Session title: CIHR Canada


UK New Dynamics of Ageing Research Initiative


In this ses
sion,
the projects presented were research initiatives under UK


Canada
collaboration.
Two presentations were on the development and evaluation on the assessment
for the effectiveness of
assistive technologies
, in particular those related to continence
pr
oblems.
Van den Heuvel and Jutai

introduced the Psychosocial Impact of Assistive Devices
Scare (PIADS), while they admitted that more sensitive measures shall be developed in the
future.
Southall and Jutai, who worker on the

d
evelopment and
v
alidation of a

questionnaire
to measure the psychosocial impact on assistive technologies for continence in elderly
individuals
, revealed that they had conducted a meta
-
analysis, supported with i
nterviews with
elderly individuals, caregiviers and health care professiona
ls

to evaluate the effectiveness of
assistive devices on controlling

continence

problems. The qualitative study was still ongoing
at the time of presentation and the researchers had shared their progress with the attendees.


In the presentation on "
Sustai
ning IT (Sus
-
IT) use by older people to promote autonomy and
independence
", by
Damodaran, Young, et al.
, it was quoted, from national statistics that,
m
any
people aged
65+ are regular and enthusiastic users

of the Internet.
The author quoted,
from the UK D
igital Inclusion Panel Report, that


"there is a real risk that in the medium to long term, significantly more citizens
will migrate from being digitally engaged to being unengaged than the other way
round, as their capabilities change".


The author
further suggested that the hurdles in using ICT were f
orget
fulness, lack of
confidence

and

fear
.


The project was designed to identify ways to engage effective participation of older people in
ICT policy, research and design; to investigate sustained use o
f technology by older people;
to explore how to sustain autonomy and independence of older people by ICT and to
influence policy and design related to ICT use by older people. And from the project, the
Administer Digital Engagement Questionnaire (DEQ)

was
developed to measure the degree
of engagement in ICT by the older adults. At the time of presentation, many works are done
on the preparatory purposes and the results of the
projects will be available after completion
of project in 2012.

Page

9


Topic: What is the

contribution of technology to ageing
-
in
-
place?


Anthea Tinker, the Professor of Social Gerontology of King’s College London (UK), shared
that surveys across the world show that ageing in place (including specialised housing) was
the preferred options for

most elderly. Gerontechnology focus on the fundamental aspects of
technology to serve the ageing society. According to UK, gerontechnology is considered
specifically ‘assistive technology’, ‘aids and adaptations’, telecare, telemedicine and robots.
Smart
home is the design putting all technology together.

Assistive technology (AT) is an umbrella term for any device or system that allows
individuals to perform tasks they would otherwise be unable to do or increase the ease and
safety with which they can be performed. An assistive device is equipment that ena
bles an
individual who requires assistance to perform the daily activities essential to maintain health
and autonomy and to live as full a life as possible. Aids and adaptations is a major focus of
housing policies and home improvement agencies. Telecare i
s care provided at a distance. It’s
used for continuous, automatic and remote monitoring of real time emergencies and lifestyle
changes over time in order to manage the risks associated with independent living. The
information about health related issues w
as transferred between one or more sites.
Telemedicine refers to the employment of communication technology to provide assistance in
the diagnosis, treatment, care and management of health conditions in remote areas. Robots
refer to machine capable of carr
ying out a series of complex actions automatically for many
purposes, such as helping in the home with domestic tasks, acting as a personal assistant for
bed transfer. In UK, most assistive technology is fairly basic even in remodelled buildings.
Telecare,

especially alarms and sensors, is high on the agenda of government social care
policies but telemedicine is rarely applied for older people at this stage.


Developments in alarms, monitors, and sensors have great potential for addressing safety and
securi
ty needs, but do not address many of the other needs that arise from mobility or
cognitive limitations. Moreover, all the technology in the world in terms of monitors and
alarms can be provided but it’s still essential to have human response back
-
up. It is

suggested
that technology has to be considered as part of other services and that there is a danger in too
much faith being put in technology to the exclusion of human support.


There are various factors and limitations affecting the use of technology suc
h as differences
between generations, users’ acceptability, safety, usability of the AT and etc. There is a need
Page

10


for guidance about the use of AT and to explain to older people what it is and how it works. It
is also clear that AT needs to be introduced be
fore people are too old, when it may be more
difficult to learn new and quite complex procedures, in order to provide benefits as
monitoring and alarm systems in later years. The key importance of AT is design for all and
the need for simplicity, and it is

expected to be compact, simple to operate, maintain, and in
response to the needs of the older person.

In the conference, several symposia of the programme presented the current developments of
domotics that supporting ageing in place in the community, w
hile some of them are tailored
made for person with dementia (PwD). There are also papers about the ongoing research and
development of fall preventive measures, such as hip protectors, compliant floor materials,
fall detective and analysis system, as well

as advanced wheelchairs for tackling the mobility
limitations encountered by older person.




Page

11


Topic: Active and Passive Monitoring Technologies to Support Aging
-
in
-
Place


Monitoring technology, a kind of telecare, has evolved to provide the potential for

focusing
on personal needs of the individual who requires monitoring by providing information about
health and functioning that supports and assists them to maintain independent living in the
community. Monitoring aids worn by the user and passive monitor
ing systems embedded in
the user’s living space were introduced in the symposium.




