Exploring digital health platforms to support independent living on Country

By Georgina Chelberg (nee Hobson), University of Queensland
Member of the AAG SECG Communications Team

Smart home technologies

Emerging digital technologies are designed to assist older Australians to live safely and independently where possible, in their homes or residential aged care. Gradual or sudden changes in the activities of daily living (ADLs) can be detected via passive, remote monitoring with smart sensors that feed data to a central portal. Variations from an individual’s usual ADLs prompts a follow-up contact and review to clarify if medical concerns (e.g., illness, mobility or mental health challenges) are the cause of the changes.

People aged 65 years and over reported mixed perspectives for the relevance and acceptability of smart monitoring systems1,2. While participants expressed concerns about living alone (e.g., risk of falls), they strongly valued their independence and freedom from ‘monitoring’2. While older adults recognised the capacity of smart home systems to support ageing in place, they were not convinced they needed monitoring, as they had not experienced any decline in capabilities yet1,2. Participants also expressed the value of people physically checking up on each other, whereas the introduction of monitoring may keep people at a distance, risking isolation1,2.

Factors such as self-awareness, cognitive decline or choice, pose challenges to identification of changes in health or self-care. As such, monitoring activity through in-home systems may offer assurance and be useful in predicting early cognitive (acute and gradual) changes in elderly people that require medical intervention1-3.

Smarter Safer Homes

The Commonwealth Scientific and Industrial Research Organisation (CSIRO) has developed the Smarter, Safer Homes (SSH) platform that utilises smart sensors for in-home monitoring. The SSH platform is unobtrusive, flexible and low maintenance with interoperability with commercially available sensors and devices. The system is designed to monitor objective ADLs determined at baseline, of older adults in their own home environment to provide a personalised picture that best reflects the individual’s functional and health status. Residents, their health care provider and family members can view data activity through a tablet. Any adverse changes of independent living seniors’ activity pattern will send notifications to family members or carers for prompt intervention when these changes are drastically away from normal patterns4-10.

Residents’ perspectives of living with the SSH platform were mixed, but overall positive4,5. After a period of adjustment, residents did not find the system interfered with their lifestyle or routines and they became more confident in use of the tablet to view data. Participants also expressed that although they knew the sensors did not include cameras or audio recording, they did have hesitations about private and personal activities.

Health and ageing with Aboriginal and Torres Strait Islander people

Ageing-related conditions are experienced at earlier ages for Aboriginal and Torres Strait Islander people than non-Indigenous Australians. Historical and contemporary experiences of colonialist policies and racism (direct and indirect) have contributed to this gap and have severely disadvantaged Aboriginal and Torres Strait Islander people, including those in urban areas11,12. With the majority (79%) of Aboriginal and Torres Strait Islander people living in cities, there is increasing importance of accessible and culturally appropriate health and aged care services12-15. Solutions to support Aboriginal and Torres Strait people to live with autonomy and safety on Country are needed 16.

Scoping work to explore potential of SSH

In late 2019 scoping activities were conducted to consider the feasibility of SSH and its cultural appropriateness for urban Aboriginal and Torres Strait Islander older people17. Community engagement involved informal discussion groups with Members and staff of the Winnam Aboriginal and Torres Strait Islander Corporation (‘Winnam’). Topics of discussion included the usefulness of SSH, its cultural appropriateness and its potential to support Aboriginal and Torres Strait Islander people to live and age well on Country - either in their homes or, in a residential aged care setting.

Overall, Winnam participants were receptive to the SSH platform and noted the potential for data to support preventative health steps and to support Winnam Members ‘living alone and/or away from their family’. However, an important learning was the participants did not feel the SSH system would be relevant to them (yet) as they did not currently rely on home care services. They believed the system would be best suited to their Elders, ‘older persons’ in the preceding generation (persons approximately 80 years and older).

Winnam Members emphasised the significance of their family connections, shared culture, historical impacts, their privacy and health which strongly influence their daily decisions. Five cultural and social aspects were emphasised in the design and delivery of future SSH research trials.

  1. Engagement – It is vital that all stakeholders are engaged in the process of tailoring the SSH platform to be trialled with Aboriginal and Torres Strait Islander people in the area. This must include all staff, residents, families, visiting HCP and caregiver agencies and local Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ATSICCHOs). Engagement processes would need to consider installation, maintenance, literacy, cultural aspects of the portal, relationships and agreements with in-home and health workers, etc.
  2. Privacy – Winnam Members emphasised the need to address the privacy concerns held by participants and stakeholders of the trial.
  3. Target audience – Clarification would be needed about the proposed versus actual participant profile for a feasibility trial. That is, Winnam Members expressed a perceived lack of relevance of the SSH system for themselves, viewing it as more beneficial for their older Elders. In addition, familiarity with digital devices and other technology for those in the older generation must also be considered.
  4. Established networks – Winnam Members were clear that the project’s feasibility and reach would be significantly strengthened by working with established networks in their region. This would include reaching out to gain permission and seek collaboration with all local Elders, Housing Co-ops, and local ATSICCHO. Furthermore, working with ATSICCHOs, GPs and health workers known to residents would build trust, understanding and engagement in a feasibility trial. Use of local language and artwork in the SSH portal would also be significant.
  5. Education – All members of the SSH project teams should ensure they have a contemporary understanding of the Aboriginal and Torres Strait Islander Community values and acknowledge the generational challenges that have and continue to impact Aboriginal and Torres Strait Islander people. In particular, Winnam Members requested that the project team (including SSH installation personnel) ‘must take into account that everyone has complex families and history’.

Further CSIRO research collaborations are continuing to explore the relevance and cultural safety of the SSH platform and other digital health technologies with Aboriginal and Torres Strait Islander people.

07 June 2021

Georgina is a PhD Candidate at The University of Queensland with research to explore the role of digital technologies for dementia awareness and support with Aboriginal and Torres Strait Islander people. The research builds on collaborative relationships between key Aboriginal and Torres Strait Islander stakeholders, CSIRO and the Queensland Aboriginal and Islander Health Council. Georgina has recently worked in several Research Assistant roles and has previously held several health promotion roles including Project Manager of a new corporate wellness program for a large multinational, and Health and Wellness Project Officer. Georgina also has professional experience in marketing, communications, and publishing.

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