Behavioral telemedicine: A new approach to the continuous nonintrusive monitoring of activities of daily living

A fully automated, passively activated data-acquisition system was developed to allow routine, continuous, nonobtrusive monitoring of selected Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADLs) and the production of a behavioral record that could be subjected to trend analysis. The monitoring system uses "off-the-shelf" technology-standard heat, motion, vibration, and electric current sensors-to record the presence or absence of selected behavior and the time, date, duration and frequency of occurrence of sensor signals. Unlike other telemedicine and personal response system applications, this approach monitors strictly object-oriented behavioral indicators. Hence, the individual is not required to wear any special apparatus nor press buttons. The individual continues to undertake her/his normal activity as if the system were not in place. Objects in the environment, e.g., pill bottle, the refrigerator door, a kitchen cabinet, are electronically monitored, but not the individual her/himself. Because the system is "software driven," the monitoring of specific tasks can easily be added or subtracted with no real limit in the overall number of tasks to be monitored. The system's installation does not require retrofitting of the residence and is almost invisible once installed; thus, it can be used in a wide variety of residential environments. The system was tested during a 12-day period in the home of a community dwelling 71-year-old non-impaired male who lived alone. Data were collected on four behavioral domains: medication adherence, movement throughout the house, bathroom use, and meal preparation.