Focus

How to help an otherwise-young person!

The EU-funded DOREMI project (Decrease of cOgnitive decline, malnutRition and sedEntariness by elderly empowerment in lifestyle Management and social Inclusion) showed that in elderly people cognitive decline can be counteract and social inclusion can be improved with the help of cognitive games and a virtual companion to be used with PCs, TVs and tablets. The decline of cognitive ability is strongly related to lifestyle, as well as social engagement, cognitive stimulation, nutrition and physical activity.
What is the DOREMI system?
According to the UCD Institute of Food and Health, three are the most notable health promotion and disease prevention programs that target the main causes of morbidity and premature mortality: Malnutrition, Sedentariness, and Cognitive decline, conditions that affect the quality of life of elderly people and drive to disease progression. These three features represent the target areas in the DOREMI project (ended in November 2016). The project vision aimed at developing a systemic solution for elderly, able to prolong the functional and cognitive capacity by empowering, stimulating and unobtrusively monitoring the daily activities according to well- defined "Active Ageing" lifestyle protocols. The project joins the concept of prevention centered on the elderly, characterized by a unified vision of being elderly today, namely, a promotion of the health by a constructive interaction between mind, body and social engagement. To fulfill these goals, food intake measurements and personalized metabolic control, exergames associated to social interaction stimulation, and cognitive training programs have been proposed to an elderly population enrolled during a pilot study. The project combines multidisciplinary research areas in serious games, social networking, Wireless Sensor Network, activity recognition and contextualization, behavioral pattern analysis. By recording and monitoring information about the use of the adopted lifestyle protocols, it was possible to track the users performance over long periods, providing a potential alert for signs of malnutrition, physical and cognitive deterioration. The close collaboration between the healthcare representatives and experienced technological partners drove the ICT development needed to release a set of prototypes to be validated in the pilot study. The effectiveness and impacts, on both users and on the healthcare system, have been proofed in the pilot study set up in Italy and UK, involving both elderly users and care providers.
The Doremi system is constituted by: i) a "smart carpet" in the form of a Wii-based balance board for daily weight measure and balance assessment; ii) an Android tablet containing all DOREMI apps; iii) a bracelet, which collects the heart bit rate, calculates the kilo-calories consumption, steps count and outdoor localization. When the user is at home, the bracelet sends its data directly to the DOREMI station, installed in the apartment; when outside, data produced by the bracelet are sent to the user's smart phone, which stores them and send them to the DOREMI station when the user goes back home; iv) environmental sensors, installed in each of the selected apartments to check the habits of the user and his level of socialization. These sensors (about 10 per apartment, but the number depending on the dimension of the apartment) are integrated with the bracelet, in the sense that the system is sure to collect data relevant the DOREMI user only, i.e the person wearing the bracelet.
The DOREMI apps are: the fit app (a virtual support for daily physical activity to perform in-house regular activity according to international guidelines); the cognitive app (a series of games to support several areas of cognitive function); finally, the METADIETA dietary app developed in the DOREMI project for English users. Thanks to a visual approach the user can fill in a personal food diary, selecting food types and portions through the images. Medical doctors will remotely check the diary and, if necessary, modify participant's diet to promote healthy nutrition according to the general guidelines promoted by DOREMI.
The serious game solution adopted is not a stand alone solution, but is was just thought and designed for the target people involved in DOREMI; the data produced are integrated with all the other data collected and are represented on a dashboard for the physicians' analysis. Everything in DOREMI is some way connected: habits of the user, exergames and serious games aggregate their single information in order to have a view as much comprehensive as possible of the person. As an example, results on the daily physical activity influence the diet.
One dashboard offers services for the remote inspection and control of the devices and another dashboard provides information about the status of the end-user to the specialists. Each single installation in each house has its own specific plan of installation, and its devices are linked to their actual position in the Homer database. This installation information, which needs to be kept consistent and made anonymous for privacy reasons, is also very important for the interpretation of the acquired data (think what may happen if the caloric consumption of an individual is mixed with the food intake of another by mistake).
The trials
32 older people (age 65-80 years) were involved in UK and Italy DOREMI trials (3 months). Subjects were characterized at baseline in terms of physical activity (SPPB, PASE test, daily steps/meters, 6MWT), hemodynamic and biochemical parameters (blood pressure, HR, lipid profile, glycaemia, etc.), dietary habits (caloric intake) and balance assessment (BERG scale). Trough the DOREMI technological platform, users were stimulated to perform indoor physical activity protocol (exergame on tablet); monitored by DOREMI bracelet (heart rate monitoring); invited to fill diet e-diary, receiving nutritional advice provided by the expert through the same application; tested for balance (DOREMI smart balance board). At the end of trial, users underwent the same test battery of baseline.
In both the test sites, in the examined DOREMI population an overall increase in physical activity was observed, with a significant improvement in hemodynamic (decrease in blood pressure at 6 minute walking test - 6MWT) and in tests scores (increase in Short Physical Performance Battery score, covered meters during 6MWT). Changes of dietary habits have produced also remarkable effects on blood markers (decrease in glycated hemoglobin and increase in hemoglobin), on somatometric parameters (decrease in waist and hip circumference and of their ratio) (increase in TBW).
In both cases, the response of the care providers has been very positive, as they can utilize the DOREMI system through the dashboard created for them in order to follow in the time the lifestyle of their patients.
DEEPVIEW
- Project Coordinator: Prof. Oberdan Parodi, CNR-IFC (National Research Council - Institute of Clinical Physiology)
- Project Scientific Corrdinator: Dr. Erina ferro, CNR-ISTI (National Research Council -Institute of Information Science and Technologies)
- Funded under FP7, Grant Agreement no. 611650
- Project website: http://www.doremi-fp7.eu