MOBISERV – FP7 248434
An Integrated Intelligent Home Environment for the
Provision of Health, Nutrition and Mobility Services to the
Elderly
Deliverable
D2.3: MOBISERV System Requirements
Specification Volume II
Date of delivery:
Contributing Partners: UWE, SMH, ANNA
Date: 4 Jan-11
Version: Vol II v4.1
D2.3: MOBISERV System Requirements Specification, VOLUME II
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Document Control
Title:
D2.3: MOBISERV Initial System Requirements Specification
Project:
MOBISERV (FP7 248434)
Nature:
Report
Authors:
UWE, SMH, ANNA
Origin:
UWE
Doc ID:
MOBISERV_D2_3_Vol II _ver5.docx
Dissemination Level: Restricted
Amendment History
Version
Date
Author
Description/Comments
V1
2010-07-5
UWE
Draft – literature review
V2
2010-09-13
UWE
Draft - ILAEXP summary
V2.1
2010-10-11
UWE, SMH
Draft - Function Process Specifications
V2.2
2010-11- 22
UWE, SMH
Draft – Data Analysis
V3
2010-12-6
UWE, SMH
Draft – Detailed use-cases
V4
2010-12-20
UWE, SMH
Draft – Policy Context
V5
2010-1-07
UWE, SMH
Final version
The information contained in this report is subject to change without notice and should not be construed as a commitment by any members of
the MOBISERV Consortium. The MOBISERV Consortium assumes no responsibility for the use or inability to use any software or
algorithms, which might be described in this report. The information is provided without any warranty of any kind and the MOBISERV
Consortium expressly disclaims all implied warranties, including but not limited to the implied warranties of merchantability and fitness for a
particular use.
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Table of contents
EXECUTIVE SUMMARY ....................................................................................................... 8
GLOSSARY .............................................................................................................................. 9
1
INTRODUCTION ............................................................................................................. 10
1.1 OBJECTIVES OF THIS DOCUMENT ............................................................................... 10
1.2 STRUCTURE OF THIS REPORT ...................................................................................... 10
2
LITERATURE REVIEW .................................................................................................. 11
2.1 CONSTRAINTS TO IMPLEMENTATION OF ASSISTIVE TECHNOLOGY ........................... 11
2.1.1 Barriers and exclusion at home ............................................................................ 11
2.1.2 Attitudes towards technology ................................................................................ 12
2.2 COPING STRATEGIES AND COMPENSATORY BEHAVIOUR ........................................... 12
2.3 PSYCHOLOGICAL AND SOCIAL ASPECTS OF AGEING .................................................. 13
2.4 CRITERIA FOR ACCEPTANCE OF TECHNOLOGY ......................................................... 14
2.4.1 Response to companion and service robots .......................................................... 15
2.5 TRAINING NEEDS FOR LEARNING TO USE TECHNOLOGY ......................................... 16
2.6 OVERVIEW OF EXISTING ASSISTIVE TECHNOLOGY AND SERVICE ROBOTICS SYSTEMS
17
2.7 CONCLUSIONS ............................................................................................................. 25
3
FURTHER ANALYSIS OF THE DATA GATHERED ................................................... 26
3.1 MECHANISMS USED TO TRANSLATE USER NEEDS INTO SYSTEM SPECIFICATIONS .... 26
3.2 CODING AND INTERPRETATION .................................................................................. 27
3.2.1 User Characteristics ............................................................................................. 27
3.2.2 Key Themes ........................................................................................................... 27
3.2.2.1
3.2.2.2
3.2.2.3
3.2.2.4
Nutrition .................................................................................................................................................... 27
Health and Well-Being ............................................................................................................................. 28
Safety ......................................................................................................................................................... 28
Comfort ..................................................................................................................................................... 28
3.2.3 Clustered feedback to the concepts ....................................................................... 29
3.3 CONCLUSION ............................................................................................................... 30
4
DETAILED FUNCTIONAL AND NON-FUNCTIONAL REQUIREMENTS ............... 31
PRIORITISATION AND SELECTION – SUMMARY OF EXPERT
COMMITTEE DISCUSSION AND RESULTS ............................................................................... 31
4.2 SUMMARY OF HIGH LEVEL FUNCTIONS AND DISCUSSION POINTS ............................ 32
4.3 DETAILED FUNCTIONAL REQUIREMENTS .................................................................. 36
4.1 REQUIREMENTS
4.3.1 Function for reminder and encouragement to eat (Nutritional Assistance) ......... 36
4.3.1.1
4.3.1.2
4.3.1.3
4.3.1.4
4.3.1.5
Use cases .................................................................................................................................................... 36
Function specification and assumptions ................................................................................................. 36
Content Requirements: ............................................................................................................................ 37
Sub-Function Requirements .................................................................................................................... 37
Process Specification ................................................................................................................................ 37
4.3.2 Function for Reminder and Encouragement to drink (Dehydration Prevention) . 39
4.3.2.1
4.3.2.2
4.3.2.3
4.3.2.4
4.3.2.5
Use cases .................................................................................................................................................... 39
Function specification and assumptions ................................................................................................. 39
Content Requirements ............................................................................................................................. 39
Sub-Functions Requirements .................................................................................................................. 40
Process Specification ................................................................................................................................ 41
4.3.3 Function for Reporting to health professionals .................................................... 42
4.3.3.1
4.3.3.2
4.3.3.3
4.3.3.4
4.3.3.5
Use cases .................................................................................................................................................... 42
Function specification and assumptions ................................................................................................. 42
Content Requirements ............................................................................................................................. 42
Sub-Function Requirements .................................................................................................................... 42
Process Specification ................................................................................................................................ 43
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4.3.4 Function for a tele-medicine/self-check ................................................................ 44
4.3.4.1
4.3.4.2
4.3.4.3
4.3.4.4
4.3.4.5
Use cases .................................................................................................................................................... 44
Function specification and assumptions ................................................................................................. 44
Content Requirements ............................................................................................................................. 44
Sub-Function Requirements .................................................................................................................... 44
Process Specification ................................................................................................................................ 45
4.3.5 Function for Games for Social and Cognitive Stimulation ................................... 46
4.3.5.1
4.3.5.2
4.3.5.3
4.3.5.4
4.3.5.5
Use cases .................................................................................................................................................... 46
Function specification and assumptions ................................................................................................. 46
Content Requirements ............................................................................................................................. 46
Sub-Function Requirements .................................................................................................................... 46
Process Specification ................................................................................................................................ 47
4.3.6 Function for Voice/Video/SMS via robot communication with friends and
relatives ............................................................................................................................. 48
4.3.6.1
4.3.6.2
4.3.6.3
4.3.6.4
4.3.6.5
Use cases .................................................................................................................................................... 48
Function specification and assumptions ................................................................................................. 48
Content Requirements ............................................................................................................................. 49
Sub-Function Requirements .................................................................................................................... 49
Process Specification ................................................................................................................................ 50
4.3.7 Function for a mobile intercom for enabling front door entry ............................. 52
4.3.7.1
4.3.7.2
4.3.7.3
4.3.7.4
4.3.7.5
Use cases .................................................................................................................................................... 52
Function specification and assumptions ................................................................................................. 52
Content Requirements ............................................................................................................................. 52
Sub-Function Requirements .................................................................................................................... 52
Process Specification ................................................................................................................................ 53
4.3.8 Function for responding to call for help from the user ......................................... 54
4.3.8.1
4.3.8.2
4.3.8.3
4.3.8.4
4.3.8.5
Use cases .................................................................................................................................................... 54
Function specification and assumptions ................................................................................................. 54
Content Requirements ............................................................................................................................. 54
Sub-Function Requirements .................................................................................................................... 54
Process Specification ................................................................................................................................ 55
4.3.9 Function for Encouragement for exercising ......................................................... 56
4.3.9.1
4.3.9.2
4.3.9.3
4.3.9.4
4.3.9.5
Use cases .................................................................................................................................................... 56
Function specification and assumptions ................................................................................................. 56
Content Requirements ............................................................................................................................. 56
Sub-Function Requirements .................................................................................................................... 57
Process Specification ................................................................................................................................ 58
4.4 NON-FUNCTIONAL REQUIREMENTS............................................................................ 59
4.4.1 User Acceptability ................................................................................................. 59
4.4.2 Environmental and Operational............................................................................ 59
4.4.3 Training Needs and Support ................................................................................. 60
4.4.4 Usability and accessibility .................................................................................... 60
4.4.5 Comfort.................................................................................................................. 61
4.4.6 Help and documentation ....................................................................................... 62
4.4.7 Performance .......................................................................................................... 62
4.4.8 Maintainability and Support ................................................................................. 62
4.4.9 Security and privacy .............................................................................................. 63
4.4.10 Cultural and Political.......................................................................................... 63
4.5 FINAL CONCLUSIONS .................................................................................................. 63
5
CONTENT RECOMMENDATIONS FOR FUNCTIONS ............................................... 64
5.1 ADVICE ON NUTRITION ............................................................................................... 64
5.2 ADVICE ON EXERCISE ................................................................................................. 65
6 POLICY CONTEXT AND EXISTING PRACTICE FOR PROVISION OF SUPPORT
SERVICES FOR OLDER ADULTS ....................................................................................... 66
6.1 IN THE UK ................................................................................................................... 66
6.1.1 Prevention policy................................................................................................... 67
6.1.1.1
6.1.1.2
6.1.1.3
Prevention and early intervention ........................................................................................................... 67
Joint strategic needs assessment (JSNA) ................................................................................................ 68
World class commissioning ...................................................................................................................... 68
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6.1.1.5
6.1.1.6
6.1.1.7
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Personalisation .......................................................................................................................................... 68
Market development ................................................................................................................................ 69
Partnership and whole system approaches ............................................................................................. 69
Involving older people and carers ........................................................................................................... 69
6.1.2 Provision of support services for older adults in the UK ...................................... 70
6.1.2.1
7
Background Statistics ............................................................................................................................... 70
APPENDICES ................................................................................................................... 72
7.1 NL QUESTIONNAIRE RESPONSES ............................................................................... 72
7.1.1 Setting A – Residential .......................................................................................... 72
7.1.1.1
Care staff ................................................................................................................................................... 72
7.1.2 Setting C – Independently living ........................................................................... 78
7.1.2.1
8
End-Users .................................................................................................................................................. 78
REFERENCES .................................................................................................................. 84
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Table of Figures
Figure 1 MOBISERV’s user-centred design approach ............................................................ 26
Figure 2 Methods used to translate user needs into system requirements and specifications. 27
Figure 3. Process specification for the Nutritional Assistance Function ................................. 38
Figure 4 Process specification for the Dehydration Prevention function ................................ 41
Figure 5 Process specification for reporting to health professionals ....................................... 43
Figure 6 Process specification for tele-medicine ..................................................................... 45
Figure 7 Process specification for games function .................................................................. 47
Figure 8 Process specification for video/voice/SMS Outgoing communication ..................... 50
Figure 9 Process specification for video/voice/SMS Incoming communication ..................... 51
Figure 10 Process specification for mobile intercom .............................................................. 53
Figure 11 Process specification for responding to call for help ............................................... 55
Figure 12 Process specification for encouragement for exercising ......................................... 58
Figure 13. The eatwell plate, FSA ........................................................................................... 64
Figure 14 Brightly coloured pictures from www.ageuk.org.uk ............................................... 65
Figure 15 Demographic data, current and projected from the National Statistics Office UK . 66
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List of Tables
Table 1. Summary of recent and current assistive technology ................................................ 24
Table 2 Summary of prioritisation discussion for the High Level Functions .......................... 35
Table 3 Sub-Functions for F_1 ................................................................................................ 37
Table 4 Sub-Functions for F_2 ................................................................................................ 40
Table 5 Sub-Functions for F_19 .............................................................................................. 42
Table 6 Sub-Functions for F_17 .............................................................................................. 45
Table 7 Sub-Functions for F_18 .............................................................................................. 47
Table 8 Sub-Functions for F_11 .............................................................................................. 49
Table 9 Sub-Functions for F_14 .............................................................................................. 53
Table 10 Sub-Functions for F_6 .............................................................................................. 55
Table 11 Sub-Functions for F_8 .............................................................................................. 57
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Executive Summary
This document, D2.3: MOBISERV Initial System Requirements Specification, Volume II
presents further analysis and investigation of stakeholder issues, following on from the last
submitted deliverable – MOBISERV D2.3 v8.
This report is seen as a continuation of the previous deliverable, which will be referred to as
Volume I, and as such, is seen a living document with a new volume being compiled for each
review, which will build on and extend the previous findings as more issues are identified.
The findings reported in these Volumes I and II should assist in bringing the lifestyles of the
older persons and other stakeholders closer to the engineers. This will help to ensure that the
MOBISERV technologies are centred on a solid appreciation of user needs and contexts.
Investigating the people, activities and their contexts continues to be achieved through a
series of primary research as well as secondary research – valuable information from other
similar studies. This information will continue to provide guidance on how the MOBISERV
components should be designed to ensure user acceptance, usability and utility.
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Glossary
Term
MOBISERV
F_x
F_x.y
ILAEXP
Prospagnosia
Aphasia
Agnosia
MOBISERV
Explanation
An Integrated Intelligent Home Environment for the Provision of Health,
Nutrition and Mobility Services to the Elderly
Function id (Original ids retained)
Sub-Function Requirements id (Original ids retained)
Independent Living & Ageing & cross-industrial committee of experts
Facial perception disorder which inhibits the ability to recognise facesi
Also known as Anomic aphasia, inability and difficulty with recalling words
and namesii
Neurological illness or consequence of a severe brain injury which results
with a loss of the ability to recognise people, objects, shapes, sounds despite
no defect in a specific sense or major memory lossiii
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1 Introduction
1.1 Objectives of this Document
This document has the following objectives:
1. To review current and previous research in the areas of understanding the context
within which assistive technology will be used for older adults.
2. To present the outcomes of a deeper analysis of the data gathered as part of Task 2.3.
3. To provide a refined corpus of scenarios to be used to inform the design and
evaluation of the MOBISERV technology
4. To identify a refined set of functional and non-functional requirements
5. To identify appropriate content for realising the implementation of the functional
requirements
6. To understand the policy context and existing practice for provision of support
services for older adults in the UK
1.2 Structure of this report
In Section 2 there is a state of the art review of requirements based on a comprehensive
secondary literature review. Section 3 provides the outcome of further analysis of the data
gathered as part of task 2.3. Section 4 provides a refined set of functional and non-functional
requirements, as well as use-cases and process flow specifications. Section 5 provides
content that can be incorporated within the functions to ensure validity of the information. In
Section 6 there is a review of policy context and existing practice for provision of support
services for older adults in the UK which will ensure contextualisation and grounding for the
services being developed within MOBISERV. This will assure that the design and
development is taking place within an existing framework, evolving with reference to it,
rather than outside it.
The Appendices contain further user data from the NL site, extracted from questionnaires
and cultural probes with end users and direct stakeholders such as professional caretakers.
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2 Literature Review
A secondary literature review has been conducted to find out what issues have been elicited
for contexts similar to the MOBISERV system. The issues are discussed in relation to the
following themes that have emerged: Constraints to implementation of assistive technology,
barriers and exclusion at home, attitudes towards technology, coping strategies, criteria for
acceptance for technology and response to companion and service robots. These issues
provide a comprehensive understanding of the contexts within which we need to design our
systems as well as providing useful guidance for conducting our trials.
2.1 Constraints to implementation of assistive technology
2.1.1 Barriers and exclusion at home
Barriers to the use of digital technologies
A qualitative report by Age Concern UK and Help the Agediv, supported by the BT British
Telecom has revealed and distinguished barriers that older people must overcome if or when
using modern digital technologies. In the UK, 64% of people over 65 have never used
Internet technologies. Large portion of this group comes from lower social-economic
background and higher ages.
In this report four key barriers have been identified in relation to internet use: 1. Lack of
understanding of and confidence with ‘how it works’, fears and anxieties about ‘doing
something wrong’ as well as internet security 2. Digital technologies dismissal, people who
have a means of accessing the Internet but choose not to, either because they are against the
idea, or a way to justify their lack of confidence 3. A perception that it will be too hard to
learn, 4. Affordability for people with a low income.
Outcome for MOBISERV requirements: A common feature is a lack of understanding and
confidence when using digital media which is a barrier, therefore ensuring the provision of a
support and training framework as part of the system will be important to consider.
Barriers to aging at home and mobility
One of main objectives of the MOBISERV project is to allow older people to maintain a
good quality of living in their home environment. As the aging process advances, the existing
home environment poses increasing number of challenges. Sixsmith et al.v report barriers at
home that have been investigated through a series of interviews. The findings have shown
that physical aspects of houses (stairs, steps) present a fundamental problem often requiring
significant investments to be adjusted for physical impairments. Another problem arises from
the fact that elderly, fragile people are sometimes reluctant to modify their environments for
aesthetic reasons or because of simple refusal to face their own physical decline. Often
people are unable to accept their physical and cognitive decline, choosing to conceal their
increasing frailty.
External barriers are by and large related to transport difficulties. For elderly people living
outside city centres, travelling can be essential for socialising, shopping or health visits. A
good proportion of over 70s is not able to drive anymore and have to rely on public transport.
This brings problems like waiting on bus stops in severe weather conditions. Reduced
mobility typically affects socialising, which consequently provokes loneliness and isolation.
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Outcomes for MOBISERV requirements – It will be important to ensure sensitivity
towards any modifications that might need to be made, eliciting issues in a supportive manner
to enable appropriate customisation of the system, as well as flexibility in relation to aesthetic
preferences.
2.1.2 Attitudes towards technology
In a comprehensive study by Mitzer et al.vi where 113 older adults participated in focus
groups in the USA to discuss their use and attitudes about technology in the context of their
home, work and healthcare, it was found that positive attitudes outnumbered negative
attitudes suggesting that older adults perceive the benefits of technology use to outweigh the
cost of such use. Positive attitudes were most frequently related to how the technology
supported activities, enhanced convenience, and contained useful features.
These included speed of response, the technology’s ability to perform operations quickly,
such as to access, store and retrieve information. Also the portability and small size of
devices were positively viewed.
Negative attitudes that were most frequently associated with technology included creating
inconveniences such as interruptions – phones ringing at inconvenient times, and physical
and mental effort required to use devices. In this study, physical inconvenience was a
complaint specific to healthcare technologies. The researchers stated that this could be due to
the fact that many measures of physical health status rely on some sort of physical intrusion
or discomfort. Another negative attitude was expressed when technologies had too many or
too few features or programming options and the researchers suggest that customisation or
adjustability or features may be a preferable case where it is possible. Security and reliability
concerns are also a source of negativity towards technology. Safety concerns include worries
of physical danger and health risks. Reliability issues include experience of technology
performing inaccurately or undependably.
Outcome for MOBISERV requirements: The scope of each of the features will have to an
adequate level of customisation to ensuring a match with physical and cognitive abilities, as
well as personal and social requirements of the individual.
2.2 Coping strategies and compensatory behaviour
Dickinson et al.vii conducted observations in users homes as part of the UTOPIA Usable
Technology for Older People: Inclusive and Appropriate) project which gave them an insight
into observing how people cope with everyday issues and their use of artefacts around them.
Observing an older adult retrieving her phone with her walking stick and hitting it several
times suggests a phone must be robust enough to withstand such treatment.
Forlizzi et al.viii describe an ecology of aging, comprised of people, products and activities
which take place in their home and surrounding community. The components of the ecology
of aging are part of a system and are interconnected. They state that these components are
adaptive, illustrating this by means of the following example: If one part of an older person’s
life breaks down (e.g. the person is no longer able to drive safely), another part must change
(the person will rely on family and make less frequent trips, or hire a community taxi
service). They also find that the flow of information among components can be complex and
have unexpected consequences, such as sources of information and information channels
between the older person and the health care provider. Another aspect of the components
within the ecology is that they are dynamic and evolving, and the experience of the person
