HAAL: A healthy ageing eco-system for people with dementia

Abstract

Purpose The world population is ageing with a decreasing workforce of care personnel, with dementia as one of the largest challenges in long-term care (Gauthier et al., 2021). Assistive technologies and services on several aspects of lifestyle could be of support because dementia impacts the daily lifestyle of people with dementia (PwD) and (in)formal caregivers. The HAAL project proposes an approach of an integrated ecosystem; a bundle of Ambient Assisted Living (AAL) products and an AI-driven dashboard. The vision of the HAAL project is to adopt Machine Learning to extract valuable information on a central dashboard. With global rapid development, user requirements for a state-of-the-art integrated ecosystem need iterative and local revisions. To achieve a feasible result, HAAL takes the Living Lab methodology (Bergvall-Kåreborn et al., 2009) as the core methodology – an approach of co-creation amongst stakeholders (i.e. researchers, PwD, informal caregivers, formal carers and technology developers). This research aims to study the end-users perceptions and opinions of an integrated-technology ecosystem. In addition, a rating and ranking study of the AAL products and technology combinations supports a careful consideration for implementation. Finally, the study sets the direction of the design of the future AI-driven dashboard. Method Three studies were conducted; user requirement investigation, HAAL technology demonstration and MoSCoW prioritisation (Kuhn, 2009). 32 PwD, 19 informal caregivers and 114 formal carers participated in the Netherlands, Italy, Taiwan and Denmark. The methods included interviews, focus groups, technological trials in demo rooms and survey research. Meaningful Tryout cards (Cornelissen & Suijkerbuijk, 2022) and working AAL Purpose In the European-Taiwanese project Horizon AAL (HAAL), a dashboard is being developed that can act as a decision-aid for caregivers of community-dwelling people with dementia (PwD). In the dashboard, which is driven by artificial intelligence (AI), the data from a number of interoperable AAL (Active and Assisted Living) solutions are gathered and analysed in order to provide insights and predictions about the health and well-being of the PwD. In addition, the dashboard may provide recommendations that help caregivers to assess the care and support needs of their clients. The increasing advancements of AI-technologies such as the HAAL AI-driven dashboard come with benefits such as faster, more accurate, and more efficient data-analysis and the augmentation of human decision-making (Hassani et al., 2020), but also with challenges from a social and ethical perspective, e.g. related to privacy, transparency, human control and trust. In this line, it is broadly acknowledged that the proper embedding of healthcare technologies driven by AI requires innovators and other stakeholders to actively anticipate and reflect on, and be responsive to promises and risks and to societal values, needs and expectations (Morley et al., 2019; Tsamados et al., 2021; WHO, 2021). In the ongoing HAAL study, it is therefore explored what decisions and actions can be taken in the design of the dashboard and its cross-cultural implementation in order to account for the needs and values of end-users, and to achieve responsible innovation (RI) that is socially desirable, ethically acceptable and sustainable (Von Schomberg, 2013). Method Through a mixed-methods approach, a survey, focus groups and semi-structured interviews were performed in the Netherlands, Italy and Taiwan, to explore the perspectives of (1) HAAL project partners, (2) end-users and (3) experts outside the consortium on RI in HAAL. Two scenarios about the HAAL Purpose Dementia has become one of the most important and challenging areas in health care (Gauthier al., 2021). Improving quality of life for people with dementia (PwD) relies heavily on optimal care quality and efficiency, which however, is difficult to be achieved as most health institutions are understaffed. Ambient Assisted Living (AAL) technologies provides an alternative approach of increasing the health outcomes of PwD as well as reducing the care burden for caregivers. As part of the European Union ‘Active and Assisted Living Programme’ project “HAAL: HeAlthy Ageing eco-system for peopLe with dementia”, this study aimed to investigate the perspectives of formal caregivers working with PwD to establish priorities and components of designing a HAAL platform which combined different AAL technologies. Method There were nine major technologies combined in the HAAL platform to assist and/or improve the care quality for PwD including a senior tablet, indoor sensors, a smart mattress, a GPS tracker, a medicine dispenser, a care robot, cognitive and physical game, rehabilitation game, and a fall detection sensor. MoSCoW analysis (Kuhn, 2009) and Meaningful Try-out cards (Cornelissen & Suijkerbuijk, 2022) were mainly used as the co-design methods. We recruited 24 participants between Dec 2021 and Feb 2022. At the beginning of the session, all products were introduced to them, and then they were asked to rate individual products or combinations of the technological products as whether they thought a certain technology or combination as a ‘must have’, ‘should have’, ‘could have’ or a ‘would (nice to) have’? To evaluate the requirement levels of different technologies, weighted average was applied by taking into account the varying degrees of the number of participants who chose different levels. We labelled the level ‘must have’ as 4 and ‘would (nice to) have’ as 1, with higher scores indicating higher requirement level. In addition to the requirement level, we also asked participants the reasons why they gave that rate for a certain product or combination. The Meaningful Try-out