Mobile monitoring to support independence and safety

(Monitoring aids worn by the user)


AFrame Digital, Inc, (Crump) a research
-
based mobile technology company
(http://ww
w.aframedigital.com), has developed a ‘Personal Help Device’, called ‘myPHD’. It
incorporates passive and active monitoring, as well as software
-
based data analysis and web
access. The myPHD is intended to be worn 24 hours a day and monitors an individual’
s
activity, location and physiological status in real time, indoors and outside and may take the
form of a wristwatch or under
-
bandage device, to meet the needs of the monitored individual.


The data collected include location information, impact detectio
n, skin and ambient
temperature, health surveys, blood
-
oxygen saturation, heart rate, blood pressure and weight.
Some of the data will be measured using the AFrame myPHD watch monitor. The device was
also tested to detect falls and monitor changes in gait.

The wireless, third party devices that
are part of the AFrame system used for this study will include a pulse
-
oximeter, which
provides both heart rate and blood
-
oxygen saturation level, a weight scale, a blood
-
pressure
cuff and a user
-
friendly device for
responding to a daily health questionnaire.


The goal is to be able to continuously and non
-
intrusively monitor individuals to prevent falls
and the medical complications that follow. Caregivers or managers have a mobile
touch
-
screen device to receive alerts and check activity and health data. AFrame

Digital is a
technology company delivering intelligent, nonintrusive, and secure wireless wellness
monitoring and alerting solutions to senior living communities, rehabilitation facilities, and in
the home. The AFrame Digital system is FDA
-
cleared and in
use in several long term care
facilities and independent residences. The company is actively engaged in research in
collaboration with the Defense Advanced Research Projects Agency, Brooke Army Medical
Page

12


Center and Walter Reed Army Medical Center in US to su
pport the recovery of wounded
warriors and veterans in outpatient and home settings.






Passive monitoring to meet individual health and safety needs


(Passive monitoring systems embedded in the user’s living space)


WellAWARE™ (http://www.wellawaresyst
ems.com) is a system that provides unobtrusive
monitoring services that empowers families and professional caregivers with information
about potential health concerns. This solution (Mack) enables caregivers, both professional
and personal, to monitor the
daily activities of cared for individuals and subsequently provide
a more proactive approach to care. The empowerment of families and professional caregivers
is accomplished through the system’s ability to provide trend
-
oriented data, which is then
compare
d to individualized baseline information. From this data, caregivers gain insight into
a monitored individual’s wellness and can adjust care planning accordingly. Caregivers
(whether family members or health care professionals) can expand and improve care
delivery
to seniors with WellAWARE by:




Monitoring key wellness indicators, such as eating, sleeping, bathing, activity, toilet use,
and psycho
-
social aspects by Wireless Sensor Array



Interpreting the trend analysis and pro
-
activity intervening to minimize

serious medical
complications from undetected acute or chronic health conditions by Data Manager as
well as the Capture Analysis & Reporting Engine.



Delivering reassurance to families and partnering with caregivers by providing frequent
status updates on
the well being of monitored individuals



Enabling cared for individuals to live independently as long as possible


This system has partnered with Volunteers of America and The Evangelical Lutheran Good
Samaritan Society to offer caregivers assistance in ma
king the lives of others easier. It was
designed for whether a person needing care lives in their private home, an Assisted Living
Community, a Memory Care Neighborhood, or perhaps a Group Home.





Integration of active and passive monitoring technologies i
nto care services

The major intention in developing passive and active monitoring technologies has been to
Page

13


support safety, serve health needs and provide medical monitoring, creating a ‘medical home’
(Parker). There is increased interest in helping people
to ‘age
-
in
-
place’, where they are living
in the community, to avoid the personal and public expense of nursing home or hospital
placement. Development of information and communication technologies (ICT) and data
driven practices facilitate the connections
and communications among electronic health
record of medical care sectors, supportive service records of social sectors and personal
health records of clients. After the symposium, it’s identified that there was potential for the
existed systems of the two

companies (Aframe Digital & WellAWARE) to work in hands to
formulate comprehensive system and service network as the support of aging
-
in
-
place for
older people at home environment.




Activity Monitoring and Sensors

A system (Alexander et al.) comprised of
motion sensors and density map designed to serve
this purpose was introduced in the programme. Motion sensors were placed throughout the
apartments of 17 residents living in an independent care facility. Density maps were produced
which depicted the level
and intensity of movement, activity and time away from home.
Graphic representations of movement, including location and intensity of the movement and
a time recording of when the movement occurred were captured with the system. Through
retrospective analy
sis of the data, and using the early illness detection model, activity pattern
changes were identified in residents who experienced physical and mental health problems,
for example changes in the patterns of bathroom activity may be related to abnormality
of
continence.


There was another presentation of system adopted a holistic approach to monitor and manage
three of users’ most frequent health
-
related activities, which include diet, exercise and
medicine intake, with a combination of wearable and enviro
ment sensors. It’s proposed that
with an innovative interface built on the service
-
oriented architecture (SOA) with web
services and OSGibundles, the resulting health mangement system is integrated at the data,
service and knowledge levels.