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depends on the choices made, for example choice of assistance after breaking a hip, ranging
from home to institutional. Forlizzi et al. also state that the ecology has a potential to break
down, for instance opting for a particular option can have a detrimental impact on certain
aspects of the person’s quality of life and well-being. Having an appreciation of this balance
of this ecology and ensuring adaptability and flexibility of the MOBISERV system to
respond to the changes will be an important part of the system’s ultimate success. Changes in
physical and cognitive ability over time will contribute to fundamental changes in the
interactivity with the system, as well as the level of reliance on the system that need to be
considered.
They examined how perceived status can affect their social interactions, why they want
certain products, how they use those products, how they operate in their environment and the
activities and experiences that they engage in at home or in their community. They found that
for older adults new products can meet emerging needs, but they can also serve as a source of
frustration and hardship. For example a Zimmer frame offers a chance to retain autonomy,
but if it is too heavy or cumbersome then it may prompt further reliance on others. Objects
and experiences present new meanings in the ecology of aging and it is up to the researchers
to identify these issues and address them accordingly. Longitudinal studies are suggested as a
means of studying how users lives unfold, for example as they make the transition from
independent living to institution.
Outcome for MOBISERV requirements: It will be important to take a holistic view of
individuals’ environment and lifestyle, not as a one off assessment, but a more in depth
consideration of routine and social activities, within and outside the home over a period of
time. This will help to ensure that the system truly integrates to the personal behaviours and
circumstances.
2.3 Psychological and social aspects of ageing
Loss of close companionship, resulting in loneliness and depression is often something that
has been found to accompany growing oldix, v. Risk factors for depression, as a clinical
condition, include self-perceived health, functional limitations and smaller network size,
which can have differing impacts depending on biological factorsx. Aguirre et al.xi have
considered making older people and their relatives aware of a possible presence of depression
through monitoring patterns of communication, loss or gain of weight and variations in sleep
patterns and encourage frequent social contact by suggesting social activities.
Outcome for MOBISERV requirements: The MOBISERV components have the potential
of also monitoring some of these risk factors through the Wearable Health Status Monitoring
Unit and analysis could provide deviations from individual basal patterns established at the
start. Therefore keeping a long-term record of appropriate data with the consent of the users
could result in the capability of incorporating this functionality in the future. However
Bharucha et al.xii point out that there are a number of critical research gaps in the efficient
collection and storage of voluminous real-time continuous data from multi-modal sources, as
well as the need to develop automated data reduction and mining techniques to identify
clinically meaningful events and deviations from a prior baseline. These are opportunities
that can be also be addressed by the MOBISERV consortium.
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2.4 Criteria for acceptance of technology
Heerink et al.xiii explored the concept of enjoyment as a possible factor, which might
influence acceptance of robotic technology by older adults. They conducted an experiment
with a conversational robot, iCatxiv, on 30 users, which incorporated both a test session with
an interactive robot and a long-term user study. Ages ranged from 65 to 94 with 22 female
and 8 male. Data was gathered using questionnaires and observation sessions. This study
confirmed the role of enjoyment as a positive factor influencing robotic technology
acceptance by older adults and that the model of technology acceptance that implies that
intention to use reflects the user’s actual use is also applicable to specific technology used by
older adults.
Users who indicated that they were not interested in participating with the robot were all
observed interacting with the robot in the tearooms, as soon as the room was empty, implying
that just because someone does not wish to participate in a test, this does not mean they are
not interested in (or curious about) the system. The authors suggest that these users may have
been prevented from participating because they felt embarrassed. They are interested in
finding ways to tempt these users to participate and avoid creating the impression that test
subjects will ultimately encounter some form of embarrassment. They suggest it may be
valuable to encourage these potential users to participate in different ways.
The study implies that non-functional aspects could be an important factor in raising the
levels of enjoyment for older adults who use a system and the fact that a social robot is not
just for assistance, but also a welcome companion.
In a more recent study, Heerink et al.xv describe a UTAUT (Unified Theory of Acceptance
and Use of Technology) Toolkit they have developed to assist in the evaluation of a user’s
acceptance of social robots. Previous results have shown that a more extravert robot was
perceived as more socially intelligent and was more likely to be accepted by the user than a
more introvert version.
The researchers felt it was necessary to develop the model because this type of research is
multidisciplinary and requires some formalisation of method of interpretation. UTAUT
constructs that were applicable were Anxiety, Attitude, Facilitating Conditions, Social
Influences and the ‘classic TAM (Technology Acceptance Model) constructs which are
Perceived Ease of Use and Perceived Usefulness. These constructs are shown to have a
degree of interrelations. Although used in this study to measure technology acceptance it
could perhaps be used to measure a user or carers anticipated level of technology acceptance
when eliciting non-functional requirements for the system.
Forlizzi et al.xvi found that older people generally want products that match their aesthetic
desires and use products that support their functional needs and abandon those that don’t.
Also the most important products are the ones that support their values of personal identity,
dignity and independence.
Outcome for MOBISERV requirements: Considering ways of making the interaction with
the system enjoyable and engaging as well as ensuring utility of the functionality will be
important. It will also be vital to investigate whether assistive service robots and technology
are better presented as aids rather than carers, and to what extent the image of being “cared
for” by a machine affects a person’s concept of dignity and independence. The findings will
have an impact on the embodiment of the Portable Robotic Unit.
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2.4.1 Response to companion and service robots
Wada et al.xvii used questionnaires read to participants to evaluate the effects of a seal robot,
Paroxviii, on older adults in a nursing home. They used a Profile of Mood States (POMS) scale
(McNair et al, 1992)xix and the social readjustment rating scale (Homes and Rahes, 1967) xx to
investigate subject’s mood before and after introduction to the robot. They conducted
experiments over three weeks and participants were exposed to the robots in 2 groups for an
hour a day, 4 days a week. The robot was passed between the participants in turn and they all
spent an equal amount of time with it. They found that the robot increased happiness in those
that used it and that they interacted with it willingly. It also encouraged them to communicate
with each other and the nursing staff. One resident who was not sociable with others or staff
sang to the robot and made the rest of the group laugh, another made up a song about the
robot and sang it to the robot. Two robots were used in the study - one with interactive skills
and a placebo, the authors noted that both had positive effects on the users, as determined by
post session questionnaires. Their stress levels were reduced. Interestingly the subjects did
not notice that the placebo Paro's actions were following a pattern rather than in reaction to
their actions. Also participants interpreted their own meaning from the actions of the robot.
Another study involving the Paro seal robot, by Kidd et al.xxi, also conducted in a social
community setting where the robot was introduced as a shared artefact, belonging to the
group. Here it was found that the robot stimulated social interaction between residents, giving
them something to talk about and allowing them to share an interesting social experience,
which raised their esteem.
Ezer et al.xxii sent questionnaires through the post in order to investigate the types and
characteristics of tasks that younger and older individuals would be willing to let a robot
perform. They mailed questionnaire packets to 2500 younger adults (aged 18-28) and 2500
older adults (aged 65-86). A total of 310 packets were mailed back from respondents. Of
these, 177 were completed and answered by individuals in the targeted age groups – 60
younger adult respondents (M = 22.7 years) and 117 older adult respondents (M = 72.2 yrs) –
thus the effect rate of return was just 5.6%. They found that respondents from both groups
would prefer a robot to perform infrequent but important tasks that require little interaction,
such as emergency notification, rather than service - type chores that require recurrent
interactions. Older adults reported more willingness than younger adults in having a robot
perform critical tasks in their home and results suggest that both younger and older
individuals are more interested in the benefits that a robot would provide than in their
interactive abilities. The results contradict the belief that older adults are less willing to have
a robot in their home than younger adults.
Outcome for MOBISERV requirements: The above supports many of the envisioned
MOBISERV use-cases and functionalities, by stating that a robotic system should support
“infrequent but important tasks that require little interaction”. Many of the MOBISERV
functionalities, such as the ‘nutrition assistant’, the ‘dehydration prevention’, the ‘panic
responder’ and the ‘physical exercise encouragements’ will run in the background, and show
up only when absolutely necessary.
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2.5 Training Needs for Learning to Use Technology
Mitzner et al.xxiii explored training preferences for learning to use technology and found that
older adults definitely had a desire for additional training for technology items they used in
the home. Their training needs varied depending on their goals and they expressed an interest
in training particularly for specific tasks rather than general or basic training. Older adults
benefit from procedural training to a greater extent than conceptual training. People also
generally preferred the training to be conducted by themselves, family and peers, and domain
professionals. Czaja et al.xxiv has also noted that a negative attitude and low perceived selfefficacy are likely to impact learning proficiency.
Mitzner et al.’s findings also suggest that older adults have a strong preference for selftraining by reading manuals and other printed instructions and by hands-on learning through
trial and error.
Outcome for MOBISERV requirements: Training methods for learning to use technology
is something we will definitely explore more within MOBISERV; how to introduce the robot
and associated MOBISERV system and components to the end users. We will start from the
findings above, and explore ways to let the robot introduce itself to the end users, and teach
the end users the specific functionalities by hands-on learning and trial and error.
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2.6 Overview of existing assistive technology and service robotics systems
A review was conducted to understand the scope and potential of existing developments in the area of assistive and service robotics, which provides
strategic underpinning for technology being developed as part of MOBISERV.
Type of AT
Name of AT
Cognitive
Prospective
Memory aid
Memory Glassxxv
Cognitive
Prospective
Memory aid
MemoClip xxvi
Cognitive
Prospective
Memory aid
Friedman xxvii
MOBISERV
Target
Audience
Amnesia
sufferers,
mild
Alzheimer’s
disease,
dementia,
prosopagnosia,
normal
aging,
mild
cognitive
impairment
Amnesia
sufferers,
mild
Alzheimer’s
disease,
dementia, normal
aging
Normal
aging,
mild
cognitive
impairment, mild
Alzheimer’s
disease or other
dementia
Research or
Commercial
Research
Description
Status
Context-aware eyeglasses which Evaluations conducted with healthy
can be used to manage anomia participants
and agnosias. Reminder system. No evaluations have taken place with
less healthy participants
Research
Wearable badge attached to
users
clothes
which
is
associated with task information
such as time, location and
context
Evaluations conducted with healthy
participants
No evaluations have taken place with
less healthy participants
Research
Wearable microcomputer which
uses both radio and ultrasound
to determine user’s location and
provides task based information.
Voice prompts are only issued
when required which reduced
the user’s dependence this aid
Evaluations conducted with healthy
participants
No evaluations have taken place with
less healthy participants
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Type of AT
Cognitive
Prospective
Memory aid
Cognitive
aphasia
Name of AT
Target
Research or
Audience
Commercial
AutoMinder xxviii
Normal
aging, Research
mild
cognitive
impairment, mild
to
moderate
Alzheimer’s
disease, or other
dementia
VERA
(Visually Normal
aging, Research
Enhanced
Recipe aphasia
Application) xxix
Cognitive
aphasia
Cooks Collage xxx
Environmental
PlaceLabxxxi
Physiological
Bedwetting alarms xxxii
Physiological
GlucoMON xxxiii
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Normal
aphasia
aging, Research
Research
Anyone
Commercial
regardless
of
cognitive
impairment
Anyone
who Commercial
requires
their
blood
sugar
levels
to
be
Description
Status
Cognitive orthotic device which Early prototype has not been
can model user’s daily activities evaluated with intended target
and issue reminders accordingly audience
Sound and text based interface
which mainly provides visual
displays
for
cooking
instructions
that
can
be
customised for aphasic users
Video reminder system which
displays the various stages for
preparing a meal using previous
six stages taken on a monitor
Detects motion and activities
with a combination of sensing
devices integrated into the
architecture of the house as well
as on devices and wearable
sensors
Pads detects moisture
It has not been determined whether
text or sound is more suited for
issuing cooking reminders
Monitors blood sugar level
Can be operated with existing blood
sugar level monitoring devices
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Evaluations are currently in progress
Effective in association of usage with
other similar environment sensing
aids which can be used to detect and
monitor user activities
Various bedwetting alarms
commercially available
are
D2.3: MOBISERV System Requirements Specification, VOLUME II
Type of AT
Name of AT
Target
Research or
Audience
Commercial
monitored
Vulnerable
to Commercial
falls
Physiological
Fall detector xxxiv
Physiological
University of Virginia Vulnerable to
Research
floor vibration based falls
fall detector xxxv
Vibrating gel insoles Vulnerable
to Research
xxxvi
falls
Physiological
Advanced
integrated
sensor set
BodyMedia
Bookmark
defined.
Advanced
integrated
sensor set
Garmin
MOBISERV
xxxviii
xxxvii
Error! Anyone
who Commercial
not requires
monitoring
of
metabolic
and
physiological
data
Forerunner
Anyone who
Commercial
requires
monitoring of
metabolic and
physiological
data
19/85
Description
Status
This Wireless sensor is worn on
a belt or in a pouch with an
elastic belt can automatically
detect serious falls and raise an
alert to the monitoring centre or
designated carer.
Piezoelectric sensor joined to
the floor monitors floor
vibration patterns
Viscoelastic silicone gel insoles
with
embedded
vibrating
components to assist and
improve balance
A button on the front can also be
used to call for assistance which
could be used to replace the Amie or
Gem Pendant.
Very successful lab tests (100%
accurate detection 0% false alarms),
Sensor is lightweight and so can
easily be embedded in shoes
Wearable upper arm band that Available for general public
monitors user’s metabolic and
physiological
information.
Armband maybe uncomfortable
and or intrusive for some older
people
Wearable wrist GPS device Mainly designed for use by athletes
which monitors heart rate,
distance covered and calories
burned
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Type of AT
Name of AT
Advanced
integrated
sensor set
CareWatch
Bookmark
defined.
xxxix
Advanced
integrated
sensor set
CareMedia
Bookmark
defined.
xl
Advanced
integrated
sensor set
COACH
(Cognitive
Orthosis for Assisting
Activities
in
the
Home)xli
MOBISERV
Error!
not
Error!
not
Target
Audience
Mild cognitive
impairment, mild
to
moderate
Alzheimer’s
disease or other
dementia
Mild to severe
Alzheimer’s
disease or other
dementia
Mild cognitive
impairment, mild
to
moderate
Alzheimer’s
disease or other
dementia
20/85
Research or
Commercial
Research
Research
Research
Description
Status
Multisensory system which Published data of clinical trials is
informs carer whether user is now available
moving within the home,
attempting to open a door or in
bed
Automated system which uses
video and sensor to monitor
behaviour, activity and social
interaction
Computer vision system that
can interpret hand positions
with stages of hand washing
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Feasibility study and follow up
comprehensive study has taken place
in a dementia ward
Tested with 10 moderately to
severely demented users who were
able to complete 25% more stages
correctly without carer assistance
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Type of AT
Advanced
integrated
sensor set
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Name of AT
Target
Research or
Audience
Commercial
Radio frequency (RF) Anyone at risk Research
transmitter
home from dementia
monitoring
system
xlii
Error! Bookmark
not defined.
Advanced
integrated
sensor set
PROACT
(Proactive Mild cognitive Research
activity toolkit) xliii
impairment, mild
to
moderate
Alzheimer’s
disease or other
dementia
Advanced
integrated
sensor set
European Commission
on
SmartFarbrics
Project
(WEALTHY
garment, MyHeart) xliv
MOBISERV
Research
Description
Status
Motion detection sensors and
wireless network is installed at
the users home and user is
required to wear a watch so that
the system is able to monitor
their motion within their home
The feasibility of the research
prototype
has
only
been
demonstrated in a single home using
a 3-week longitudinal record of RF
transmission data as part of a larger
study of persons at risk for dementia
Computer based system which
uses RF technology to recognise
activities of daily living and
performance of these activities.
User wears a glove which
detects RF signals placed on
objects within the users home
Wearable vest which monitors
EKG, breathing, EMG and
physical activity
Tested on a group of participants
aged 25 to 63, results showed the
system recognised 14 activities of
daily living and detected 88%
occurrence, 73% of which were
correct
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participants (none over the age of 64)
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Type of AT
Advanced
integrated
sensor set
Target
Audience
BioHarnessBTxlvError!
Anyone who
requires
Bookmark
not
monitoring of
defined.
metabolic and
physiological
data
Microsoft
Sensecam Memory loss
xlvi
Error! Bookmark
not defined.
Assistive robot
Gecko
Assistive robot
Intouch
Advanced
integrated
sensor set
Name of AT
xlviii
MOBISERV
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Research or
Description
Status
Commercial
Research and Wearable
device
which SDK available for research
Commercial monitors heart rate, EKG,
breathing, temperature and other
vital signs
Research
Wearable neck device that
consists of a passive digital
camera, sensors and 3 axes
accelerometer.
Systems Older
people, Research
CareBot xlvii
chronically
ill
and children
Mobile service robot platform
which can act as a nurse’s aide
responding to commands from
medical personnel. Carebot can
also perform various carer
related tasks such as replacing
bed pans and other mundane or
undesirable tasks allowing the
carer to focus on patients.
Carebot can carry over 200lbs
and also provides Telemedicinal
functions.
Mobile robotic platform which
provides the means for a
medical professional to provide
rapid assessment of stroke
patients in emergency rooms
health
RP-7 Medical
Commercial
professionals,
stroke victims,
hospital patients
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Case reports with older persons with
limbic encephalitis and mild to
moderate AD suggest improved
recall of autobiographical events.
Poor resolution images may not be
suitable for memory report
Cost effective monitoring, virtual
visits,
automatic
reminders,
companionship,
automatic
emergency notification and trials of
this robot have taken place
Has been tested on both stroke and
oncology wards in the USA and has
also been demonstrated with
assisting health professionals with
teaching students
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Type of AT
Name of AT
Target
Audience
23/85
Research or
Commercial
Description
Status
Research conducted with dementia
patients in Japan resulted with half
the patients showing an improvement
in brain activity after spending time
with the robot
Therapeutic
robot
Paro (National Institute Older
people, Commercial
of Advanced Industrial hospital patients
Science
and and the sick
Technology Japan) xlix
Therapeutic robotic seal which
uses tactile sensors to respond
to being stroked, petted, speech
and sounds.
Assistive robot
Ri-man (Riken bio- Bedridden
mimetic
control patients
l
research centre)
Soft humanoid interactive robot Under development
which has the skill and ability to
carry out human care and
welfare tasks. Soft areal contact
sensors measure magnitude and
position of contact force. Body
is covered with soft material for
physical safety with human
robot contact and mechanical
joints are isolated
MOBISERV
Research
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Type of AT
Name of AT
Assistive robot
Twendy-One li
Assistive robot
Companionable lii
Target
Audience
Older people
24/85
Research or
Commercial
Research
Older
people Research
suffering
from
dementia prone
to
social
exclusion
Description
Status
Human
symbiotic
robot
designed to assist with nursing
care and housekeeping. Outer
shell is overlaid with silicone
skins and force sensors which
detect physical contact
Passive
impedance
mechanism
allows the robot to adapt to
unexpected external forces
Projected cost to supply the robot
may exceed current cost of human
care
Integrated cognitive assistive Graceful, scalable cost
and domotic companion robotic integration
system for ability and security
Table 1. Summary of recent and current assistive technology
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2.7 Conclusions
This literature review has provided a number of insights into integration and interaction
issues that need to be addressed as part of the MOBISERV project, particularly in relation to
providing a system which will be relevant and thus valued and used.
The recent and current systems identified provide useful background information for the
development of the different MOBISERV components that the consortium can build upon.
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3 Further analysis of the data gathered
This chapter presents further analysis of all the primary data gathered in the first year of the
project. The focus of this analysis was to explore in more depth the themes identified in the
first release of this document as well as any relationships between the themes. The ensuing
coding helps to translate emerging issues clearly into functional and non-functional
requirements.
3.1 Mechanisms used to translate user needs into system
specifications
Incorporating a broad user-centred design approach, we used several data gathering, concept
generation, and user counselling iterations, designed to result in a deeper and more informed
understanding of issues with each succeeding approach. The foci of the subsequent stages
were refined depending on the outcome of the previous stages.
As depicted in the figure below, we started with observations in older people’s homes and
living environments. Based on what we experienced and learned here, we started
interviewing the end-users, their carers, their family and secondary stakeholders, to get a
deeper understanding of the older people’s lives, their habits, problems and needs. Based on
these outcomes, cultural probes were designed to focus on specific aspects of older people’s
daily lives, and very early concept ideas were generated and discussed in focus group
workshops with a mixture of end-users and other stakeholders.
Figure 1 MOBISERV’s user-centred design approach
During, and right after the initial user requirements elicitation phase of the project, the
extensive data from all stages of the user-centred design approach was thoroughly analysed
and coded. As shown in the figure below, key themes including their many details were
extracted and end user characteristics were analysed and grouped in several personas. Using
the personas scenarios were developed addressing the emerging key themes. These scenarios
and use cases form the basis for the envisioned MOBISERV system and its functionalities.
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Observations, Interviews,
Questionnaires, Cultural
Probes, Focus Groups
Key Themes
Scenarios /
Use Cases
MOBISERV
functions
End User
Characteristics
Personas
Function
Requirements
Qualitative &
Quantitative
Data Analysis
Figure 2 Methods used to translate user needs into system requirements and specifications.
3.2 Coding and interpretation
Previously coded data fragments extracted from the results of the initial user requirements
elicitation phase (appendices of deliverable 2.3 Volume I) and subsequently gather data were
reanalysed in more depth. A very short summary will be given here.
3.2.1 User Characteristics
A large variability in the data was noted:
 Age between 59 to 95
 Gender ratio male/female between 1:7 to 1:15
 Most live alone, on their own or in a residential home
 Most are not graduated
 Type and level of handicap:
o mild dementia
o limited mobility, they can’t do what they want to do
o severe somatic handicaps, that is physical, not mental
o incontinence
o social isolation, loneliness
o malnutrition, do not eat and drink enough
o falling
o exhaustion caused by restlessness
 Variety in technology use, most have a TV, some have a cell phone, few have a computer,
very few use internet or email
3.2.2 Key Themes
3.2.2.1 Nutrition
The data gathered has illustrated different ways in which older people regulate themselves in
order to ensure they are eating and drinking enough. This provides a valuable insight into
how these functions may be implemented. Suggestions from participants for content for
encouragement included showing images of food and drink, as well as using cooking sounds
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and smells to encourage an older person to eat or drink. We will be conducting further
research into evaluating different approaches that have been identified by older people
regulate themselves and methods that are used by carers, friends and family. The findings
will provide a valuable insight into how these aspects of the system can be implemented
successfully. Once this has been established and can be explained to older people, this may
increase perceived usefulness of these functions and therefore improve acceptability amongst
older people of the system as a whole.
3.2.2.2 Health and Well-Being
Our findings show that older people regulate themselves not just in regards to their diet, but
also to ensure they are taking their medication correctly (correct dosage, correct time,
managing prescriptions, etc.) and as well as exercise. This has provided useful insight into
how these actions can be supported by the functions of MOBISERV. Continuing
investigations will reveal which methods are found to be most effective, with long-term
benefits. This information will prove useful when designing the various encouragement
features while also increasing acceptability amongst older people who want to develop an
established routine in regards to ensuring a healthy lifestyle.
Utilising strategies that carers actively use to encourage a healthier lifestyle for older people
will also prove useful when designing and implementing functions related to health such as
nutrition monitoring and encouragement to exercise. For example, some users may be more
receptive to particular suggestions in regards to encouragement to exercise compared to
others. Increasing acceptability in regards to these functions may be achieved by considering
established guidelines, methods and activities are used to promote and encourage a healthy
lifestyle for older people. Consideration of attributes that are successfully applied to older
people within specific categories such as similar level of handicap, age, gender etc. suggest
options for customisation to suit individual needs.
A review of various organised activities, and methods to encourage participation within care
homes and residential villages with older adults, has highlighted the effectiveness of different
approaches towards encouraging participation in social activities. One example is the possible
use of the video conferencing to enable older people to see others exercising with them which
will be further investigated. Combining features of the system such as video conferencing to
achieve one function could be applied to others such as encouragement to exercise related to
encouragement to drink.
3.2.2.3 Safety
Our findings show that many older people are aware that they may be susceptible to injury
caused by a fall or other type of accident. However some older adults are reluctant to discuss
this with researchers on the grounds that they perceive the researcher suggesting that they are
somewhat more vulnerable than what they believe they are. This reluctance to admit frailty
and loss of functionality will be important to be aware of when customising and
individualising the system to an individual. Concealment could lead to inappropriately or
incorrectly configured systems that are not suit to the individual’s real condition.
3.2.2.4 Comfort
Physical comfort in relation to any devices that must be worn, and psychological comfort
associated with the perceived usability and reliability of technology are key areas of concern
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that have emerged throughout. These are also found linked to acceptability in regards to
computer anxiety.
Identifying specific issues in relation to the MOBISERV system will only be possible when
all the prototypes being to be evaluated as part of the field trials.
3.2.3 Clustered feedback to the concepts
This section covers issues arising in relation to the selected functions selected by the
ILAEXP.
Nutrition Monitoring
Malnutrition
 Many older people do not eat or drink enough.
 Especially people living (semi-) independently.
 Many older people are dehydrated and do not understand the importance of drinking
enough.

