Review articleInformation technologies for active and assisted living—Influences to the quality of life of an ageing society
Introduction
The World Health Organisation (WHO) identified the demographic change as one of the biggest challenges for the society in the western countries [1]. This trend is also intensively discussed by the European Commission who reported that the ageing population in its member states will have a tremendous impact on productivity and economic growth in future [2]. The population part of the member states aged 65 years and above will increase from 17.4% in 2010–29.5% in 2060. This could lead to a doubling of the ratio of dependent elderly (aged 65 years and above relative to aged 15–64) [3]. The ageing population will put pressure on the social care and health care systems and will lead to a reduced availability of care staff in the affected areas. To deal with these challenges information and communication technologies (ICT) and assistive technologies will play an important role to help people stay healthy and live independently at home for a longer time [1].
Within the European Commissions’ action plan ‘Ageing Well in the Information Society’ a program called ‘Ambient Assisted Living Joint Research Programme’ (AALJP) was established that has the aim to develop appropriate ICT solutions. The technologies shall improve peoples’ quality of life (QOL), increase health and enable them to live independently in their familiar environment as long as possible. The AALJP recently was prolonged within the research program Horizon 2020 under the term ‘active and assisted living’ (AAL) lasting from 2013 to 2020 [4].
The concept of ambient assisted living (respectively the new term ‘active and assisted living’) includes systems using ICT and socio-technical services in daily life and working environment to enable individuals to live an active, socially involved and independent life up to old age [5], [6]. The range of these technologies include very sophisticated and quite simple ICT solutions like smart home systems, applications in the field of tele-health, reminder functions, fall detection systems, videophones, video game and a lot more. They all have in common that their objective is to improve the QOL of the recipient or user. The majority of available studies and project outcomes of AAL-solutions deal with technical aspects and feasibility engineering and do not provide sufficient data or evaluation outcomes of the impact to the users’ QOL.
This is why the aim of this review is to analyse possible impacts of ICT-components, typically used in AAL-solutions, to the health and QOL of elderly. Due to the integrating and comprehensive character of AAL-solutions the content partially overlaps what means that selected papers may be discussed in several sections. Furthermore the evidence of the AAL-related effects to the individuals’ QOL was investigated by conducting a literature search of current AAL-projects. The pathways and associations between QOL and the impact of technology are reviewed and summarized according to the multidimensional model of QOL of the WHO [7]. Possible implications for further development and research in the field of ICT and AAL-solutions and QOL were discussed and recommendations issued.
In the field of health promotion ICT can play several roles in public health. It can be used as a medium of intervention (for behaviour change, e.g. smoking cessation or for the distribution of health information), as focus of research (seeking for health information), as a research instrument (electronic surveys), and for theoretical and conceptual issues (for professional development) [8]. In this review the character of different ICT solutions as a medium of intervention to influence the individuaĺs QOL is highlighted and investigated in more detail.
In health promotion and public policy decision making the construct of QOL is used as instrument for evaluation of intervention outcomes in clinical as well as non-clinical settings [9], [10]. The WHO defines QOL as an “individual’s perception of his or her position in life in the context of the culture and value systems they are living and in relation to their goals, expectations, standards and concerns”. This broad concept is affected by the “physical health, psychological state, level of independence, social relationship and their relationship to salient features of their environment” [7].
This definition implies that the process of ageing can affect one or more of the dimensions of the old person’s subjective QOL. Most of the frequently used instruments for measurement of QOL- outcomes, e.g. the WHOQOL- BREF/100 [7], [11] questionnaires, cover the physical, psychological, social and environmental domain that comply with George L. Engeĺs bio-psycho-social holistic approach of subjective health [12].
For aged people QOL is an important area of concern because it reflects their health status and well-being considering the vulnerable issues of their daily life [13]. It is crucial to understand which factors lead to their perceived life satisfaction and QOL according to the individuals’ needs and limitations [14].
The main objective of this study was to identify influences of AAL-solutions to elderly’s QOL and health and explain the pathways of these effects. Therefore first the contributions of ICT to elderly’s QOL were reviewed and QOL-outcomes of AAL-projects were analysed.
Section snippets
Methods
After initial literature search it became obvious that the QOL-related available literature in the field of AAL is very rare, heterogeneous and provides not enough information to conduct a systematic review on AAL-solutions. This is why we decided to conduct a narrative review based on a structured literature search on ICT-solutions usually used in AAL-systems and their impact to the QOL of elderly. Additionally, all relevant findings of QOL in AAL research were structured and summarized.
The
Results literature review
The search in the databases resulted in a total amount of 1153 articles. After clean-up according to the defined selection criteria 74 articles remained in total.
This section summarizes the findings of ICT-associated QOL-impacts. The findings are outlined beginning with the simplest technologies (e.g. Basic ICT) to more complex solutions usually used as modules in AAL-systems (e.g. Environmental Control Systems and Tele-Health solutions).
Results project review
This section summarizes the findings regarding elderly’s QOL- and health outcomes of completed and ongoing AAL- and ICT-projects. The results are presented in Table 2. These projects typically aim to combine the technical solutions outlined in the previous sections and investigate the impact of the system to the QOL of a group of older people. In some of the conducted studies also the QOL-outcomes of affected caregivers had been investigated. However, those results are not included in this
Discussion and recommendations
The results of this review are synthesized and presented in Table 3. We showed that ICT and AAL-solutions can contribute to individuals’ QOL by providing a broad range of impacts in the domains physical health, social participation, environmental aspects and psychological health. Most of the found studies in the field of ‘ICT and AAL for elderly’ report positive outcomes. Because of the rarely mentioned threatening or negative effects to elderly’s QOL in the project reports and study outcomes
Conclusion
The findings of this review indicate that there are many possible ICT-associated positive impacts to the individual’s QOL and subjective health. The summarized literature shows that ICT and AAL-solutions for elderly do not only encompass questions about technical aspects that have to be taken into account in projects. Future customers and recipients must be involved in development, before rollout, so that ICT can successfully contribute to QOL and health. Current projects and evaluation studies
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
CS is the main author of this manuscript. CS did the literature search and summarized the results. TD participated in the critical review of the manuscript. Both authors approved the final manuscript.
Summary points
What was known before this study?
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Ambient Assisted Living solutions are developed aiming to improve the health and quality of life of dependent as well as active elderly
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Previous research primarily focusses on technical issues instead of investigating the effects of assistive technologies to the aged individual
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Recent reviews of information and communication technologies do mainly focus on single functions of ambient assisted living solutions (e.g. smart homes, tele-medicine)
What did this study
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