Designing Usable Technologies for Older Adults via Data-Driven Whole-Person User Personas

Using machine learning to create data-driven user personas for the design of usable technologies for older adults
Awardee Organization(s): University of Minnesota

Principal Investigator(s): Robin Austin, PhD, DNP, DC, RN-BC
Official Project Title: Designing Usable Technologies for Older Adults via Data-Driven Whole-Person User Personas
AITC Partner: PennAITech
Website(s): www.nursing.umn.edu

The long-term goal of this research led by Dr. Robin Austin at the University of Minnesota and her team is to improve health outcomes by combining whole-person patient-generated health data with EHR data, to inform clinical conversations, predict patient trajectories, and identify appropriate interventions. This research, Designing Usable Technologies for Older Adults via Data-Driven Whole-Person User Personas, will create a set of data-driven user personas based on data from 6 studies where 783 adults 65+ years old independently completed a comprehensive health assessment using the MyStrengths+MyHealth (MSMH) mobile app developed by Dr. Robin’s team. MSMH assesses 42 strength/problem areas (e.g., Income, Spirituality, Nutrition) divided into four categories (e.g., My Living, My Mind and Networks, My Body, My Self- Care). Individuals can specify any of 335 challenges (e.g., Hard to concentrate) and any of 4 needs related to each strength/problem area (e.g., Check-ins, Hands-on Care, Info/Guidance, Care Coordination). We will use machine learning approaches, clustering analysis and association rule learning, which are frequently used to develop user personas. These whole-person user personas will account for a 360 degree view of the person, meaning the environments in which individuals live, their psychosocial and physical health needs, and their strengths. This research will inform person-centered technology design and develop a better understanding of the types of older adults who may use AI-based technologies.

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Detecting Respiratory Distress in Patients with Advanced AD/ADRD Using Radio Sensors

AI-enabled near-field coherent sensing (NCS) radio sensors to detect respiratory distress for advanced AD/ADRD patients who are unable to self-report
Awardee Organization(s): Weill Cornell Medicine
Principal Investigator(s): Veerawat Phongtankuel, MD, MS
Official Project Title: Detecting Respiratory Distress in Patients with Advanced ADRD Using Radio Sensors
AITC Partner: PennAITech
Website(s): www.weill.cornell.edu

This project focuses on designing and developing conversational care technologies for older adults and their caregivers. In prior work, we surveyed informal caregivers and older adult care receivers to understand their care routines. Survey findings showed how nearly 20% of care partners used voice assistants in their homes, signaling an opportunity to extend research on older adults’ conversational technology use to include care partners. Next, we conducted a diary study and interviews with caregivers and care receivers to investigate gaps in care interactions and conversations. We found that care receivers experienced more communication frustrations than caregivers and that older adult caregivers wanted more opportunities to influence their care routines.
In this project, we will use these findings to develop in-home conversational technologies that use prompts to structure care conversations between older adults and their caregivers. We contribute a nuanced dyadic perspective to care relationships as most care research focuses solely on caregiver perspectives. We also extend conversational technology research beyond information seeking to include more social uses by developing conversational technology applications with mainstream voice technologies (e.g., Amazon Alexa) to support improved care relationships, social and emotional well-being, and quality of life.

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Determinants of Access to and Outcomes Following Specialized Palliative Care for Patients with ADRD

Awardee Organization(s): Palliative and Advanced Illness Research (PAIR) Center
Principal Investigator(s): Emily Moin, MD, MBE
Official Project Title: Determinants of Access to and Outcomes Following Specialized Palliative Care for Patients with ADRD
AITC Partner: PennAITech
Website(s): https://pair.upenn.edu/