Monitoring
 The majority of the carers agreed that nutrition monitoring is very important
 Carers suggested that nutrition monitoring may be of use to users suffering from
dementia, as some have no understanding of what food is what and often need to be
told what to eat.
 The majority of the end users were very negative towards nutrition monitoring.
 The majority of end users were against having cameras in their home and felt that it
would invade their privacy.
Eating / drinking
 Monitoring the amount that people drink was suggested as more important than
eating.
Locations
 Most end users sit in the same place to eat all their meals, either at the table or sat in
a comfy chair.
Assistant Robot
Input



Voice



Embodiment

Control




Functionality


All agreed that voice recognition is the best way to communicate with the robot.
The issue of voice recognition of multiple users was also raised.
Some suggest that a graphical interface would be useful for people who had had a
stroke and were unable to speak.
The majority thought that it would be important to personalize the robot by
selecting gender and accent.
Most did not like the American accent and would prefer an English one.
The style of the interaction on the demonstration video was found “cold” and
lacking emotion.
Some thought that a humanoid robot might be best and would like it to have some
kind of facial expression to make it seem more human.
While some thought that it looked cute, others found thought it looked very scary.
A few thought that it didn’t need to have a form at all and just needed the base.
Some were open to the idea of it being a pet but that fur might not be practical.
A number of participants pointed out the importance of being able to turn the robot
off and to put it away, for example in a cupboard.
Many suggested that it would be very useful if the Robot had an arm or grabber so it
would be able to pick things up for the user.
The participants were positive about the camera on the robot if it is used for video
conferencing only, but reiterated the importance of being able to switch it off.
Smart Textiles
Clothes
MOBISERV