In addition
to innovative development of interface for information integration, it also
introduced advanced algorithms for activity monitoring among seniors living single in their
private homes. The sensors integrated inactivity alarms & false alarms concepts in the s
ystem.
The authors (Floeck & Litz) gained extensive experience in sensing human activity using
Page

14


off
-
the
-
shelf sensors in an ambient assisted living project in Germany. Both wired and
wireless sensors were used, e.g. door and window contacts, digital wall sw
itches and motion
detectors. Activity from motion detectors is referred to as indirect activity because it is not
generated by intentional actions of the tenant, whereas interactions with objects (i.e., doors,
switches) are considered direct activity. To g
uarantee self
-
determination, each user can
decide whether and how inactivity alarms are triggered in his flat. If the user does not cancel
the inactivity alarm within a set time, it is forwarded to an emergency hotline taking further
steps to safeguard the

safety and health of the tenant. Ongoing research directs to program an
assistant that helps users to establish more sophisticated alarm rules (e.g. time
-
dependent
thresholds) and that automatically adapts to changing user behaviors (e.g. winter vs summer
).




The application of Interactive voice response (IVR) systems in telecare for seniors

Interactive voice response (IVR) systems use computer
-
based voice recognition and software
algorithms to allow human/computer interactions. In the context of health car
e, IVR systems
have the potential to improve efficiency and maximize the use of health care resources.
However, in general, older people hate to interact with IVR systems due to many limitations
and barriers (Messier et al.). In response to presented probl
ems, various possible IVR systems,
such as guided IVR and assisted IVR may help.


In guided IVR, a real person monitors many IVR interactions at the same time and intervenes
to ‘help’ the IVR system by interpreting parts of the human conversation for the
computer if
there is a miscommunication. In assisted IVR, while most of the conversation is recorded and
automatically interpreted by the computer, a real person scores some problematic interactions
after the fact. Finally, we describe strategies to adapt
IVR systems and ‘conversations’ to
specific subgroups so that the IVR conversation is closer to what is expected by the user. IVR
system could also be adapted to people’s physical limitations, cognitive abilities and social
background. In older people, som
e of the important factors are speed of speech, choice of
words and expressions, number of choice, and quantify of information in each step. In health
service, two main applications are currently used in Canada. The first one is a delivery
system for healt
h information. The second one functions as a triage agent. People are
evaluated for their need of immediate medical attention and calls can be switched to attending
health practitioners. System can also be designed to forward the information gathered by th
e
IVR system to the person’s physician and/or medical team using web interfaces or e
-
mail.


Page

15




Domotics and Robotics for Supporting Seniors with cognitive impairments

The advent of wireless networks, miniature sensors and embedded systems has resulted in
rapi
d advances in domotics to make aging in place more feasible than ever. Many
applications of domotics and robotics in support of aging involving sensing, actuation and
user interactions have been prototyped or tested in real setting. Domotics is the field w
here
housing (domus) meets technology in its various forms (informatics, but also robotics,
mechanics, ergonomics, and communication) to provide better homes from the point of view
of safety and comfort. It’s highlighted that the challenges these applicati
ons facing and have
to be further tackled in future studies are the cognitive impairments in older adults, such as
person with dementia (PwD).




Page

16


Topic: Multi
-
dimensional approach in designing smart living space for ageing people
having physical and dementia impairments


In order to achieve the aim of helping people with mild dementia to have greater actual and
perceived autonomy and improved quali
ty of life, CogKnow (Mokhtari), a monitoring and
prompting system, helps sufferers navigate through their day. Through cognitive
reinforcement, its aim is to assist people to remember, maintain social contact, perform daily
life activities and enhance thei
r feelings of safety. CogKnow FP6 project
(http://www.cogknow.eu) aims to achieve a breakthrough in the development of a successful,
user
-
validated cognitive prosthetic device with associated services for people with mild
dementia. CogKnow are addressing t
his core objective by focusing on scientific and
technological objectives for the device, including:




Remotely configurable reminding functionality



Communication and interaction functionality



Supportive technology for performing activities of daily li
ving (ADLs), e.g., via voice
prompts



Abnormality detection and emergency contact

.

CogKnow provides services including:



location service with detailed information, both outward and home inside;



reminder service that will help these people enhancing their memory;



a set of services specially designed to guarantee and increase the security for both
patients and their carers and relatives;



contributes to keep their independence when they have to do
the daily activities life


The future direction of the project is the sensors of the person and living environment to be
interconnected or networked with the health care system and public facilities.




A fuzzy logic based context
-
aware reminder for elders w
ith mild dementia (Zhang et al.)


A hybrid context
-
aware reminding framework (HYCARE) was developed to help elders with
mild dementia improve their level of independence and quality of life, which is also a part of
the European project
-

CogKnow. The frame
work with a novel scheduling mechanism is
Page

17


designed which handles both synchronous time
-
based and asynchronous event
-
based
reminding services, as well as analyszed the possible conflict among different activities . In
other words, by quantifying the interru
ption degree of the “disruptive” activity and the
urgency of the planned activity via fuzzy logic. Then, through fuzzy logic reasoning, the
system generates an appropriate strategy to resolve the activity conflict and infer a proper
prompting time. In orde
r to facilitate the interaction between the caregivers and system, the
system also provides a simple software tool for caregivers to create and edit the reminding
services.