As a supplement to the PennAITech program, we will link electronic health record data from all patients at the University of Pennsylvania Health System (Penn Medicine) with inpatient encounters from 2017-2023 to claims data from the Centers for Medicare and Medicaid Services (CMS) from 2018-2024. The central goal of creating these linkages is to identify determinants of access to and outcomes following specialist palliative care (SPC) for patients with ADRD and other serious illnesses. Engaging SPC clinicians in the longitudinal management of patients with ADRD and other serious illnesses is a key priority, yet patients with ADRD less commonly receive SPC than do patients with cancer and other illnesses, and more commonly experience hospitalizations and inadequate symptom control. To surmount these inequities in care delivery requires filling key knowledge gaps related to the extents to which patients with ADRD experience novel and more holistic patient- centered outcomes than have commonly been measured, and whether patients at risk for poor outcomes can be reliably identified so as to target SPC resources toward them.
We will achieve this central goal and address these knowledge gaps through completion of three specific aims. First, we will quantify differences in SPC consultation among Medicare and Medicaid beneficiaries with vs. without AD/ADRD admitted to Penn Medicine hospitals. We will first assess SPC access using the gold-standard approach we have pioneered of measuring signed SPC notes in the electronic health record (EHR), and second using the proportions with Z51.5 billing codes (“encounter for palliative care”) in CMS data. While this claims-based approach is commonly used due to its efficiency, there are many reasons to believe it may not possess favorable operating characteristics, thereby yielding biased conclusions when used as a measure of SPC receipt. Comparing its sensitivity, specificity, calibration, and other measures to our gold standard will elucidate this approach’s utility overall and specifically among patients with ADRD.
Second, we measure changes in calculating a key patient-centered outcome – hospital-free days (HFDs), or days alive and living outside a hospital through 6 months of follow-up – using only EHR data vs. supplementing with CMS data among patients with ADRD and other serious illnesses. We hypothesize that adding CMS data to EHR data will produce more robust and accurate quantification of this critical outcome relative to either method alone. Third, we will build an Artificial Intelligence (AI) model to predict which patients with (1) ADRD and (2) all serious illnesses are at risk for low numbers of HFDs, thereby guiding the allocation of SPC services in practice enabling prognostic enrichment of patients with ADRD in future trials of palliative care interventions using this endpoint.

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Feasibility of Digital Monitoring to Detect Autonomic Markers of Empathy Loss in bvFTD

Wearable sensors capturing digital autonomic biomarkers to detect empathy loss for frontotemporal dementia (bvFTD)
Awardee Organization(s): University of Pennsylvania Frontotemporal Degeneration Center
Principal Investigator(s): Emma Rhodes, PhD
Official Project Title: Feasibility of Digital Monitoring to Detect Autonomic Markers of Empathy Loss in bvFTD
AITC Partner: PennAITech
Website(s): www.med.upenn.edu/ftd
Loss of empathy is a core symptom of behavioral variant frontotemporal dementia (bvFTD) that negatively impacts daily functioning and is highly distressing to families and caregivers. Scientific research has struggled to understand the specific causes of empathy loss in bvFTD. A relatively unexplored but promising avenue of scientific inquiry is the role of autonomic nervous system (ANS) arousal in empathy loss in bvFTD. The ANS is comprised of two complementary subsystems, the sympathetic and parasympathetic nervous systems, which operate together to regulate an individual’s level of physiologic arousal in response to emotional cues from the environment. Patients with bvFTD show abnormalities in autonomic arousal that are linked to symptoms of social dysfunction, including loss of empathy, but this line of research has been hindered by reliance on traditional methods of measuring autonomic arousal, namely hard-wired EKG and skin conductance sensors, which restrict the movement of the patient and are sensitive to motion effects. Recent advances in wearable smartwatch technology allow for precise, unobtrusive measurement of autonomic arousal with built-in motion sensors that more accurately capture key arousal variables, such as respiratory sinus arrythmia and skin conductance. Use of smartwatch technology will advance our understanding of physiologic mechanisms of empathy loss in bvFTD and other neuropsychiatric symptoms in ADRD and identify potential treatment targets. The overarching goal of this project is to test the feasibility of using a smartwatch to capture abnormalities in autonomic arousal in bvFTD and validate digital markers of autonomic abnormalities against behavioral measures of empathy loss.
In this project, we will use these findings to develop in-home conversational technologies that use prompts to structure care conversations between older adults and their caregivers.
We contribute a nuanced dyadic perspective to care relationships as most care research focuses solely on caregiver perspectives. We also extend conversational technology research beyond information seeking to include more social uses by developing conversational technology applications with mainstream voice technologies (e.g., Amazon Alexa) to support improved care relationships, social and emotional well-being, and quality of life.