The majority is very positive about smart clothing.
Some participants suggested it would be better as a separate device, so
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


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they would know they were wearing it and it would not need to be washed as
frequently as underwear.
A number of participants and carers suggested that it might be
necessary to have a front fastening on the vest as many older people struggle to get
into tighter clothing.
Some wonder who will be monitoring the signal.
Carers suggested it would be particularly useful if it could detect when a
user had fallen.
Several carers do not see the benefit for their clients, but think such
smart clothes would be more beneficial in a hospital.
Health Monitoring
Monitoring

Reporting



Emergencies



Emotions

The end users were generally negative about being monitored and
information being passed onto their doctor or carer.
Falls and strokes were seen as important issues by carers and end users.
Few of the participants understand the use or importance of the system
being able to produce reports.
Carers think that when users might think they are not ill enough to
'trouble' the doctor, the system can help to identify their illness and choose to contact
the doctor if needed.
Most end users felt that in an emergency a carer or doctor should be
contacted straight away.
A number suggested that the system should ask the user first and if
there was no response should then contact someone.
An 'override' function was suggested for certain situations programmed to suit the needs of the individual.
Some carers could see the benefit of facial recognition but felt that end users may
feel that it was an invasion of their privacy.
Video communication
Social interaction
Virtual contact
with carers




Social isolation was identified as a very important issue.
Video communication can be very helpful.
Some people still prefer using the telephone, which they feel most comfortable with.
Some staff have experience with video communication, but think it could be much
improved and then be very helpful.
 Several clients and social carers mention that they would be very happy with a video
communication system.
3.3 Conclusion
The findings summarised here and presented in Vol I have enabled the consolidation of
specific functional and non-functional requirements that are presented in the next chapters.
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4 Detailed Functional and Non-Functional
Requirements
4.1 Requirements prioritisation and selection – Summary of
expert committee discussion and results
From the scenarios and functions identified in Volume I of the requirements specification,
nine of them gained high ranking in the Independent Living & Ageing & cross-industrial
committee of experts (ILAEXP) workshop (on prioritising MOBISERV requirements) held
on September 21, 2010 in Paris, France. The committee used the following criteria to support
their decision:

Strategic Value: Does this feature address the project’s objectives (DoW) in
promoting health and well-being and independence for an individual?

Utility - Secondary stakeholders: How useful is this feature for secondary
stakeholders? (By usefulness we mean, the secondary stakeholders are able to provide
better services and improve the utilisation of their existing resources)

Utility - Tertiary stakeholders: How useful is this feature for tertiary stakeholders?
(By usefulness we mean, the tertiary stakeholders are able to provide better services
and improve the utilisation of their existing resources)

Technical Feasibility: Is there any technical or other risk associated with this
requirement/ feature (keeping in mind correspondence with the proposed technical
solution in the DoW)?
Scale of 1 (there are serious concerns about feasibility, the availability of staff with
the needed expertise and/or resources, or the use of unproven or unfamiliar tools and
technologies, within the scope and lifetime of MOBISERV) to 5 (no risk, the feature
can be very easily implemented).

Market exploitation potential: Is this function exploitable from a financial
perspective?

Innovation: Is this function new? Does it significantly contribute to an increase in
scientific research on AAL, and is it not already part of many other research projects?
The process of prioritisation involved a discussion of the scenario and use-case related to a
particular function followed by independent voting. Each member of the committee then read
out their score and explained the rationale behind their score and this was noted. Using a
weighted average, the overall score was calculated and noted. On ranking the scores in order
and applying a cut-off threshold, 11 functions were selected, with four being combined into
two, resulting in a total of nine functions.
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4.2 Summary of High Level Functions and discussion points
Proposed
Functionality
Encouragement to
drink
Score Discussion
Encouragement to eat
35.5
Reminder to drink
35
Reminder to eat
32.5
MOBISERV
36.5
It was recommended that this function be merged
with Reminder to Drink. The research would be in
the area of developing effective persuasion
techniques from a psychological level and this
would have to be an aspect that was customisable.
It was recommended that this function be merged
with Reminder to Eat. Again there was a lot of scope
for researching persuasive methods. From a
psychological perspective this was very important.
It was discussed that while this was a challenging
function from a technical and practical perspective
good results had been achieved in a laboratory
setting. As such, the experts deemed the market
potential important. A name change to Dehydration
Prevention was recommended to clarify
functionality. This function was seems to have a
high innovation aspect. Further evidence for
supporting this function can be found in the Dutch
national task force annual reportliii of 2010 on
malnutrition shows that currently 17% of people
receiving care at their home suffer from
malnutrition. This is 21% for people living in care
homes. Dehydration numbers are expected to be
even higher, up to 25% of people living at home)
This function was deemed particularly important on
strategic value. It was suggested that this function
could be linked with the encouragement function.
Some issues discussed included - thinking about
what measures could be taken if the person did not
give an accurate response - this could be by
validating user response by using information from
sources. It could be also useful to consider help in
relation to unhealthy eating- offering people healthy
options as suggestions and tracking dietary intake
when self declared and advising appropriately.
Interactivity should include asking the person what
was eaten and logging the information appropriately
should be considered. It was recommended that the
wording of the function be altered for clarity. How
the act of eating is detected needs to be
communicated, as this is an innovative aspect of the
project. Nutritional Assistance was one suggestion
made. The discussion also included what
information would be communicated to the
secondary and tertiary stakeholders and the utility of
the information for them. It is also important to
consider how the reminder would be personalised.
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Proposed
Functionality
Reporting and
communicating to
health professionals
Score Discussion
31.5
A tele-medicine/self
31
check platform.
(Finding out if
everything is okay - in
cases of detection of
irregular patterns)
Games for Social and 30
Cognitive Stimulation
Voice/Video/SMS via 29
Robot communication
with friends and
relatives
A mobile screen
connected to the front
door
28.5
Response to call for
help from the user.
(Panic responder –
Being able to call
someone in an
emergency)
28
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The utility and role of tertiary stakeholders needs to
be considered in more depth, in relation to their roles
and commitments and how this could fit in with
existing service models. The utility for healthcare
staff will also have to be clearly defined.
Clear provision of protocols and process will need to
be considered and defined.
This was seen as a very good and useful feature that
could also have a positive impact on overall usage of
the system. It was also recommended that exercises
could be encouraged through games as well so there
was potential to consider linking with
encouragement to exercise functionality. With the
potential ability to have an affective response
during game play, by recognition of facial
expressions for instance, was seen as an innovative
development. Serious considerations need to be
given to the types of games available and the
development costs associated with this.
There will be overlap between this function and the
one involving communication to health
professionals. The two-way communication could be
initiated by care-givers to remotely communicate
with the person in case of not being able to visit,
alleviating social isolation and loneliness. As there
are products already available for this purpose, it is
important to define clearly the added value that
MOBISERV can bring in terms of usability and
accessibility for the target user groups.
Combining this function with the other proposed
features will enhance the overall utility of the
MOBISERV system giving it added value. The
utility of the MOBISERV proposal for this
functionality is that it is mobile, the person does not
need to go to a fixed point, but the portable robotic
unit can come to the person.
Considerations were given to the technical aspects of
enabling this functionality effectively. Suggestions
were made in regards to embedding microphones in
the environment or person. False positives would be
important to consider avoiding overloading the
response team who might be contacted. This is a risk
of failure from a number of issues due to real life
complexity and it was recommended that further
careful consideration should be given to the risk
factors to ensure reliability.
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Proposed
Functionality
Encouragement for
exercising
Score Discussion
28
Reminder to take
medication
27.5
Allow user to check a
particular medication
27.5
Food inventory
26.5
A mobile remote for 26.5
the house (lights,
heating,
curtains,
locks)
Reminder for personal 25
hygiene
Diary
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24.5
There was potential for this to be developed into a
very innovative function by considering ways of
reliably recognising inactivity/activity levels and
making appropriate suggestions that are
customisable to suit individual issues and
circumstances. The interface should be given careful
consideration - as with other functions. If an emotion
centric element were considered for the nature of the
encouragement, this would have a high innovation
potential.
Identifying the potential of incorporating a social
element to this feature as well as linking to the
games could be explored. A review of existing
technology, such as the Nintendo WiiFit was
advised.
THRESHOLD
There are a number of competing products which
already exist in regards this function. As such there
was a consensus over the low score on all criteria.
There was potential for combining this with the
reminder for taking medication, however an
automated process is fraught with complexities
relating to safety and reliability issues, as medication
is not always retained in its original packaging,
which also varies considerably. At its simplest level,
this could be achieved as part of the first-person
telecommunication with medical personnel.
The committee members agreed that carers and
relatives would be checking the contents of the
fridge and pantry on an intermittent basis anyway.
While providing this information to people with
dementia is important, the technical feasibility of
this would be quite complex - particularly managing
leftovers etc. and non-pre-packaged meals and food.
There is a possibility of enabling the users to
interactively inform the system, but that somewhat
defeats the objective of automation. Additionally it
was noted that there has been quite a lot of research
in this area already with no significant success.
This was viewed as having low market potential and
innovation and outside the scope of the project as
envisaged requiring a high level of external
integration.
This was viewed as having low market potential and
innovation and outside the scope of the project as
envisaged and could requiring a high level of
monitoring. If required, this could be made part of
the dairy scheduler.
Extremely low scores in relation to the innovation
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Proposed
Score Discussion
Functionality
reminder/management
criteria. Already implemented by Robosoft as part of
(Being reminded of
their existing platform.
social engagements
and other diary
appointments)
Facility for carrying
23.5
While this could help people with mobility issues,
things from one room
people with mobility difficulties already have
to the next
carrying facilities as part of their ambulatory
assistants. There would be little overall benefit in
relation to resources for redesign. Low score on
innovation criteria.
Automated checking
23
This was defined as being outside the scope of the
of gas, water,
project required excessive integration with external
windows, doors
elements.
Responding to
19.5
Information is available via other media channels
requests for Weather
already in use. This is also part of the existing
Information/News
functionality implemented by Robosoft on their
mobile platform.
Table 2 Summary of prioritisation discussion for the High Level Functions
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4.3 Detailed Functional Requirements
4.3.1 Function for reminder and encouragement to eat (Nutritional
Assistance)
This function will serve to prevent malnutrition for people that tend to forget to eat or do not
feel like eating, and tend to skip meals.
4.3.1.1 Use cases
Use-Case 1:
As Brenda has diabetes, her doctor has advised her to eat regularly. She is also prescribed
some medication for her diabetes, which needs to be taken after meals, so it is important that
she eats on time.
Brenda’s daughter has setup meal-time periods using the MOBISERV touch screen interface.
When the intelligent monitoring system in the environment and robot has not observed any
eating activity around such a timeslot, the system will ask Brenda if she has eaten. If she
replies that she has not, it gently suggests that she should have something to eat.
On the occasions when Brenda is out, the system knows that she is not in, so the reminder
will not be issued. Later, the MOBSIERV system confirms whether she has eaten when she
returns by politely inquiring.
Use-Case 2:
Aalbert lives on his own and often feels depressed and lonely. He has never been very good
at cooking and consumes very little nutritious food, mainly relying on packaged food. Often
he does not eat at all.
When the monitoring system has not observed any eating activity for a pre-set period of time
(set-up in consultation with Aalbert) or has received a negative response in response to the
reminders, the system recommends to Aalbert that he eats something by a persuasive (to be
determined by research and customisable to individual preferences) encouragement. It
suggests meal options (based on the contents of his refrigerator or larder if these are known)
or items that it has recorded as being Aalbert's favourite nutritional snack. It also lets him
know of the benefits of eating regular healthy meals, and suggests that doing so will make
him feel better. The system has a set of ways of proposing nutrition and does not repeat the
same information every day.
4.3.1.2 Function specification and assumptions

The function is activated using the Graphical User Interface (GUI):
When user
deactivates the function a warning will be issued and an e-mail will be sent to the
caretaker or a relative. Meal types and eating periods are pre-specified by a healthcare expert or relative using the GUI (remotely and locally). The person responsible
for this should set a realistic interval because the EatingDetection system will be
switched ON at the start of those eating periods and will be running just for the
duration of the meal periods. (AUTH should specify if the monitoring system will is
going to be running continuously or not. In case the EatingDetection system runs
continuously then EatingDetection Initialisation and termination are unnecessary)
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
It is assumed that the user is at home. Otherwise the function must not start. When the
user comes back home the robot should ask for information about the user’s eating
activities while he was out.