Holistic night
-
time care NOCTURNAL

(Night Optimised Care Technology for UseRs N
eeding Assisted Lifestyles)

NOCTURNAL (Augusto et al.) is another project focusing on how the use of technology,
such as the use of lighting guidance, simulated presence and verbal instruction, to assist those
with dementia during the hours of darkness, en
abling the client to remain in their own home
safely. This is a funded project under the Assisted Living Innovation Platform in UK.


This system aims firstly to develop new algorithms that detect changes in patterns of behavior
of person with dementia (Pw
D), understanding better the role of lighting to shepherd PwD
and the role of bedside music therapy to alleviate feelings of anxiety and disorientation. Then
it also provides time pacing during the day in an attempt to regulate sleep patterns and
dissuade
excessive daytime napping. The time pacing will comprise: easy wakening,
structured music and reminiscent (photographs) therapy sessions delivered via digital TV.
These will be scheduled at a time to suit PwD and carer (via a carer schedule interface).
NOC
TURNAL is designed to provide lighting guidance to assist with the trip from bedroom
to toilet (and back!) during the night. It will utilize current bed switch, toilet switch and PIR
sensors to accomplish this. In addition the digital TV can be used to pro
vide a simulated
presence and to provide reassuring instruction. If the PwD is guided by the instruction and
returns to bed, as appropriate, then NOCTURNAL has achieved its purpose, otherwise an
alert can be sent to the carer (or to a remote monitoring sta
tion, if applicable).


NOCTURNAL builds upon the findings of survey that illustrated solutions using technology
to assist PwD with a holistic approach and an emphasis on night
-
time assistance. This project
is in the stage of seeking and interoperating ambi
ent solution, using tried, tested and familiar
technology where possible to provide lighting guidance, simulated presence and verbal
Page

18


instruction, all of which have merit in the hours of darkness.


On the other hand, a pilot study (Spreeuwenberg et al.) in

a Dutch nursing home indicated the
potential effects of dynamic lighting on the day
-
night rhythm of clients with psychogeriatric
disorders. A programmed lighting system may be developed as a tool to influence the
day
-
night rhythm of PwD.




Location based t
echnology for memory impaired elderly

The available location based technologies (door alarm systems, GPS or RF based location
devices, GSM camera system and short range RF communication device) could be divided
into three types: those that operated within

the home, devices used in close proximity to the
home (e.g. garden), and devices for use outdoors at arbitrary distances from the home. In
Finland, a study (Perala et al.) was conducted to investigate the effectiveness of the location
based technologies w
hich are suitable for use by elderly persons with memory impairment
that are prone to wandering. Following are the implication and constraints of the geolocation
application found:



No satisfactory devices were found for use outdoors in close proximity to t
he home as
too many false alarms triggered.



The technologies should be installed when the elderly is at the early stage of dementia



At later stages of dementia, it is usually impossible for the elderly to adequately adopt
the device.



This is a major
challenge, as the elderly themselves might not recognize early stage
dementia and will reject tracking devices.



It will be too late to implement new devices if the elderly person was not acquainted
with them at an early stage of the disease.


For facilitat
ion of the advanced development of geolocation services for the elderly, LocSys:
Localization framework for smart spaces (Abdulrazak et al.), is the solution that has been
deployed and tested in different scenarios in DOMUS lab (DOMUS laboratory is a
multi
disciplinary lab aimed at research in DOmotics and Mobile Computer Science and
located at Université de Sherbrooke in Canada), which is a highly interfered environment due
to multitude of sensors and heterogeneous technologies. It provides location estimat
ion at the
interval of five seconds up to 0.8 meters estimation error. The components of this architecture
are implemented using Open Services Gateway initiative (OSGi). Experiments results show
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19


the efficiency and dynamicity of architecture. LosSys framewo
rk enables quick development
of assistive applications in various smart environments. It is infrastructure independent and
supports various technologies. The components of this architecture are highly distributed to
deal with limited computational and memo
ry resources of client devices.




Computer & online games to enhance brain fitness in senior citizens


It is highlighted the potential for using technology to extend the retained abilities of people
with dementia (PwD) while minimizing their impairments. T
he aim of the Computer
Interactive Reminiscence and Communication Aid (CIRCA) project was to develop a
multimedia computer system to encourage interactions between PwD and a caregiver.
“Living in the Moment” (Astell) is a project emerged from the work deve
loping CIRCA. It
enables and supports PwD to use a touch screen computer independently. PwD can enjoy
immersive and engaging computer games, as well as to experience Flow, sense of autonomy
and control. The touch screen system enabled PwD to participate in

positive interactions as
equal partners. In “Living in the Moment”, PwD participated as partners in the research,
providing feedback and suggestions on all of the activities at each stage of the project.



There is significant interest in the use of cogni
tive exercise and social stimulation to increase
cognitive reserve and slow down mental aging. “Serious” (Baecker et al.) is an online game
project which is equipped with game development toolkit and programming language to
facilitate the design and implem
entation of a large variety of board and card games; Table
Talk Poker, an online Poker environment that allows and encourages players to communicate
privately via voice chat with partners who could be peers or mentors (make use of Skype).
There is a mental

fitness games testing environment for running over the internet.