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Intelligent decision-making tool to connect individuals with AD/ADRD and their caregivers to health app technologies

Awardee Organization(s): University of Pittsburgh
Principal Investigator(s): Julie Faieta, PhD, MOT OTR/L
Official Project Title: Health App Review Tool: Connecting those Affected by Alzheimer’s to Needed Technology Support
AITC Partner: PennAITech
Website(s): https://www.shrs.pitt.edu/

The goal of this project is to connect those affected by Alzheimer’s disease and related dementias (ADRD) with effective apps using an intelligent decision-making aid, the Health App Review Tool (HART). The HART is comprised of a User Assessment and App Assessment, that together characterize the features of health apps relative to the needs, abilities, and preferences of individuals with ADRD and their informal caregivers. The HART assesses the goodness of match between user and app variables in order to guide app selection.
The first phase of this pilot project will be used to develop a web-base and app interface to house the HART. The dedicated interface is necessary in preparation for real-world and wide-spread use of the HART. There will be a user interface displaying the HART assessment questions, a back end that completes the scoring process, and a results display. In addition, we will establish a cloud-based library of app scores that can be downloaded and compared to new HART users in the future. The second phase of the project will be a usability study to gather feedback and insight on the HART interfaces for those impacted by ADRD.
The Health App Review Tool (HART) is expected facilitate clinicians, caregivers, and community organizations to select the best apps to meet the unique needs of individuals with ADRD and their caregivers. Improving access to person centered, easy to use technology guidance is intended to increase the impact and equity of app-mediated care.

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Leveraging Patient Portals to Support Caregivers

Using natural language processing to create an AI-based algorithm from EMR data to identify non-traditional caregivers who might benefit from dyadic interventions
Awardee Organization(s): University of Colorado | Kaiser Permanente
Principal Investigator(s): Jennifer Portz, PhD
Official Project Title: Leveraging Patient Portals to Support Caregivers
AITC Partner: PennAITech
Website(s): www.medschool.cuanschutz.edu/general-internal-medicine, www.kpco-ihr.org

Caregivers for people living with dementia (PLWD) make up a diverse group of individuals and can include family, friends, and paid direct care workers. Nearly 30% of caregivers in the United States report caring for a PLWD. While providing care to a loved one can be rewarding, some caregivers may feel caregiver burden and become self-neglectful (e.g., eating poorly, poor exercise habits), which have the potential to lead to poor health outcomes among caregivers. Caregiver-specific interventions are beneficial for improving mental health, confidence in caregiving, and self-care. However, caregivers often experience barriers to such interventions such as time and access. The objective of this pilot is to develop a data-framework for finding caregivers from the electronic medical record (EMR) who can benefit from caregiver and dyadic interventions. PLWD and their caregivers often receive health care services within the same healthcare system and their data hosted within the same EMR. Our previous work found that health outcomes, such as hospitalization, for caregiver-PLWD dyads living in the same household are linked. However, our current model is limited to caregivers living in the same household, often spouses, who share health insurance. Natural language processing can fill this gap by analyzing unstructured EMR data to find patterns among caregivers that will allow us to further identify non-traditional caregivers (e.g., friends, neighbors) and caregivers outside the home (e.g., adult children, extended family members). By automating the process of caregiver identification through the EMR, interventions can be more easily delivered to engage and support the caregiver.

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Multimodal conversational AI to assist older adults with daily tasks at home

Awardee Organization(s): Pennsylvania State University
Principal Investigator(s): Rui Zhang, PhD | Marie Boltz, PhD, GNP-BC
Official Project Title: Task-Oriented Multimodal Conversational AI for Assisting Seniors with Daily Tasks
AITC Partner: PennAITech
Website(s):
https://www.eecs.psu.edu/
https://ryanzhumich.github.io/

With a global population of over 1 billion people aged 60 and above, there is a rapidly increasing need for innovative age tech solutions to improve the quality of life of older adults. Conversational assistants, powered by cutting-edge technologies in Artificial Intelligence (AI), Natural Language Processing (NLP), and Large Language Models (LLM), are permeating into home care, assisted living, and nursing facilities for smart elderly care. One type of conversational assistant is task- oriented, which can significantly enhance the life experience for senior people by helping them with real-world complex daily tasks. A task-oriented virtual assistant facilitates daily tasks spanning diverse scenarios such as calling for help in response to emergencies, helping with online grocery shopping, recommending cooking recipes, managing smart home devices, and providing financial education and decision-making. It greatly promotes the life quality of older adults by improving their well-being, efficiency, safety, and independence. In this proposal, we design, develop, and deploy a task-oriented multimodal conversational assistant to help older adults with daily tasks. The innovation of this proposal lies in the fact that we will employ a human-centered participatory approach by emphasizing collaboration between designers and end-users through interviewing, prototyping, and testing to address their unique needs and preferences to improve their daily lives.

