by Markus Tauber and Benedikt Gollan (Research Studios Austria FG), Christoph Schmittner (Austrian Institute of Technology GmbH) and Thomas Ballhausen (University Mozarteum Salzburg)
In this paper we propose an approach to use assistive technologies beyond traditional Ambient Assisting Living Setups for a more accessible and inclusive society. This supports including and involving elderly people via sharing of cultural content and linking it to individual biographies and supporting the work of caregivers who require this information to support their patients more adequately.
Elderly woman using immersive technologies for training and recreation.
Europe is currently experiencing the emergence of an increasingly ageing society. According to the WHO, there is "little evidence to suggest that older people today are experiencing their later years in better health than their parents" [L1]. Older people prefer to stay in the comfort of their own homes, to age in place . It very much seems like traditional forms of assisted living, such as living in institutional residences or facilities, have fallen out of favour. In such cases, mostly professional nurses treat patients. The nursing profession involves a range of activities that demand a great deal of strength from nurses, both mentally and physically. The current COVID-19 situation increases the effort required in a caregiver's daily routine due to various safety regulations and spacing requirements. Monitoring vital signs and performing important activities is combined with a lot of effort in an already challenging nursing job.
The consideration of Internet of Things (IoT) sensors, third-party cloud services and other Ambient or Active Assisted Living (AAL) related technologies has been shown [L2]   to be of significant use in collecting information regarding the vital conditions of patients automatically and hence has potential to ease the work of caregivers. Furthermore, it allows elderly people to remain in their homes.
Additionally, we see a positive effect of arts and music on people [L3], which, especially if related to personal experiences, e.g., in the patient’s individual biography, will have a positive impact on the conditions of the people who receive treatment and those who provide it. Careful and informed selection of content and the monitoring of related vital signs will support caregivers in keeping their patients active but also supports them in identifying requirements for improved treatment and, most importantly, improves the lives of the people receiving care.
We outline here a concept of how an invigorated understanding of culture tech can be combined with technology beyond what is commonly known as AAL to improve the life and caregiving for elderly people and prevent social exclusion.
To realise such a concept, we consider three conceptual building blocks – technology, beyond traditional AAL, culture tech and the compliance with existing security, safety and ethical standards.
- Quantified Self – Wearable devices are becoming less intrusive and more intuitive, enabling the continuous assessment of vital signs and enabling the notifications in emergency situations but also for regular monitoring over a longer period.
- Infrastructural Assistance Technologies, and physical assistance devices – Smart home automation technologies can also substantially support elderly people to live at home. Recent advances in IOT enable devices to be automatically configured and controlled via explicit (consciously controlled processes) or implicit interaction (e.g., presence, behaviour analysis). This will make the use of the technology for collecting information about patients even more attractive.
- Edutainment – Immersive technologies can also be used for gamification approaches to (i) avoid the cultural and social disconnect of elderly people (contact to relatives, participation in cultural experiences, maybe also linked to their biography) and (ii) contribute to physical and mental health (e.g., serious games as a physical rehabilitation measure or to present cognitive challenges and prevent dementia).
Content, Curatorship, Culture Tech:
- Such content-driven support, inclusion and care of elderly people will strongly benefit from the availability of cultural content in a free and structured manner such as in Europeana or Historiana. Next to the open access of carefully curated digitised artefacts, the advantages of enriched metadata, narrativity and interconnectedness within the respective collection will allow sensible and serious use of the repositories in question.
- This use of digitised cultural heritage will be particularly successful if culture itself is the basis of all relevant development steps and work processes. We therefore aim at a renewed understanding of culture tech to ensure an intertwinedness of culture and technology that transcends the concept of a mere toolbox to help distribute or market content. That also includes a broader and more informed understanding of cultural heritage that is not only material for the worst-case stress test of technological developments, but rather at the core of all described endeavours.
Security, Safety, Ethics
- Using technology in support of giving care to elderly people also requires reliable and available properties of the components, as delayed response time between any of the modules might be dangerous, especially if timely correlation of the monitoring data is important. This is a safety aspect that will be considered during the design of an architecture to ensure using the technologies that are suitable for real-time data processing and will require revisiting the correspondent methodologies in this setup.
- The technology must be trustworthy for patients and caregivers alike. This can be achieved by designing corresponding feedback and explainability approaches. Trust, ethical and legal norms related to such technology may mean different things depending on the type of stakeholder it concerns. A structure and role-based approach is required to document and assess the technology and services used. This should be inspired by existing work like the EC HLEG publication “Ethics Guidelines for Trustworthy AI” (Final report April 2019, HLEG AI).
Overall, the availability of content, technology and guidelines for how to use them in a secure, safe and ethical manner has great potential for improving the life of elderly people and the entire caregiving process. Our investigation of supporting topics and existing work shows great potential for related research in upcoming projects.
 J. H. Johnson, S. J. Appold: “US older adults: Demographics, living arrangements, and barriers to aging in place”, Kenan Institute, 2017.
 M. El Kamali, et al.: “Towards the NESTORE e-Coach: a tangible and embodied conversational agent for older adults”, in Proc. of the 2018 ACM Int. Joint Conf. and 2018 Int. Symposium on Pervasive and Ubiquitous Computing and Wearable Computers, ACM (2018), pp. 1656-1663.
 N. Van den Berg, et al: “AGnES: supporting general practitioners with qualified medical practice personnel: model project evaluation regarding quality and acceptance” Deutsches Ärzteblatt Int., 106 (1–2) (2009), p. 3.