The InterCultrual Online Health Network (iCON)


Technologies can be brought into full play for a technology
-
supported education and patient
engagement strategy aimed at improving quality o
f life for dementia patients and their
caregivers. The limited availability of accessible and reputable we
-
based resources is
amplified by language barriers and cultural disconnects, particularly within non
-
English
speaking communities across Canada. Recog
nizing this gap, the eHealth Strategy Office at
the University of British Columbia’s Faculty of Medicine integrated digital media and
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20


informatics with healthcare to optimized dementia care within the Chinese
-

and
Punjabi
-
speaking populations of Metro Vanco
uver.


iCON used a multi
-
channel engagement strategy of linguistically and culturally appropriate
public education events, online support materials, as well as printed companion materials
made available through the health authorities, at public events and
physicians’ offices, to
promote mutual ownership and partnership (Ho et al.). This approach incorporates
intergenerational learning in public engagement through media promotion and health
professional students from the University of British Columbia. The l
ive forum component
reinforced the advantages of collaborative learning between family members, caregivers and
those with dementia via the iCON website, its resources and dialogue regarding
self
-
management and dementia care.


Findings of the project evalua
tion indicate that these resources support patients and their
families in living healthier lives, with desire to learn more about prevention and symptoms of
illnesses, to develop the ability and capacity for effective management and prevention
practices.




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21


Topic: Technology for the Prevention of Fall
-
Related Injuries among Older Adults


Falls are the primary cause of injuries and injury
-
related deaths in older adults. Two
directions to the prevention of falls are: 1) Developing technologies (such as weara
ble
sensors and video
-
based networks) for providing objective, real
-
time data on the cause and
circumstances of these events; 2) The need to develop, implement, and evaluate improved
technologies (such as compliant flooring and active wearable hip protecto
rs) for reducing the
risk for injury in the event of a fall.




Video capture of the causes and activities associated with real
-
life falls among older
adults residing in long
-
term care (LTC)


Most falls are no witnessed and self
-
recall of these events is oft
en unreliable. Accordingly,
we have little understanding of the true cause and circumstances of falls and how these
associate with physiological and environmental factors. A research team (Robinovitch et al.)
have worked with two LTC facilities to collect
video footage of 184 real
-
life falls occurring
in common areas (for instance, dining rooms, hallways) used a structured questionnaire to
determine the cause and circumstances of each fall captured on video. These results challenge
current assumptions regar
ding the cause and prevention of falls in older adults residing in
LTC. Following table summarised the findings:


4 Most frequent cause of fall





4 Most frequent activities at the time
of fall

1)

Incorrect transfer or shift of body weight (51%)

1)

Walki
ng forward (26%)

2)

Trip or stumble (22%)

2)

Standing quietly (22%)

3)

Hit or bump (21%)

3)

Sitting down or lowering (16%)

4)

Loss of support with external object (13%)

4)

Getting up or rising

(13%)




Capturing the cause and circumstances of falls through wearable sensors


Wearable sensor arrays (for instance, accelerometers) represent a promising technique for
determining the cause and circumstances of falls in high
-
risk individuals. Previous

studies
have shown that the occurrence of a fall can be sensed reliably from the high acceleration
generated at impact. This study (Aziz et al.) extends the research by developing and
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22


evaluating a sensor array system for determining the cause of several k
inds of fall. It’s found
that inertial sensors from three body location (two feet and sternum) provided at least 96%
sensitivity in classifying the three types of falls, including slips, trips and others. Therefore,
future study is to utilize miniature ine
rtial sensing technology to characterise postural stability
during daily activities and capture the exact cause and circumstances of falls in an ambulatory
fashion.




Update on wearable hip protectors and compliant flooring for fracture prevention


Wearable

hip protectors (padded undergarments) and compliant flooring represent promising
strategies to decrease impact force and fracture risk. However, clinical trials have yielded
conflicting results on the effectiveness of existing hip protectors. This likely
results from poor
compliance among users in wearing the device (often less than 50%) and the results from
biomechanical studies showing that most available hip protectors reduce the force applied to
the proximal femur by less than 30%. These two issues can

be addressed by the design of a
rapidly deploying ‘airbag
-
like’ inflatable device, which should provide much greater force
attenuation while maintaining a much slimmer profile when uninflated (Sims
-
Gould et al.).
Below are the proposed directions of furt
her development of hip protectors:

1)

To be integrated with status monitoring functions to provide information on

a

User compliance in wearing the device

b

The occurrence and severity of impact to the protector

c

Positioning of the device

2)

Comfortable
enough to avoid skin irritations

3)

Does not impede washroom activities to avoid compromised continence

4)

Water proof

5)

Durable

6)

Different options for different residents

7)

Educate carers about the use of the devices and to be the ones encouraging th
e use

An alternative to hip protectors is to reduce the stiffness of the floor. This passive
intervention requires no decision on the part of the user and therefore 100% compliance.
However, large reductions in floor stiffness would likely be counter
-
produ
ctive due to their
negative effects on seniors’ gait, balance and the use of walkers or other mobility aids,
impacts on other users, such as impeding the use of rolling lifts or other architectural issues.
The best existing floor for fall risk reduction fo
und in the study is play ground tile (Feldman
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23


et al).





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24


Topic: The advance of wheelchair mobility in older adults


For a growing number of older adults, power mobility devices (PMDs), which include power
wheelchairs and, more recently, scooters, represen
t the only alternative to independent
mobility, since 59
-
76% of those above 65 years of age cannot self
-
propel manual
wheel
-
chairs.