“No response” function (see flowchart): this function will first check for technical
problems (e.g. low volume) and repeat the notification. If this fails again, an e-mail
should be send to the care-taker/doctor/relative.
4.3.1.3 Content Requirements:


Nature of information and presented format - Pictures/Video on screen, speech,
sound
Timing specifications: default values of how long after the meal time will the first
encouragement occur and after that how often will it be repeated (Z). These values
will be determined by the carer/relative in consultation with the end-user.
4.3.1.4 Sub-Function Requirements
SubFunction
ID
Sub-Functions
Requirement
F_1.1
Ability to turn function ON or
OFF
F_1.2
F_1.3
Setup meal timeslots and periods
of eating for each meal
Detect a missed meal
It should be clear to the user and others
whether this function is in the ON or OFF
mode
Touch screen interface for carer or user
F_1.4
Locate the person
F_1.5
Issue a missed meal reminder to
the person
Detect an acknowledgement of
meal reminder by the user
F_1.6
F_1.7
F_1.8
F_1.9
Detect the action by the user in
response to the reminder
Issue a highly persuasive
encouragement to eat to the
person, after not responding to a
reminder.
Log a missed meal
Camera monitoring status should be visible
to the user
Option of actions to take if the person can’t
be located within a pre-set time limit
Voice or melody or screen (Allow for
selection by user or carer)
If the reminder has not been acknowledged
within 10 minutes (for example), reissue x
number of times, after which take a predetermined course of action
Request verbal response if no action is
identified.
Voice / on screen, persuade for instance by
showing favourite food, or available food.
Log date and time. Take pre-set action when
a pre-set number of meals are missed.
Table 3 Sub-Functions for F_1
4.3.1.5 Process Specification
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Start service
Google
Calendar
PRU loads
Data
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Alternatives:
 Internal database,
 text file,
 intranet,
 other web-based
database etc
Initiate
EatingDetection
Notify user that
he is being
monitored
Eating activity
detected
YES
Reminder
NO
HOW?
PRU Locates user
PRU asks user
if he has
eaten
User responds
question
Using Dialogue
and/or a GUI
No
Trigger
separate
“No
response”
function
Yes
If user has
eaten
YES
No
Using Dialogue
and/or a GUI
Issue a
reminder
Encouragement
Log
acknowledgement
If eating activity
detected
Within the preSpecified time
interval
NO
Yes
Log
missed
meal data
Terminate
EatingDetection
Encourage
user to eat
Yes
Log meal
data
YES
If eating
activity
detected
No
End service
If Z minutes
have passed
Figure 3. Process specification for the Nutritional Assistance Function
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4.3.2 Function for Reminder and Encouragement to drink (Dehydration
Prevention)
This function will serve to prevent dehydration for people that do not drink enough, or tend to
forget to drink.
4.3.2.1 Use cases
Use-Case 1:
Brenda often forgets to drink enough during the day.
Brenda’s assistive robot will remind her to drink in combination with the other reminders or
at moments where she is eating or taking her medicines. These reminders and triggers can be
set-up by Brenda’s daughter through the GUI on the PRU. Only when more than a pre-set
number of hours pass by, without any drinking events, the robot will suggest to have a cup of
tea, coffee or water. To detect this, intelligent sensors in the environment will be combined
with the sensors of the robotic assistant.
John, who will also find having this reminder useful, might potentially have problems with
interpreting and recognising the reminder because of his memory problems. Therefore, the
system will be fully customizable in terms of the interface mode used for the reminders, as
well as the appearance of these reminders.
Use-Case 2
When Dafne is at home, her assistant robot provides gentle encouragements to drink, by
proposing many varying fluids, on varying times of the day. Think about water, milk, coffee,
tea, orange juice, wine, etc. The system learns what Dafne likes and what not, and adjusts the
schedule to this, but every now and then, it will still propose new or other drinks.
For Brenda, her weak eye-sight has to be taken into consideration, so the information should
not only be presented on the screen. For John, there might be potential problems with being
able to interpret, recognise and respond to the encouragement because of his dementia. So for
him, the messages should be very easy to understand and structured.
4.3.2.2 Function specification and assumptions
ON/OFF Setting on GUI should issue warning when switching off and send e-mail to a
relative or when ON user should be notified that they are being monitored
GUI should also provide settings setup for:


the interval the robot should wait until issues a reminder again
If reminders should be issued when user is taking medication or is having a meal (if
this is the case, the best way to accomplish this is to integrate this function with the
eating and medicine functions)
Drink preferences should also be taken into consideration.

4.3.2.3 Content Requirements

Nature of information and presentation format - Pictures/Video on screen, speech,
sound
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Timing specifications: default values when the first encouragement occurs and after
that how often will it be repeated (Z). These values will be determined by the
carer/relative in consultation with the end-user.
4.3.2.4 Sub-Functions Requirements
SubFunction
ID
F_2.1
Sub-Functions
Requirement
Ability to turn function ON or OFF
It should be clear to the user
and others whether this function
is in the ON or OFF mode
F_2.2
F_2.3
Detect lack of drinking activity
Issue a reminder to drink, together with a
eating reminder
Detect drinking activity
Issue a reminder to drink, when detecting an
eating activity
Detect and log the user’s response to the
reminder
Keep a list of drinks, and preferences of the
user
Issue a highly persuasive encouragement to
drink to the person, after not responding to a
reminder.
F_2.4
F_2.5
F_2.6
F_2.7
F_2.8
Voice / on screen, persuade for
instance by showing favourite
drinks.
Table 4 Sub-Functions for F_2
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4.3.2.5 Process Specification
Start service
Time of consumption of
last drink,
Preferred drinks etc
Google
Documents
/database
Load data
DrinkingDetection
NO
Locate
user
YES
Ask user when did he last
drink something and get
response
YES
If user last drank
something > X hours
ago
No
Within a prespecified time
interval
Issue Reminder and log
acknowledgement
Log
missed
drink data
If drinking activity
detected
YES
Log drink
Data
Yes
Encourage
user to drink
DrinkingDetection
End service
No
Yes
NO
If Z
minutes
have
passed
Figure 4 Process specification for the Dehydration Prevention function
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4.3.3Function for Reporting to health professionals
This function will facilitate easy, reliable and frequent communication between the user and
certain carers (social and/or professional).
4.3.3.1 Use cases
Use-Case 1:
Dafne has some physical problems, related to her age. Every now and then, she feels pain
somewhere, or she does not feel as well as usual. She always wonders whether this is all
related to her age, or that there is something more. She does not want to go to the doctor
everytime as it is quite cumbersome to get to the clinic. With MOBISERV, Dafne can ask for
a very quick but effective tele-consultation. This means that through an audio and video link,
she can hear and see the doctor, and the doctor can hear and see her. She has to make an
initial request to see the doctor via the system and then when there is a free slot the doctor
calls her. The doctor has some standard questions, and Dafne can ask about her specific
complaints. If needed, this tele-consultation can be followed up by a real consultation.
4.3.3.2 Function specification and assumptions

Medical personal will hold complete records for the person with information
regarding any changes or variations to conditions and treatments.
4.3.3.3 Content Requirements



Need to log the problem the older person is experiencing clearly in a pre-defined
format.
Enable user to define the mode of initial communication depending on the nature of
their query - use email as the default. The user has the option to also use the
emergency services (e.g. 999) via traditional means.
Need to receive acknowledgment to the query/appointment request.
4.3.3.4 Sub-Function Requirements
SubSub-Functions
Function
ID
F_19.1 Ability to turn function ON or OFF
F_19.2 Ability to easily add / remove contacts like
family, carers and doctors
F_19.3 Ability to setup a audio and/or video
connection to a remote party
F_19.4 Ability to follow the user with the webcam
F_19.5 Ability to follow the user with the robot
F_19.6 Ability for the user to focus on a body part
which is not the face
F_19.7 Ability to mute the audio and/or video
Requirement
It should be clear to the user
and others whether this function
is in the ON or OFF mode
The user should be asked for
audio, or audio and video
For small movements
For big movements
Should be intuitive and simple,
maybe using the touch screen
Table 5 Sub-Functions for F_19
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4.3.3.5 Process Specification
Start Service
Start Service
User requests teleconsultation
If doctor /
carer calls
NO
Locate and go to
user
Request
problem
information
from user
Email
doctor/
carer
End Service
Mute option
Notify/show outgoing video
so the user knows that
camera is active
Remote control of webcam
& video
Voice or on-screen
command for call
termination
Notify
user
Call Social
carer/
Remote
Call
Centre
NO
If user
responds
Setup audio/
video call
No
If real
consultation
required
Make
appointment
End service
Figure 5 Process specification for reporting to health professionals
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4.3.4 Function for a tele-medicine/self-check
This function will facilitate easy and non-intrusive health check-ups, and/or long-term health
monitoring, and/or advice to improve the users general health and well-being.
4.3.4.1 Use cases
Use-Case 1
Brenda has mobility issues and has been prescribed with an exercise regime to improve her
walking, balance and general fitness. She also has a heart problem, so her breathing and heart
rate have to be monitored at the same time.
Mobiserv system monitors the most important vital functions using smart garments and
activity sensors, which Brenda puts on before the exercise sessions. The smart garment can
follow her activities and issue an alarm to her to slow down or stop, for instance when her
breathing and pulse functions become too high or irregular. All the readings during her
exercise session are recorded and emailed to her doctor at the end of the week.
Use-Case 2
Aalbert does not eat much and is prone to hypothermia due to low body weight, particularly
at night in the winter.
Aalbert puts on the MOBISERV smart garment night wear (or has smart sheets on his bed)
that monitor his body temperature while he sleeps. If his temperature falls below a certain
threshold, the system takes remedial actions – such as issuing an alarm to Aalbert, issuing an
alarm to a neighbour, controlling the heating, or sending an email to the doctor.
4.3.4.2 Function specification and assumptions

Baseline measures will be made, recorded and stored on an individual basis prior to
monitoring as part of a calibration process.
4.3.4.3 Content Requirements



ON/OFF Setting on GUI
When ON user should be notified that he is being monitored.
Instructions about how to put on/operate the smart garments and smart sheets should
be available in a variety of formats – text and photos, video, audio
4.3.4.4 Sub-Function Requirements
SubSub-Functions
Function
ID
F_17.1 Ability to turn function ON or OFF
F_17.2 Display the steps of how to put on
the smart garments
F_17.3 Detect certain exercises
MOBISERV
Requirement
It should be clear to the user and others
whether this function is in the ON or
OFF mode
User can indicate to the system if they
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are about to embark on an exercise
routine or some particular activity which
they want monitored.
Video or sensor data can be used if
available
F_17.4 Give feedback based on the analysis
of the exercises
F_17.5 Detect vital functions through the
smart garment or smart bed sheets
F_17.6 Give feedback based on the analysis
of the data from the vital functions
F_17.7 Issue an alarm based on the analysis
of the data from the vital functions
F_17.8 Log all the data recorded
F_17.9 Mail a summary of the data to a carer Ensure the summary is formatted and
/ doctor
structured to enable readability
Table 6 Sub-Functions for F_17
4.3.4.5 Process Specification
Start Service
If function is ON
YES
Monitor
and log
user’s vitals
Setup on
GUI
After each
session/
day/week
NO
If
certain time
has passed
since last
email
YES
Summary of
logged data
since last
email
Send
email to
carer /
doctor
YES
Vitals’
analysis OK?
NO
End Service
Google documents, intranet,
database?
Definition of
OK:
Manual: setup
on GUI
Automatic:
software
NO
Issue alarm
to user and /
or carer
Alarm
based on
analysis of
vitals
Figure 6 Process specification for tele-medicine
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4.3.5Function for Games for Social and Cognitive Stimulation
This function will improve the acceptance and increase the usage of the overall system,
making the system more fun and affording a higher level of engagement through affective
computing.
4.3.5.1 Use cases
Use-Case 1
Although John has dementia, he really enjoys playing games such as Scrabble with his son.
Sometimes he needs a little bit of guidance but for the most part he plays very well and
enjoys the challenge of the game. The MOBISERV system will have inbuilt gaming
functionality to stimulate users and also promote acceptance of the system. Users will be able
to play against the machine and also against friends who have the same system or via a
special website. John can play Scrabble and cards with his friends at the day centre from his
own home, or play against the machine.
Use-Case 2
Lilian likes to play board games with her husband when she can, particularly Othello. No one
at the care home knows how to play Othello so Lilian has to wait until the weekend to play
her favourite game.
Lilian can also play Othello with her husband when she is in the home or play against the
machine.
4.3.5.2 Function specification and assumptions
Users will be provided training in playing the games and understand the scope of the
game play.
4.3.5.3 Content Requirements


Provide access to a range of games with animated instructions on how to play.
When monitoring facial expressions, only processed data should be available. Access
to this should be determined and secured.
4.3.5.4 Sub-Function Requirements
SubSub-Functions
Function
ID
F_18.1 Ability to turn function ON or
OFF
F_18.2 The system offers games for
different cognitive levels
MOBISERV
Requirement
It should be clear to the user and others
whether this function is in the ON or OFF
mode
Card games, or word games which are
commonly played by participants currently
could be used.
While the efficacy of “Brain Training” games
has not been conclusively established, games
remain an important mechanism to keep
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F_18.3 The robot offers social
engagement during periods of
physical inactivity or on
request by the user.
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people engaged and alert.
A future enhancement could involve enabling
the robot to function as a social companion in
playing games with the user using affective
computing.
Table 7 Sub-Functions for F_18
4.3.5.5 Process Specification
Start service
NO
GUI
Settings setup for
levels
If function
is ON
GUI
Voice recognition:
“Start …”
Select against:
Robot/friend/website
YES
If game
selected
NO
YES
Monitor face for
expression
recognition
Play game
Readjust game
structure or
level
New
game?
YES
NO
End service
Figure 7 Process specification for games function
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Function for Voice/Video/SMS via robot communication with
friends and relatives
This function will support and increase the frequency of social interaction with friends and
family.
4.3.6.1 Use cases
Use-Case 1
Terry really misses his friends. He moved to the residential home from his hometown 250
miles away to be nearer to his children. His mobility issues prevent him from leaving the
home very often to visit his family, and he misses things like the grandchildren's birthday
parties as he is too frail to attend.
The MOBISERV screen enables Terry to use video calling or hand free telephone calling
(voice only) to his friends and family. Video calling helps Terry to feel like his distant friends
are in the room with him. It also enables him to remotely attend birthday parties or family
events with two-way interaction. Terry's family can also use the system to upload photos or
videos of their activities to share with Terry at any time. Terry is able to select whether or not
he wants the audio visual calling or voice only calling options with a one-step interaction, and
it is clear to Terry when the camera is on and what the other person is able to see.
Use Case 2
Because Aalbert’s sons and daughter live quite far away, they cannot come by every day or
every week. Still, they do want to know about how their father is doing, and sometimes worry
about his health and his loneliness.
With the MOBISERV system, they found a solution for this. Every morning, one of the
children checks in on their father through the robot’s audio and video connection. This can be
done from a computer, laptop or smart phone. They can see their father, find out how he is
doing, and have a chat. Because of the mobile robot, this can be done in any room and in any
location in their father’s apartment. Aalbert has the option of setting a do not disturb option if
he does not wish to be contacted at any time, or turn the camera off and use voice only.
4.3.6.2 Function specification and assumptions
Outgoing calls
The function is activated using the Graphical User Interface (GUI):
When user deactivates
the function a warning will be issued.
When function is activated the robot should inform the user for the operation of this function
(i.e. special commands like “Call <contact>” or “Text <contact>”).
A database holds contact details (usernames, phone numbers, pictures etc)
When the robot interacts with the user there should be a detection of a “no response” function
that will firstly check for technical problems (e.g. low volume) and repeat the notification. If
this fails again, an e-mail should be send to the care-taker/doctor/relative.
Incoming Calls
The function is activated on the Graphical User Interface (GUI):
When user deactivates the
function a warning will be issued.
When function is activated the robot should inform the user for the operation of this function
(i.e. special commands like “Answer call” or “Open SMS”).
A database holds contact details (usernames, phone numbers, pictures etc)
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If the user is not at home the system should function log the call. When the user comes back
home the robot should notify the user if he has any missed calls or unread SMS.
When the robot interacts with the user there should be a detection of a “no response” function
which will firstly check for technical problems (e.g. low volume) and repeat the notification.
If this fails again, an e-mail should be send to the care-taker/doctor/relative.
4.3.6.3 Content Requirements