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Non-intrusive in-home activities of daily living monitoring using a self-supervised multi-sensor fusion model that detects behavior changes associated with AD/ADRD

Awardee Organization(s): University of California San Diego
Principal Investigator(s): Xinyu Zhang, PhD | Alison Moore, MD, MPH
Official Project Title: Non-Intrusive, Fine-Grained In-Home Daily Activity Transcription for Alzheimer’s Monitoring
AITC Partner: PennAITech
Website(s): http://xyzhang.ucsd.edu

Recent research identified a strong correlation between onset of Alzheimer’s disease (AD) and changes in fine physical activities, e.g., movement and dwelling time across locations, daily routines like medicine/water intake. Early detection of such indicators is crucial in compiling better treatment and slowing the progression. Conventional methods for monitoring the activities of daily living (ADL) rely on observation or self-report, which are time consuming, error-prone, and require strict patient compliance. This project aims to transcend such limitations and bridge the key technology gaps in bringing ADL sensing close to clinical practice. The project focuses on the development of EgoADL, a system that uses non-intrusive smartphone/smartwatch sensors to sense ADL. EgoADL builds on a novel self- supervised sensor fusion model that trains itself without user intervention. Instead of classifying among a small known set of ADLs, it directly transcribes raw multi-modal sensor signals into text logs of ADLs which can be interpreted by clinical practitioners or AI models. EgoADL will be the first to use non-visual sensors to transcribe fine ADLs (e.g., human-object interaction) with near-vision precision, in real-time and in a privacy-aware manner. The sensing data can facilitate follow-on clinical and AI analytics, potentially enabling early detection of chronic diseases and safe aging in place. Ubiquitous health monitoring is particularly important for rural and underserved communities, who either do not have access to or cannot afford prolonged hospitalization. EgoADL will be verified through a pilot study in UCSD’s and Upenn’s healthy aging facilities.

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Non-invasive AI-powered blood glucose monitoring device for older adults with diabetes

Awardee Organization(s): Kennesaw State University
Principal Investigator(s): Maria Valero, PhD, MsC | Katherine Ingram, PhD
Official Project Title: GlucoCheck: A Non-Invasive & AI-Assisted Blood Glucose Monitoring Device for Older Adults
AITC Partner: PennAITech
Website(s):
https://ccse.kennesaw.edu
Iotas.kennesaw.edu

The GlucoCheck project presents a significant advancement in the realm of diabetes management, with a specific focus on enhancing the quality of life for older adults. In light of the escalating global prevalence of diabetes and its associated complications, the imperative for non-invasive, accurate, and user-friendly blood glucose monitoring has never been more pronounced. Diabetes poses severe health risks, particularly for older adults, making effective and comfortable glucose monitoring paramount. Existing methods, characterized by frequent finger-pricking and subcutaneous needle implants, entail discomfort, infection risks, and potential tissue damage, particularly in individuals with diminished skin elasticity and compromised immune responses. GlucoCheck emerges as a pioneering solution, harnessing near-infrared spectroscopy (NIR) technology augmented by AI. This device offers a non-invasive means of consistently monitoring blood glucose levels by simply wearing it on one’s finger. Importantly, GlucoCheck integrates AI algorithms that adapt to individual skin attributes, including color and texture, enhancing precision across diverse demographics. This project’s core objectives encompass rigorous validation of GlucoCheck’s efficacy, with a primary emphasis on older adult demographic. Comparative analyses will be conducted, aligning GlucoCheck’s measurements with conventional blood glucose monitors to ascertain accuracy and reliability. Our mission is underscored by the desire to deliver an efficacious, user-centric device tailored to the unique requirements of older adults. The project’s outcomes will furnish valuable insights that drive refinements in GlucoCheck, propelling us closer to positively impacting the livesof millions of individuals grappling with diabetes.

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