Power mobility use among community living older Canadians: Predicting the impact on
new and experienced users.


The concept
of life
-
space mobility, defined as the area through which a person moves over a
period of time, has been used to characterize how far, how often and with what type of
assistance older adults move around in a continuum of environments. A study (Auger et al.
)
found that the life
-
space mobility (measured by Life Space Assessment composite score) of
the PMD users was no significant difference between the initial stage (first 1
-
6 months) and
expert stage (12 to 18 months). The life
-
space mobility increase after
PMD procurement and
appears to be stable across the stages of initial and expert use. However, factors such as
gender, the nature of activities and device type explained variance (15.9
-
18.0%) in the
life
-
space mobility. To appreciate the impact of PMDs, cl
inicians should consider the
environment and a combination of personal and devices factors that are associated to the
range of life
-
space mobility in the first 18 months of use.





The future of power mobility: Intelligent wheelchairs


Power wheelchairs are

commonly prescribed to enhance mobility in the older adult
population. However, safe operation of these wheelchairs requires drivers to have minimal
cognitive impairment. In almost all cases, older adults with significant cognitive impairment
are not pres
cribed a power wheelchair resulting in reduced mobility, increased dependence on
caregivers, and a decreased quality of life. In order to address this problem, an intelligent
wheelchair (Viswanathan et al.) is developed that can automatically detect obstac
les in the
driver’s path and prevent collisions. In addition the system will enable users to navigate to
desired destinations in a timely fashion, by issuing adaptive audio prompts. It’s shown that a
stereovision camera can be used for obstacle avoidance.



Preliminary work has been completed in using floor plans of homes and the objects recognize
Page

25


within them to automatically label specific regions of interest, for instance, kitchen and
bathroom. These labels can be used along with the driver’s daily schedule to determine the
desired location at a specific time. Further data needs to be collected to

incorporate
information about the user’s wheelchair driving patterns and speed. In addition, the model
must be extended to include various levels of prompting. For example, users with mild
dementia might require simple reminders, while more detailed promp
ts might be necessary to
assist users with severe dementia.





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26


Topic: Technologies for caregivers of frail elders


Geoff Fernie
, the Vice
-
President (Research) of Toronto Rehabilitation Institute (Canada),
highlighted that the most significant challenge to enabling more frail seniors to continue
living in their own homes as they age is to invent affordable new products and services

to
help their informal caregivers. It’s because family caregivers will become largest component
of health system manpower. Technological products should be designed to address the most
demanding tasks for caregivers including assisting with mobility, toil
eting, bathing and
dressing. Heavy lifting is one issue needed to be tackled as nurses are injured more than any
other workers and most family caregivers struggle to lift their loved ones.


Robots for heavy lifting

Environmental factor is one factor of he
alth according to the International Classification of
Functioning, Disability and Health (ICF1), and therefore health
-
designed environment should
embed the spirit of designs for all and aged friendly.



Reference: ICF International Classification of Funct
ioning, Disability and Health. Geneva:
World Health Organization; 2001.



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27


Selected presentations:


Wireless Sensor Assisted Care and Point of Care Documentation in a Long Term Care
Facility


The p
urpose of "Wireless Sensor Assisted Care and Point of Care D
ocumentation in a Long
Term Care Facility’’ is to prevent pressure ulcers, measures including repositioning schedules
should be initiated. More than one third of adults 65 and older fall each year in United
States. Among older adults, falls are the leadi
ng cause of injury deaths and are the most
common cause of nonfatal injuries and hospital admissions for trauma. The rates of
fall
-
related deaths among older adults rose significantly over the past decade. In skilled
nursing facilities many of these fall
s occur at night and are the result of elderly persons
attempting to ambulate without assistance.


The method is a novel fiber optic sensor can detect levels of movement as a risk factor for
development of pressure ulcers or falls. Long term care focus gr
oups were interviewed and
a system was developed:


i)

Resident location: In / Out of Bed

ii)

Movement level as indicator of risk for pressure ulcers (low movement) and falls
(high movement).

iii)

Caregiver presence and activity at bedside.

iv)

Automated documentation of r
esident and caregiver activity.


This system was optimized to permit non
-
invasive, continuous monitoring for risk of pressure
ulcers and falls. It provides a personal digital device prompting caregivers to perform ADLs,
respond to critical situations and
permit Point of Care Documentation of caregiver and patient
activities. It permits monitoring of patient movement in bed. Sensor data can be analyzed
with clinically useful information provided to the caregiver’s personal digital device prompts
such as ‘
’ Turn Patient ’’, ‘’ Fall Risk ‘’ or ‘’ Patient Out of Bed ‘’.









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28























It can be concluded that monitor and detect decreased movement as risk for pressure ulcers
and increased movement as risk factor for falls. Besides that, alert caregivers that actions
are needed at the bedside. It can document conincidental user activity

with sensor data and
automate documentation of caregivers at bedside.



Development of multi
-
camera gate for fall detection in nursing home with face
-
recognition


The purpose of this system is to prevent falls in corridors in nursing homes and to spend
time
in as dayroom by many residents with dementia. Therefore, many falls occur in the corridor.
These incidents are mainly detected by the care staff, but sometimes delayed. It is necessary
to detect these incidents earlier. So, a new and multi
-
gates
system which can detect these
incidents automatically with face
-
recognition.