Allow GUI/Speech commands (e.g. “Call <contact>”, “Text <contact>”) in regards to
accessibility regarding the function
Enable Create, Read Update, Delete with access available for Google contacts or MS
Outlook format
During the call the robot should be put into silent mode and recognise only specific
commands like: “Camera ON/OFF”, “Mute”, “End Call”.
4.3.6.4 Sub-Function Requirements
SubSub-Functions
Function
ID
F_11.1 Ability to turn function ON or OFF
F_11.2 Ability to select the mode of the
communication (including synchronous and
asynchronous)
F_11.3 Configuration of contacts - Ability to easily
add / remove contacts
F_11.4 Check current availability/status of contacts
F_11.5 Ability to setup a connection to a remote
party
F_11.6 Ability to mute the audio and/or video
Requirement
It should be clear to the user
and others whether this function
is in the ON or OFF mode
It should be clear to the user
which mode of communication
is currently selected and what is
its status receiving/transmitted/both
Usability of the contacts
configuration should be
straightforward to use.
Open Source software available
for friends and family members
to install locally.
If the friend or relative is
currently unavailable it should
be possible to contact them to
request communication in
imminent future via an
alternative means.
Voice or touch screen
command.
Voice or touch screen command
Table 8 Sub-Functions for F_11
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4.3.6.5 Process Specification
Start Service
User specifies the type
of communication and
person
Contacts
Audio/
Video Call
SMS
SHACU
Load Data
PRU: GUI/Speech
(dictation)
Load Data
Dial contact
Message
composition
NO
Repeat the message
to user and confirm
Verify
message
Send
message
Notify
user
If contact
YES
responds
Audio/
Video call
Notify user and
ask if he wants to
leave message/
send SMS instead
If user
responds
positively
NO
YES
Record Video/
audio message
or write SMS
and send
Confirm
recording or
message to user
End service
Figure 8 Process specification for video/voice/SMS Outgoing communication
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Start service
Contacts
Load data
Icon on screen or
reminder after a
while
NO
SMS
Notification
SHACU
SMS
Audio/
Video call
Locate
user
Locate
user
Notify
user
Notify
user
If user wants to
open the SMS
If user
answers
YES
YES
Display/
Say SMS
Audio/
Video call
Show caller’s
photo and display
name/announce
who is calling.
Icon on screen or
reminder after a
while
NO
Missed call
notification
User reply NO
YES
Send new
SMS
This will send
contact’s
details to a
function
similar to
this
Function’s
Part I
End service
Figure 9 Process specification for video/voice/SMS Incoming communication
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4.3.7 Function for a mobile intercom for enabling front door entry
This function will support people with mobility problems to increase control over safety.
4.3.7.1 Use cases
Use Case 1
Aalbert is at home, in his apartment on the 7th floor. He sits in his favourite chair, and is
watching television. The doorbell rings. There is a visitor outside, in front of the main
entrance of the building. Due to his impaired mobility, he misses quite some visitors; they
leave before he reaches the intercom in his hallway. Sometimes Aalbert is also nervous about
answering the door when he is not expecting anyone and does not know who is calling.
With the MOBISERV system, combining the smart environment with the robot assistant, the
robot comes up to Aalbert’s chair when the doorbell rings. On the robot’s display, it will
show a live video of his visitor standing in front of the door. Aalbert can easily see who is
there, then start an audio connection with the visitor if he wants to, or let her/him in right
away, by telling the robot to open the door, or by pressing a button on the robot’s touch
screen.
When Aalbert is not at home, the system will know this, and a short video will be record
showing the visitor in front of the door. When Aalbert comes home, the robot will show a
message with the option to see this video.
4.3.7.2 Function specification and assumptions
The person can set the system to a do not disturb mode to avoid unwanted interruption
which could be communicated to the caller without the need for interaction.
4.3.7.3 Content Requirements


Log audio/video clip => so the video should start recording once the visitor pushes the
button. Other option that can be included: take a picture
Automatic adjustment of image quality
4.3.7.4 Sub-Function Requirements
SubSub-Functions
Function
ID
F_14.1 Ability to turn function ON or OFF
F_14.2 Recognise the door-bell
Requirement
It should be clear to the user
and others whether this function
is in the ON or OFF mode
Either by direct integration with
the door-bell system or sound
recognition.
F_14.3 Locate and move to the user
F_14.4 Enable the user to select mode of
communication, voice or video
F_14.5 Start link
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F_14.6 Ability for the user to initiate desired action,
open an electronic lock, call for help
Table 9 Sub-Functions for F_14
4.3.7.5 Process Specification
Start service
If doorbell
rings
YES
Locate and go
to user
User at
home?
YES
NO
On-screen
video
Log
missed
visitor
Open
door?
NO
NO
Call for
help?
Notify
user
NO
Talk to
visitor?
YES
YES
YES
Open
electronic
lock
Call remote
call-centre
Start audio/
video
intercom
End service
Audio/Video Call =>
Locate and go to user
Figure 10 Process specification for mobile intercom
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4.3.8 Function for responding to call for help from the user
This function will increase safety at home and the feeling of being not being left isolated in
an emergency for people that live alone.
4.3.8.1 Use cases
Use Case 1
John enjoys being at the day care centre, and likes the carers and nurses very much. He
sometimes forgets where he is and what time it is, and starts to panic. At the day care centre,
they know how to help him relax. Sometimes, this also happens at his home, even in the
middle of the night. Once, he ran out of his bedroom, shouting for the nurse.
John’s MOBISERV system is able to detect loud voices, such as shouting or screaming. The
system will locate the person in panic, and the robot will to him/here, and setup an audio and
video connection with the care call centre. The person in the call centre can immediately talk
to John, to help him relax and set him at rest. John has memory problems, so the response
will have to be appropriate for this. In the intelligent environment, panic or falls could also be
detected or corroborated by monitoring sensors in smart clothing or smart bed sheets.
Use Case 2
For Aalbert, Brenda, Carol, Dafne, Lilian and Terry, the system will have the ability to
trigger a call to the care call centre in response to a fall or a voice call for “help” from the
person, informing the centre of the nature of the alarm, resulting in appropriate action.
Brenda has poor eyesight and a pre-existing medical condition which should be known by the
system and also communicated. Lilian’s loss of hearing means that she might need alternative
modes interaction with the call centre.
4.3.8.2 Function specification and assumptions
There should be a defined protocol for transferring services to alternative components
when the PRU is being charged.
4.3.8.3 Content Requirements




Detect a range of pre-defined incidents such as falls, loud noises, yells, screams, etc.
Provide information about the nature of alarm / identity and conditions of user resulting to
appropriate response from caretaker
In regards to feedback to the user: Investigate alternative methods according to person’s
conditions: visual (text messages on screen), tactile (vibrating bracelet)
Settings for feedback available on GUI
4.3.8.4 Sub-Function Requirements
SubFunction
ID
F_6.1
MOBISERV
Sub-Functions
Requirement
Detect loud noises, yells,
screams, etc.
This should be tested and validated, for every
room in the house
Microphones might be installed in every room
and linked to
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F_6.3
F_6.4
Detect falls
Locate the user, and go there
Call and connect with a remote
call centre
Focus the camera on the user
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Audio and/or video
Reliable recognition
Table 10 Sub-Functions for F_6
4.3.8.5 Process Specification
Start service
Detect falls/
loud noises,
screams...
NO
Emergency
detected?
YES
Call remote
call centre
Contacts
Locate
and go to
user
Focus
camera
on user
Video
conference
End Service
Figure 11 Process specification for responding to call for help
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4.3.9Function for Encouragement for exercising
This function will support and encourage physical activity in order to stay healthy, stay in
good condition and stay independent for as long as possible.
4.3.9.1 Use cases
Use Case 1
Aalbert, like many older people, suffers from very stiff muscles, especially in his hands, arms
and legs. He does not engage in much physical activity during the day, so therefore the doctor
told him to do some exercises, preferably every day. Aalbert knows the benefits, but still does
not really like to do these exercises, and tends to skip them most of time.
The MOBISERV system functions as a persuasive agent in this case. First, it detects when
Aalbert is sitting still for long, by sensors in the environment, and by interaction through the
robot. The system will try to find a pattern in Aalbert’s daily activities, to find out the best or
most preferred opportunity to propose and do some exercises. The system knows many
exercises to offer diversity, and will ask for feedback after each exercise. This way it learns
what Aalbert likes, when he likes to do exercises, and how many time he wants to spend per
session. Among other things, Aalbert is encouraged by feedback on his exercises, showing
his progress and describing the benefits of regular gentle exercises, such as promoting a good
night's sleep.
Use Case 2
For people with mobility problems, such as Brenda, Dafne, John and Lilian, the activities will
have to be specifically designed by a medical practitioner or physiotherapist. If needed, data
from the exercises, for instance from the intelligent clothes or from the robot’s video camera,
can be recorded and analysed by a caretaker, for safety reasons, or for feedback or
adjustments on the execution of the exercises.
4.3.9.2 Function specification and assumptions
The function is activated using the Graphical User Interface (GUI):
When user deactivates the function, a warning will be issued
Function will monitor activity levels during daytime only and based the outcome of the user’s
baseline measure.
Exercises and initial schedule (will be later modified according to the user’s response) should
be added by via a web interface. Exercises should be tailored to each user’s needs, taking into
consideration each user’s situation.
Messages should be persuasive describing the benefits of regular gentle exercises, such as
promoting a good night's sleep.
It is assumed that the user is at home. Otherwise the function must not start.
4.3.9.3 Content Requirements


Instructions and guide available throughout the exercises in a variety of formats
The exercises are selected and specified by a qualified therapist based on the specific
user’s conditional and ability.
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4.3.9.4 Sub-Function Requirements
SubFunction
ID
F_8.1
F_8.2
F_8.3
F_8.4
F_8.5
F_8.6
F_8.7
Sub-Functions
Requirement
Ability to turn function ON or OFF
It should be clear to the user
and others whether this function
is in the ON or OFF mode
Detect and rate physical activity
Enable a carer or doctor to insert new
exercises.
Issue persuading messages to do an exercise.
Ensure persuasiveness and
credibility
Detect patterns in the user’s response to the
persuading messages
Adjust the schedule of messages to the user’s
pattern and his other activities
Keep a basic log of the exercises done.
Table 11 Sub-Functions for F_8
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4.3.9.5 Process Specification
Start service
DataLogger: Sensors
InteractionManager
Detect
Activity
levels
NO
If long period of
inactivity detected
YES
For time of last
persuading
message and ideal
times
PRU
checks
Scheduler
NO
If it’s time for new
message
YES
PRU loads
Exercises
PRU informs
user that he’s
inactive for
very long and
suggests an
exercise
Modification of
Scheduler
Log acknowledgement
PRU guides
user through
the exercise
When exercise
is finished PRU
asks for
feedback
Monitoring user’s vitals
and adapting, showing
progress and describing
the benefits to keep use
going etc
Time, difficulty and
duration of exercise
Log exercise data,
feedback and adjust
scheduler and
exercise accordingly
Figure 12 Process specification for encouragement for exercising
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4.4 Non-functional Requirements
Analysis of the data gathered from across the different locations and the secondary literature
review has helped to identify the following non-functional requirements which will be vital to
consider in the context of the MOBISERV system.
4.4.1 User Acceptability
o The system should enable the user to maintain their current routine as
much as possible
 Older people tend to like to sit in the same place to watch TV, or to eat
dinner. They like routine and familiarity in their everyday lives. So the
MOBISERV system needs to be able to map onto existing patterns of
behaviour, existing meal times, place that meals are eaten, nap times,
hours of retiring to bed and awaking, and recognition of other leisure
activities and not force people to modify their routines and habits in
unfamiliar ways.
o The user should have the ability of enable or disable all aspects of the
system functionality
 It will be important to allow users to switch off specific functions if
they so desire. This is essential both from an ethical perspective, as
well as in response to the concerns expressed by some of the older
persons regarding some of the proposed features of the MOBISERV
systems that could be viewed as an invasion of privacy in particular
contexts. Empowering users to have control over the functionality will
be a vital part of gaining their trust.
o The status of all monitoring functions should be clearly visible to the user
 The status of the cameras, both for the monitoring of activity and for
the video conferencing functions should be clearly visible to the user.
The display of the status should be prominently displayed and not
hidden or accessed via other interface elements. The ability to switch
these on or off should be directly accessible in one step.
o The system should comply with the users’ aesthetics as much as possible
 The ability to alter the voice of the speech synthesis
 The look and feel of the system should be alterable
 It might be desirable to change characteristics of the embodiment of
the portable robotic unit.
4.4.2 Environmental and Operational

All system interfaces and controls should be clearly visible and accessible in
different lighting conditions
 Some of the living areas, such as conservatories are very bright during the day,
in comparison with internal rooms that can be poorly lit, particularly on
cloudy days if the lights are not switched on.
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An automated brightness and contrast control based on ambient light will be
desirable.

The system must be able identify if an internal doors is closed and have an
appropriate response protocol
 People often like to keep internal doors shut, particularly in the winter to
prevent heat loss. This can pose a problem to ensuring that the robot has free
access to all areas of the house.
The mapping should be able to identify doors as being different to other
obstacles and issue an alert as pre-determined.

The system should to able to detect the background noise level so as to ensure
clarity and detection of messages and sounds
o Adapt the volume of system messages and sound taking into consideration
background noise level.

The system should be capable of operating at a high level of humidity
4.4.3 Training Needs and Support


A structured and phased illustration of each of the functions, sub-divided into
coherent step-by-step tasks should be provided
 The illustrations should be provided through a range of media and formats
 The different formats should take into consideration users’ goals, abilities and
experience levels.
An individual needs assessment to ensure that the system is customised for
optimal and satisfactory use should be conducted
 A person-centred planning model with pre-specified metrics should be created.
4.4.4 Usability and accessibility


MOBISERV
The limitations in mobility, eyesight, hearing and sometimes memory, which are
a result of the natural aging process, should be considered in regards to the
usability and accessibility of the technology.
The following design principles should be adhered for the graphical user
interface:
o Feedback – The results of all actions should be clearly displayed
o Consistency – The location of items should be the same across screens
and similar functions should behave the same throughout the system. This
also applies to error messages and system status information.
o Error recovery – Provide an undo option or an easy way to recover from
unintentional interactions with meaningful error messages.
o Individualisation – Allow the user to customise the look and feel of the
system and tailor the system to individual capabilities and preferences.
Ensure flexibility of the display characteristics such as size of icons and
fonts and provide more than one option/mode to perform a task.
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o Memory load – Avoid memory overload by reducing the number of steps
to complete tasks and providing suitable memory aids such as clear and
meaningful status information and labels for icons.
o Structure – Provide a clear visual map of the system structure and keep
the structure as simple as possible.
o Cognitive load – reduce information process requirements of the user by
organising the display into clear sections and providing highlighting for
critical information. Use Gestalts laws of perception to guide the design.
o Minimalistic design – Avoid visual and auditory clutter by minimising
the number of items displayed in one location and the number of sounds
and voice responses.
Memorability and learnability – It should be ensured that voice commands are
easy to remember by keeping them short and customising them to suit the user’s
vocabulary. The user should have access for the configuration of these.
Natural Ageing Factors
o Audition – Age related decline could effect hearing of high-frequency
sounds. The design should take into consideration that changes in hearing
capability influence older adults’ ability to detect tones and other sounds
as well the ability to comprehend speech. As such there should be limited
reliance on tones and a mechanism to easily adjust the volume of the
system should be provided.
o Vision – Visual acuity is affected by age and as such the system should
provide for a high contrast accessibility mode where the user can change
the size of interface elements and text. The speed with which visual
information is process increases with age and as such information shown
on the screen should have a longer level of persistence – particularly in
regards to status information and error messages. Glare can be more
problematic for older adults and care should be taken to ensure screens
are anti-glare.
o Cognition – age related decline could affect memory, attention, spatial
cognition and language comprehension (both verbal and written) and clear
instructions and feedback should be available to ameliorate this.


4.4.5 Comfort


MOBISERV
Ergonomic factors – the touch screen should be easy to operate with minimal
effort. The screen should allow for adjustment of positioning for suitable
viewing angle and operation.
Physical comfort - the wearable devices should be easy to put on and remove,
with fastenings that can be done and undone without help, with fabric that is
soft against the skin over long periods of time. The material should be allergy
tested with information of composition available.
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4.4.6 Help and documentation





The instructions should be presented in a variety of formats – video, audio and
text-based with appropriate graphics.
The language used should be simple with no jargon and the terms should be
used consistently throughout.
There should be a single step access to the help and support and it should be
context sensitive.
Aide de memoires should be easily accessible.
A training protocol should be devised which allows introduction of the system
to the user in a phased manner over a phased period of time.
4.4.7 Performance

Efficiency – operations should be completed in a minimal number of steps
without an undue number of screens or commands.

Error prevention - To minimise errors due to the user issuing incorrect voice
commands, the verification process should be transparent and robust,
providing pre-emptive and targeted feedback in a clear manner. As much as
possible, through the use of clear formatting and automated checking, the user
should not be allowed to enter data that will be erroneous or ambiguous, such
as dates and times etc.

Confirmation options should be available, and undo and redo should be
available as appropriate.

Error recovery - It should be clear to the user if the system needs to recover
from an error state, providing the user with clear information on the status of
the system and the time that will be taken for error recovery.
If the user has chosen an option or function by mistake, it should be easy for
them to leave the unwanted state without having to go through an extended
dialogue or lose previously entered information.
4.4.8 Maintainability and Support

Charging procedure – the user should be aware of the status of the battery
levels and knows when the system will be docking for charging.

The user should be made aware of the reasons for any lags or non-responsiveness
during the interaction process so that they know that it is the system that has an
issue and don’t feel uncertain about the status of the interaction at any point.
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Updates – The update process should be transparent to the user and should not
change the currently setup system settings and parameters.
4.4.9 Security and privacy

Telecare users and their carers should be informed about what information will be
collected and how it will be used.

Privacy of the recorded data should be ensured through secured storage and
transmission. Data encryption and passwords need to be set-up.

Levels of access to change crucial system setting should be identified.

All changes made to the system or system settings should be traceable through system
logs.
4.4.10 Cultural and Political
Language support – There has to be support for Dutch. The language and images used
should reflect and respect local cultural norms and preferences.
Access rights – It should be clear to the user as to who has access to system settings and
data, and these should be definable and changeable.
4.5 Final Conclusions
As stated earlier, gathering requirements is an iterative activity that we will be continuing,
particularly in relation to tasks 2.2, 2.5 and 2.6 and will continue to generate results as the
concepts and technology begin to evolve and take shape.
As we conduct evaluation studies and field trials, clarifications to these requirement
specification will start to emerge and be refined as end users and stakeholders gain a clearer
understanding and experience of the scope of the technology and the consortium sees how the
technology needs to be further adapted to suit needs.
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5 Content Recommendations for Functions
5.1 Advice on Nutrition
A range of guidance is available from
http://www.ageuk.org.uk/health-wellbeing/healthy-eating-landing/
that could be incorporated into the Nutritional assistance function when offering advice and
encouragement to the user regarding meals.
This website provides information on Healthy eating, illustrating The eatwell plate from the
Food Standards Agency (food.gov.uk) is shown in Figure 13. The eatwell plate, FSA
Figure 13. The eatwell plate, FSA
This graphical representation could be used as part of the touch screen interface to seek
information from the user in regards to their dietary intake and help them to keep track of
their daily intake – clearly identifying food groups covered and those not covered.
The AgeUK website also offers more targeted advice on Foods to improve digestion, improve
immunity, for a healthy heart and vitamins, minerals and supplements.
Brightly coloured pictures can be used to whet peoples’ appetites.
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Figure 14 Brightly coloured pictures from www.ageuk.org.uk
5.2 Advice on Exercise
Age UK provide exercise DVDs designed to help strengthen muscles, increase flexibility,
improve balance and endurance - http://www.ageuk.org.uk/health-wellbeing/keepingfit/exercise-materials/
It could be possible to link guidance and excerpts from these DVDs to the encouragement for
exercise function.
The “fit as a fiddle” national programme will be producing a range of educational resources
over a five year period, as well as providing links to local community initiatives and schemes
to promote exercise.
http://www.ageuk.org.uk/Documents/EN-GB/FAAF_booklet.pdf (Fit as a Fiddle Booklet)
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6 Policy context and existing practice for provision
of support services for older adults
6.1 In the UK
Figure 15 Demographic data, current and projected from the National Statistics Office UK
According to figures published by the National Statistics officeliv, UK, over the last 25
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years the percentage of the population aged 65 and over increased from 15 per cent in 1984 to
16 per cent in 2009, an increase of 1.7 million people in this age group.
Over the same period, the percentage of the population aged under 16 decreased from 21 per
cent to 19 per cent. This ageing of the population is projected to continue.
By 2034, 23 per cent of the population is projected to be aged 65 and over compared with 18
per cent aged under 16.
The fastest population increase has been in the number of those aged 85 and over, the ‘oldest
old’. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the
numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of
people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million
and accounting for 5 per cent of the total population.
The old-age support ratio (OASR) represents the number of people of working age to the
number of people of state pension age (SPA) and over. In 2009 the IASR was about 3.2. It is
projected that by 2034 the OASR will have fallen to about 2.8 people of working age for each
person of SPA and above; without the increases in SPA, the OASR would have been
projected to drop further to about 2.2 by 2034. The old age support ratio is a demographic
ratio and does not take into account possible future activity rates. Inactivity owing to factors
such as early retirement, health problems, disability and caring responsibilities may prevent
people from working; on the other hand, some people of SPA will choose to extend their
working lives into later life.
In 2008/09, pensioner couples received an average gross income of £564 per week, single
male pensioners received £304 per week and single female pensioners £264.
In 2008, the average weekly expenditure of households headed by someone aged 65 to 74
was £354, of which 32 per cent was spent on food and non-alcoholic drink, domestic energy
bills, housing and council tax. For households headed by someone aged 75 or over, average
expenditure was £217 per week, of which 40 per cent was spent on food, energy bills,
housing and council tax.
6.1.1 Prevention policy
The prevention package aims to raise the focus on older people’s prevention services and
encourage their use, and, in the longer term, to improve older people’s health, well-being and
independence. Developing services included in the prevention package takes place within a
wider policy context. This briefing outlines some of the relevant policy areas and levers for
implementation.
6.1.1.1 Prevention and early intervention
It has been government policy since the 1988 Griffiths Report for local authorities to find
ways that support older people to live in their own homes and to prevent unnecessary
admissions to residential care. The NHS Next Stage Review points out that because people are
living longer, there is a need proactively to identify and mitigate health risks. This includes
supporting people to take responsibility for their own health and helping them to live
independent and fulfilling lives.
The Government’s strategy for all ages concentrates on cultural change, preparation for
later life, providing the right support and delivering it effectively.
As health is a major priority for people in later years, the prevention package
contribution is a key component of the strategy.
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6.1.1.2 Joint strategic needs assessment (JSNA)
The JSNA is designed to help build the stronger partnerships between communities, local
government and the NHS that are required to develop effective prevention strategies locally.
It should be informed and shaped by local community views as well as evidence of
effectiveness, efficiency and equity to shape the future priorities for investment in services.
Behind the JSNA is a process that identifies current and future needs in relation to health,
care and well-being. It compares these needs with the pattern of existing services to inform
future service planning.
It is essential needs assessment include future projections. Modeling spending on prevention
and intervention will enable a commissioning community to put in place long-term plans to
manage the projected increase in demand for older people’s services as the ageing population
grows.
For further information, see the DH web pages on JSNA
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida
nce/DH_081097
6.1.1.3 World class commissioning
The World Class Commissioning (WCC) framework of competences aims to help public
sector commissioners achieve three outcomes for local populations:
 better health and well-being for all