The method is a multi
-
camera gate system is developed. The gate has a PC and 5 cameras
which are composed of 2 front cameras, 2 side cameras. The PC analyzes images sent from
Page

29


eac
h camera with a face
-
recognition technology and detects incidents such as a fall by the
position of the tenants’ heads.


As a result, accuracy of the face
-
recognition and fall detection was confirmed with our
developed camera gate.
The gate detects the fall based on the head position and face
identification and the ceiling camera detects moving bodies as residents. So, the other
cameras recognize faces of moving bodies and identify individuals. The gate measures
3D
-
positions of face
s in the detection space and if the face position drops or the face cannot
be recognized, the gate detects it as the fall.
















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30


(
c
) Observation / Implications to Hong Kong / Recommendations


What is the contribution of technology to ageing
-
in
-
p
lace in HK?


1

New concepts / services / experiences which are relevant to local conditions


“Gerontechnology” is not a familiar term to people in some places e.g. Hong Kong. It comes
from the words of “Gerontology” + “Technology” in fact. Gerontechnology

is a very
large
-
scare interdisciplinary research field on technology, such as mechanical engineering,
architecture, information science and technology, robotics and etc., as well as human aging,
such as aspect in medicine, physiology, psychology, sociolog
y and etc. It’s devoted to the
fundamental aspects of technology to serve the ageing society in the areas of 1) disease
prevention by controlling natural aging process; 2) compensation for declining functions by
using assistive technologies (AT); 3) enhanc
ing daily lives in fields of leisure, socialization
and communication.


In HK, basic assistive technologies are common in hospital and facilities of elderly residential
care service, such as barrier
-
free access, hoist, grab
-
rails, bed
-
alarm, walking aids
and so on.
However, for older people who are living in the community, the accessibility and application
of assistive technologies is very limited. The AT which we are most familiar with are walking
aids, wheelchair, home modifications or environmental adap
tations, and the personal
emergency link service for older people who are remain living in their own homes.


It’s well
-
recognised that there is increasing number and proportion of older people living in
the community with limitations in mobility, dexterit
y and mental capacity all over the world.
If not enough assisted living supports are provided for the older people at homes, they soon
have to turn to residential care. The International Society of Gerontechnology gave
prominence to the contribution that a
ssistive technology can make to help older people
remain living in their own homes with the recent developments in electronics have increased
the potential for AT to support people, through the use of sensors, robotic devices and remote
control device.


I
n the program, as mentioned in part (b), some research and development bodies presented
the current developments of domotics that supporting ageing in place, while some of them are
Page

31


tailored made for person with cognitive impairments. Domotics is the field
where housing
(domus) meets technology in its various forms (informatics, but also robotics, mechanics,
ergonomics, and communication) to provide better homes from the point of view of safety
and comfort. Most of domotic systems introduced are prototype or

at the initial stage of
deployment and commercialization, and therefore they cannot be immediately put into
practice locally. However, the new information inspire us to plan ahead to further develop
and coordination of the existed resources, as well as to

prepare and ready for the coming
technologies that flavour our elderly to be aging
-
in
-
place in the community.


2

Comparison between overseas experiences and that of HK

With reference to the results of a survey about the elderly profile conducted in 2008 by

the
Census and Statistics Department of HK, 96.4% of the interviewee did not plan to live at old
age home and 81.4% of them still prefer staying at home even if their health condition getting
worse. Internationally, it’s concerned with increasing the opti
ons for older people to stay in
homes of their own because of their personal preference and economical implication of the
growing demand of institutional care. In HK, there is more pressure to do this because of a
higher proportion of older people (aged 65

and over) in institutional care (6
-
7%) compared
with that of other countries around the world (3%). It is a hot issue to review research and
practice into alternative models of care for elderly people, specifically those that may allow
more dependent elde
rly people to remain living in community settings rather than in an
institutional setting.

According to studies on the topic of aging
-
in
-
place of foreign countries, alternative models to
institutional care explored are co
-
resident caring, home care, very
sheltered housing and
assistive technology. In HK, home care services become increasingly high on the agenda of
government social care policies while assistive technology is minimally applied for elderly
services at this stage. Since the past decade, there

have been increasing numbers and scales of
community and home based elderly services, such as District Elderly Community Centres
(DECCs), Neighbourhood Elderly Centres (NECs), Enhanced Home and Community Care
Services (EHCCS) and Integrated Home Care Serv
ices (IHCS) by NGOs; the out
-
reach
medical teams, existing and upcoming chronic disease management programs by HA. All of
the above services are labor intensive but still very mere for the older people in terms of
support and monitoring, especially for tho
se with cognitive impairments, compared with
those around the clock care provided by institutions.