better care for all

better value for all
WCC guidance says commissioners should promote services that encourage early
intervention, to avoid unnecessary unplanned admissions. Resources within the prevention
package are linked to WCC competencies and structured around the commissioning cycle.
For more information, see the DH pages on World Class Commissioning
http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/
Worldclasscommissioning/index.htm
6.1.1.4 Personalisation
The White Paper Our Health, Our Care, Our Say (2006) aimed to shift towards a more
personalised service, a greater focus on prevention and addressing inequality effectively. The
local authority guidance LAC1 2008 stated: “The direction is clear: to make personalisation,
including a strategic shift towards early intervention and prevention, the cornerstone of public
services.”
Putting People First (2007) introduced a vision for adult social care that is personalised for
individuals, with prevention, early intervention and enablement at its core. It contains a
commitment that local areas have a sustainable community strategy, utilising all relevant
community services, especially the voluntary sector, to achieve this. Personalisation can only
start to be delivered where councils have a strong focus on both the well-being of their
communities and a recognition that people should be helped in a way that may reduce or
prevent their need for social care support where that is possible. Prevention, early
intervention, building social capital and universal services are all at the centre of Putting
People First.
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The Darzi report NHS Next Stage Review: What it means for the third sector, contains the
vision that: “Every primary care trust will commission comprehensive well-being and
prevention services, in partnership with local authorities, with the services offered
personalised to meet the specific needs of their local populations.”
A number of services in the prevention package may be commissioned by older people
themselves through personal budgets, individual budgets or direct payments. For example,
they may pay for a personal assistant to carry out personal care and support services such as
footcare, or purchase telecare devices. Commissioners still have a role to play in ensuring that
people have a diverse range of options upon which to spend their budget allocation.
For more information, see the DH web pages on personalisation.
http://www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/index.htm
6.1.1.5 Market development
World Class Commissioning guidance says that market building means commissioners will
develop formal and informal relationships with existing and potential providers. Prevention
services and interventions to promote older people’s independence and well-being may be
particularly suited to provision by local organisations and community groups, including the
voluntary sector. According to WCC guidance, commissioners should develop an
understanding of the third sector’s ability to deliver services.
6.1.1.6 Partnership and whole system approaches
A whole system approach is crucial to prevention. Many social care interventions produce
reductions in the usage of health services; many health interventions can have an impact on
reducing the use of social care services. Jointly planning and explicitly sharing the risks and
benefits have the potential to produce the greatest improvement for all.
Other public services are crucial to promoting independence and well-being – housing,
transport, community safety, leisure services and public health, for example.
6.1.1.7 Involving older people and carers
Involving older and disabled people in the planning and monitoring of services is crucial to
ensuring that they are developed appropriately. Public and patient involvement is vital at
every stage of the World Class Commissioning cycle to understand needs, populations and
desired outcomes, and to design flexible and responsive services that can achieve real
outcomes for the local ageing population.
A constitution for the NHS in England, published in January 2009, set out the core principles
and values for the NHS, including patient and family involvement in decisions and
partnership with other organisations.
The carers’ strategy Carers at the heart of 21st century families and communities (DH, 2008)
includes a more integrated and personalised support service for carers.
The Mental Capacity Act (2005) provides a framework to protect vulnerable people who are
unable to make their own decisions and sets out a single standard test for assessing whether a
person lacks capacity. It includes provision for an independent mental capacity advocate
(IMCA) to support people who have no one to speak for them.
The National Dementia Strategy, Living Well with Dementia (DH February 2009), aims to
provide early intervention services to help people with dementia remain independent for as
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long as possible. It looks specifically at making services, including intermediate care, more
accessible to people with dementia.
The 2009 strategy Be active, be healthy: A plan for getting the nation moving highlights the
value of physical activities like walking and dancing to encourage older people to be more
active, which can help preserve their mobility and independence. Currently only 17% of men
and 13% of women aged 65 to 74 meet the Chief Medical Officer’s recommendations for
physical activity, and these figures drop considerably among over-75s.
6.1.2 Provision of support services for older adults in the UK
6.1.2.1 Background Statistics
Councils have reported an increase in Adult Social Service spend from £16.1 billion in 200809 to £16.7 billion in 2009-10, this is approximately a 4 per cent rise in cash terms and 2 per
cent in real terms.
Over a longer term, this represents a real term increase of 9 per cent since 2004-05 and 46 per
cent over the 10 years from 1999-00.
Expenditure on Older People (aged 65 and over) continues to make up the majority of the
total adult expenditure although the percentage has decreased from 59 per cent in 2004-05 to
56 per cent in 2009-10. This is unchanged from 2008-09.
This represents an increase from £9.1 billion in 2008-09 to £9.3 billion in 2009-10 (3% in
cash terms and 1% in real terms).
Expenditure on adults aged 18-64 with a Learning Disability has increased from £3.8 billion
in 2008-09 to £4.0 billion in 2009-10 (4% in cash terms and 3% in real terms).
Expenditure on Residential Care has increased slightly by £60,000 from £7.59 billion in
2008-09 to £7.65 billion in 2009-10 in cash terms (1%), but has fallen in real terms by 1 per
cent.
Expenditure on Day/Domiciliary (non-Residential) care spend has increased from £6.5 billion
in 2008-09 to £7.0 billion in 2009-10 (8% in cash terms and 6% in real terms). This is in line
with Government policy to improve independence, choice and promote people's ability to live
at home.
The expenditure on Direct Payments for adults was £812 million in 2009-10. This is an
increase of 33 per cent in cash terms and 31 per cent in real terms from 2008-09. The
percentage of gross expenditure used for direct payments for adults is increasing and equates
to 5 per cent of the overall gross current expenditure in 2009-10 compared to 4 per cent in
2008-09
Overall, 12 per cent of people aged 16 or over in England in 2009/10 were looking after or
giving special help to a sick, disabled or elderly person. This represents around 5 million
adults in England. Six per cent of adults in England were caring for someone who was living
with them, and 6 per cent were caring for someone living elsewhere only.
In 2009/10 15 per cent of households in England contained a carer. This represents around 3
million households in England.
In 2008 10% of UK residents aged 65 or over were living in residential care options including
care homes, sheltered housing and extra care housing.
Over the period April 2009 to March 2010 over half a million service users received
community equipment and minor adaptations to their home as part of a care package
following an assessment and over £233 million was spent on equipment.
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Information Sources
Age UK http://www.ageuk.org.uk/home-and-care/ and the NHS information centre
http://www.ic.nhs.uk/ provide lots of information for older people and their family carers
about care and support services that are available.
Social Care Institute for Excellence (SCIE): http://www.scie.org.uk/adults/index.asp
SCIE focuses on dissemination of good practice to the large and diverse social care
workforce and support the delivery of transformed, personalised social care services. Aimed
at social care professionals but there is much information here that will be of interest to end
users.
The Alzheimer’s Society website is a good source of information and support for people
looking after someone with dementia http://alzheimers.org.uk/
The Princess Royal Trust for Carers provide information and support, including a searchable
help directory and local contacts, at www.carers.org/
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7 Appendices
7.1 NL Questionnaire Responses
7.1.1 Setting A – Residential
7.1.1.1 Care staff
N=10, all female
Care coordinator
1
Carer
7
Care support
2
How well do you feel that your establishment is able to manage or monitor the needs of the old people in
its care with regards to the following medical issues or problems:
well
fairly well
Not
need a little
need a lot more
managed
managed
sure
more support
support
Monitoring and prevention of
heart problems
2
6
1
1
0
falling
1
8
0
1
0
incontinence
7
2
0
1
0
loneliness
1
1
5
3
0
social isolation
1
4
3
2
0
physical limitations or
impairments
3
3
2
2
0
Cognitive limitations or
impairments
1
6
1
2
0
Diet and nutrition
2
7
1
0
0
Diabetes
3
6
0
1
0
What do you feel could be done to improve the management or monitoring of the issues or problems
mentioned in the previous question?
More time for the clients.
More education and expertise.
We should be able to directly respond / reply to the needs of people. Now people have to wait quite often,
because there is no personnel.
Observing.
A better analysis of the problems a patient has, so he/she will end up at the right department.
More personnel on holidays and in weekends.
More clinical training for carers on specific topics.
More personnel.
More activity coaching.
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What do you feel the quality of life is like for the average older person in your care?
I feel very well supported
0 0%
I feel supported
6
60%
Neither good nor bad
4
40%
I would like more support
0
0%
I would like much more support
0
0%
What sort of things do they enjoy doing that you think they would like to do more of, to improve their
quality of life?
Going outside
Social contacts in apartment (one on one)
Drink a cup of coffee with the carer, have a chat.
Go shopping.
Spontaneously go for a walk.
More walking when the weather is good.
More attention for the clients like a chat.
Activities that fully address their needs.
Activities during the evening and weekends.
Cooking club, eating together with family, talking to staff.
Eating activities, open stage activities, music activities.
Personal hobbies.
How frequently do you feel unable to assist the people in your care?
very often
0 0%
often
1
10%
sometimes
5
50%
occasionally
3
30%
never
1
10%
What type of things are you unable to assist with and why?
Handling clients with psychological issues; they tend to be in a certain atmosphere, which I cannot always
handle well.
Psychological issues, not enough education.
When multiple things happen at the same time, not enough staff.
More personal attention, due to time constraints.
Giving the right care to clients with psychological issues.
When multiple requests come in at the same time. For instance, when 3 people have to go to the toilet.
People that cannot speak, and try to say something to you.
People with heavy pain, for which nothing helps.
Physical complaints.
People on the wrong department, for instance a person with dementia on the somatic department.
With the anger and frustration of clients suffering from dementia.
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What do you need to be able to support older people better?
Time
10
100%
More staff
10
100%
More training
3
30%
Better Equipment
3
30%
Better monitoring systems
3
30%
Better nutrition
1
10%
Greater physical strength
0
0%
Better entertainment facilities
4
40%
More facilities for individual clients that cannot participate in group activities.
Volunteers.
Do you feel that the average resident has enough social interaction with the following:
too much
plenty of
some
a little
no
interaction
interaction
interaction
interaction
interaction
care staff
0
7
2
0
0
social/housing
workers
0
7
2
1
0
medical staff
0
5
4
1
0
friends
0
2
5
3
0
family
0
5
5
0
0
What technology do your residents HAVE ACCESS TO?
TV
10
100%
DVD player
9
90%
Landline Telephone
10
100%
Own mobile phone
6
60%
Computer
7
70%
Internet
7
70%
Interactive TV
0
0%
Electronic games
0
0%
Online shopping
0
0%
What technology do your residents regularly USE or CONTROL?
TV
10
100%
DVD player
7
70%
Landline Telephone
8
80%
Own mobile phone
3
30%
Computer
1
10%
Internet
1
10%
Interactive TV
0
0%
Electronic games
0
0%
Online shopping
0
0%
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If they do not have access to some of these technologies, have any of them expressed a desire to use them –
if so, which ones?
We often here that people would like to have a TV on their own room.
No.
How would you rate your residents attitude to technology in general?
1 positive/open minded
0
0%
2
fairly positive
0
0%
3
neither positive nor negative
8
80%
4
fairly negative
1
10%
5
very negative/dismissive
0
0%
6
Don't know
1
10%
If technology was developed to assist you in caring for your residents, which of the following items would
you find most useful?
Very
A little bit
Not
Don’t
Useful
useful
useful
useful
know
Reporting what they eat
2
2
4
1
1
Reporting the amount of food consumed per
meal
2
3
4
0
1
Reporting the amount of times they eat
0
3
4
1
2
Reporting the amount of times they drink
2
7
0
0
1
Reporting their facial expressions to denote
issues
3
1
3
1
2
Reporting if they consuming the wrong kinds
of food or drink
0
7
2
0
1
Reporting how active they are
2
3
3
1
1
What other types of easily accessible information would you find useful for monitoring or assessing a
resident's wellbeing?
When they go to the toilet, intercom system to answer questions over a distance.
When people tend to faint.
With restless clients; a signal when they get restless and want to get out of their chair.
When people have to go to the toilet.
Unrest.
Warnings when people tend to faint.
How accepting do you think your residents would feel about certain types of monitoring device if it was
for their own benefit?
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Accepting
Tolerant
Indifferent
Intolerant
Would not
allow
Don’t
know
Cameras
0
1
8
1
0
0
Wearable sensors embedded in
clothing
0
2
4
3
0
1
Food monitoring system
0
4
2
3
0
1
Activity monitoring system
0
3
2
3
0
2
Environmental Hazard monitoring
system (e.g. trip hazard)
0
8
1
0
0
1
Facial recognition technology
0
3
4
1
0
2
Speech recognition technology
0
6
3
0
0
1
“Smart clothing” monitors things like blood pressure, temperature and heart rate with tiny sensors
embedded in clothing – do you think your residents would be happy to wear this technology embedded in
some type of light underwear such as a vest?
Yes.
Yes, if we can clearly explain what the purpose is.
Yes, if they do not feel it, and if other people cannot see it.
Yes, probably.
I think so. Most people do not like it when we have to measure their blood pressure or temperature, so this
would be very helpful.
No.
Could you foresee any practical problems getting your residents to wear or use “smart clothing”?
Are these clothes washable? Who will wash them?
Too tight clothes, irritation.
Do not know.
I think it will be uncomfortable.
Damage to the sensors?
Damage to sensors, because of wearing and pulling it.
Might be hard to put on with certain clients. Will it give the right values?
What if people spill fluids on it?
What happens for instance when a person tends to have a low blood pressure all the time?
How long do you think they would be happy to wear smart clothing for?
1 day.
During the day.
Max 12 hours?
During the day, so about 12 hours.
10 to 14 hours.
During the day, about 8 hours.
1 hour
Do not know.
How do you think most residents would feel about interacting with a robot?
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Positive/open minded
0
0%
Fairly positive
0
0%
Neither positive nor negative
4
40%
Fairly negative
4
40%
Very negative/dismissive
0
0%
Don’t know
2
20%
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Would they like it if the robot did the following
Yes
No
Don't know
Followed them around
0
8
2
Was equipped with a camera
1
6
3
Was like a person (humanoid)
5
3
2
Spoke to them
5
2
3
Listened to them
5
1
4
Had an interactive computer screen
3
2
5
Reminded them to do things (take medication etc.)
7
1
2
Reported to a control centre if it saw a problem
9
0
1
Monitored what they ate
1
5
4
How would you feel about working alongside the following types of assistive technology:
A bit
I wouldn't
Fine
OK
indifferent
worried
do it
Don't know
Monitoring Cameras
0
1
3
3
3
0
Wearable sensors embedded in
clothing
0
1
5
1
1
2
Food monitoring system
2
3
3
0
1
1
Activity monitoring system
1
3
4
0
1
1
Environment-al Hazard monitoring
system (e.g. trip hazard)
5
4
0
0
0
1
Facial recognition technology
1
4
2
0
1
2
Speech recognition technology
2
3
2
0
1
2
Interactive robots
1
2
2
3
1
1
Do you have any further concerns or comments regarding the use of technology to assist or monitor your
clients?
Let the client choose.
I think current clients are not ready to make this step.
Do not know.
I do not think that everyone will like these technologies.
Especially for people with dementia, I think a robot will mostly cause unrest.
Technology that detects dangers is very welcome.
7.1.2 Setting C – Independently living
7.1.2.1 End-Users
N=4, 1 male, age between 67 and 81
How important is it to you that you live independently in your own home?
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Really Important
3
75%
Important
1
25%
I don't mind
0
0%
Not very important
0
0%
I would rather not live at home
0
0%
How well do you feel that you cope with living at home?
Very well
2
50%
Well
2
50%
Neither good nor bad
0
0%
I struggle a bit
0
0%
I struggle a lot
0
0%
How often do you see the following people?
Every day More than once a week
Once a week
Seldom
Never
Doctor or nurse
0
0
0
2
1
Social worker
0
0
1
1
1
Housing worker
1
1
0
1
0
friends
0
0
2
0
1
Family
0
1
2
0
0
How often do you speak on the telephone with the following people
Every day More than once a week Once a week
Seldom
Never
Medical staff
0
0
0
3
0
7.2 Social worker
0
0
0
2
1
Housing worker
0
0
0
2
1
Friends
1
0
1
1
0
Family
0
1
1
1
0
Which of the following activities do you take part in and how often?
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Several times a
day
Every
day
More than once a
week
Once a
week
Seldom
Never
Talking to friends or family
0
2
1
0
0
0
Gardening
0
0
0
1
0
2
Taking medication
1
1
0
0
1
0
craft/hobby activities
0
0
2
0
1
0
Watching TV
0
3
0
0
0
0
Walking
0
2
1
0
0
0
Taking a nap
0
1
0
0
2
0
Shopping
0
0
3
0
0
0
visiting friends or family
0
0
0
2
1
0
Excursions or day trips
0
0
0
0
3
0
Cimema or similar leisure
activities
0
0
0
0
1
2
Excercise class
0
0
0
2
0
1
Is there anything not mentioned in the list that you enjoy doing that you would like to do more often?
Going on a holiday.
Are there any things that you struggle with in terms of your independence and what do you feel might
help you overcome this?
Help with household issues.
Walking with a wheeled walker.
Has a wheeled walker to walk with.
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Which of the following technology do you use at home?
TV
4
DVD Player
3
Landline telephone
4
Mobile phone
3
Computer
0
Internet
0
Interactive TV
0
Electronic games
0
Online shopping
0
Is there any technology that you don't use that you would like to?
A laptop.
Is there anything stopping you from using technology?
It is hard to program phone numbers, hard to use a phone, and I do not want to ask help from
others.
No.
No.
How would you rate your attitude towards technology in general?
Positive/open minded
1
33%
Fairy positive
0
0%
Neither positive nor negative
1
33%
Fairy negative
1
33%
Very negative/dismissive
0
0%
“Smart clothing” monitors things like blood pressure, temperature and heart rate with tiny sensors
embedded in clothing. Do you think you would be happy to wear this technology embedded in some type
of light underwear?
Yes
1 33%
No
2
67%
How would you feel about using certain types of monitoring technology in your home if it were for your
own benefit?
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Accepting
Tolerant
Indifferent
Intolerant
Would not
allow
Monitoring cameras
0
0
0
0
4
wearable sensors embedded in your clothing
0
1
0
0
3
technology that monitors what you eat
0
0
0
0
4
Technology tghat monitors how active you
are
0
1
0
0
3
Technology that looks out for dangerous
things in your home and alerts you
0
0
0
0
2
Technology which tells how you are feeling by
looking at your face
1
0
0
0
2
Technology that understands what you are
saying
0
1
0
0
2
Technology that monitors you and alerts
other people if you are in danger
0
0
0
0
3
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How would you feel about living with a helpful robot?
Positive/open minded
1
33%
fairy positive
0
0%
Neither positive nor negative
0
0%
Fairy negative
0
0%
Very negative/dismissive
1
33%
Don't know
1
33%
Would you like it if the robot did the following:
Question
Yes
No
Followed you around
1
2
Was equipped with a camera
1
2
Was like a person (humanoid)
1
1
Spoke to you
1
2
Listened to you
1
2
Was operated by a computer screen
1
2
Reminded you to do things
1
2
Reported to a helpdesk if you were having a problem
1
2
Monitored what you ate
1
2
Do you have any further concerns or comments regarding the use of technology to assist or monitor you
in your home?
If I needed help or care, I would say yes to the above things a robot could do.
The robot should not walk in my way.
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