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32


3

Recommendations on introducing these services / ideas to HK

Benefit from the current research and development of information and communication
technology (
ICT), in addition to home care, telecare could be further invest and develop to
contribute to ageing
-
in
-
place in HK. Regarding the local existed telecare services, the call
and care service, including the Personal Emergency (PE) Link Service provided by th
e Senior
Citizen Home Safety Association (SCHSA) should be the most popular. What’s more, it’s
Mobile Link Service has won the Global ICT Excellence Awards recently. Mobile Link
Service is an outdoor support and care service specially designed for senior c
itizens, and was
co
-
launched by SCHSA and CSL Limited (CSL) in December 2008. The service enables the
elderly to enjoy active lifestyles in their communities with total peace of mind. The two
parties also launched “Safety Phone”, which runs on the Mobile L
ink Service platform, in
March 2010. The Senior Safety Phone Project provides seniors with an aged
-
friendly cell
phone which is also equipped with the functions of Mobile Link device as SCHSA’s call
centre can identify the approximate location and pathway
of movement of the Safety Phone.
Tele
-
health Link is another new value added service to the PE Link users started operation in
January 2008. The service is piloted in collaboration with the Hospital Authority and local
hospitals. It consists of 3 service c
omponents, Post
-
discharge Tele
-
health Advice, Health
Advice Hotline and 24
-
hr Transmission of ePR (Electronic Patient Record).


The current local development of ICT and data driven practices facilitate the interconnections
and communications among the ele
ctronic health record of medical care sectors, supportive
service records of social sectors and personal health records of clients. With reference to the
well deployed active and passive monitoring technologies presented in the conference, such
as the AFra
me Digital system, WellAWARE™, CogKnow and context
-
aware reminding
applications (HYCARE), there is still much possibilities and opportunities for HK to further
develop our telecare services with those more advanced systems or devices in order to
support sa
fety, actively detect abnormality such as falls, serve health needs and provide
medical monitoring, creating a “medical home” for our elderly. The advent of wireless
networks, miniature sensors and embedded systems has resulted in rapid advances in
domotic
s to make aging in place more feasible than ever. For person with cognitive
impairments, some of the applications even embedded the functions of cognitive
reinforcement or navigation with an aim to assist people to remember, maintain social contact,
perfor
m daily life activities and enhance their feelings of safety in future.


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33


4

Problems and difficulties to be encountered if applied to local practices

Hong Kong encounters the similar factors and limitations affecting the use of technology as
other places arou
nd the world did. We have great differences in the knowledge and
experience with technologies between generations. We have to consider users’ acceptability,
safety, usability of the AT and etc. There is a need for guidance about the use of AT and to
explai
n to older people what it is and how it works. It is also clear that AT needs to be
introduced before people are too old, when it may be more difficult to learn new and quite
complex procedures.


Domotic elements are heterogeneous in all aspects. One day
if the market shares and
demands of the local telecare services expand and the devices come from different vendors,
have different hardware, network interfaces, and operating systems, there would be a problem
and need to interoperate. So the challenge for
the home is total interoperability. If telecare is
applied locally for home care support in the long run, it’s important to conduct serious
investigation for identifying appropriate domotic system based on the degree of openness,
scalability, heterogeneity

and on the type of topology, which directly affect the
interoperability, communication and coordination among the systems. It’s also challenging to
ensure confidentiality and protection against the transmission of malicious queries, as well as
to integrat
e the sensor network, with the administrative and medical data available in the
domotic and hospital networks.




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34


(d) Evaluation of the Event Organization


1

Arrangement of the organizer

The International Society for Gerontechnology's

7th World Conference is the principal
multi
-
disciplinary meeting for professionals working in the field of gerontechnology and this
is the first time it has been held in Canada. The conference was hosted and organized by the
Simon Fraser University Geront
ology Research Centre (GRC) and an international scientific
committee comprised of distinguished researchers and practitioners from across the world
rounds out the team. This conference did bring together researchers from around the world,
who are working
in the area of gerontechnology, to present the results of their research and
assess the implications for the development of practical solutions to the needs of older people,
family carers and care professionals. Generally speaking, the design of the websit
e, venue,
exhibitions, overall arrangement and logistics of the conference is satisfactory, except the site
visits arrangement as which costs extra charges in addition to the conference fee.


2

Area for improvement

Since many technologies or research introd
uced there were prototypes and have not been
commercialized as practical solutions yet, more presentations on the latest off
-
the
-
shelf
geretonological applications and illustration on their successful deployment strategies of
different countries are prefer
red.


On the other hand, with a key concern to move away from technology
-
push and
problem
-
focused approaches to researching technology and ageing to an approach that is
driven by gerontological theories and concepts, there were many challenges raised at t
he
conference: What are the important directions for research and development? How can we
ensure that older people benefit from these technologies? How can we ensure that some
people are not excluded from accessing these technologies? What are the potentia
l trade
-
offs
and how can these be avoided? How can we improve the design and development process to
ensure that new technologies are ‘user
-
driven’? How should we explore, visualize and map
out new areas of technology in order to exploit its potential? In f
act, the conference is just the
beginning of the debate on the above issues and all of them have to be tackled in the future
strategically. Therefore, the arrangement of additional open discussion forums on these
debatable agendas may be worthwhile for thi
s kind of world conference.


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35


(e) Conclusion


The overall experience of the conference is satisfactory. While learning and understanding
the various gerontechnological research and development overseas, it is
perceived

that the
context in which gerontechnol
ogy could be applied overseas is of much difference
compared
with local environment. The adaptation of technologies in elderly care
services

should
undergo a serious deliberation and the understanding of the needs of seniors of Hong Kong.


Furthermore, as mentioned above,
many technologies or research introduced were prototypes
and have not been

fully deployed in the market. Only few ready
-
made solutions were
featured and impact illustrated. More

illustration

on successful deployments and re
search
evidence would definitely beneficial to conference audiences and participants.