2.3.3 Wireless sensor networks (WSNs) and body area networks (BANs)

Wireless sensor networks (WSNs) find their use in smart home automation application since a while. They are used for medical application and devices to measure the patient's vital parameter. Bio-signals like body temperature, blood pressure, pulse oximetry, ECG, and breathing activity can autonomously and eventbased automatically and seamless be measured.

IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient… DOI: http://dx.doi.org/10.5772/intechopen.86247

Clinics, hospitals, and care/nursing homes can remotely use end-point devices like video and audio devices to assist family members to care for their sick member at home. Thus, home automation systems can be connected to medical emergency stations at clinics and hospitals close to the patient's residence place and regularly forward the patient's critical data gathered by WSMs and BANs. How this works is presented by Moghadam et al. in [28] where they have designed and implemented a communication system single and multi-antenna in a BAN. They wrote:

"an energy efficient data transmission technique for communication between a singleantenna medical sensor/microrobot inside the body to a multi-antenna receiver on the body surface through non-homogeneous propagation environment."

Transmitting over multiple spatial and temporal scales is challenging in advanced health informatics [29] though advancement achieved in the Internet of things (IoT) protocols like LoRaWAN with platforms like the things network (TTN) [https://www.thethingsnetwork.org/] eases transferring data today.

Wireless body area network (WBAN) is part of wireless sensor networks (WSNs) that can enable monitoring and collecting the patient bio-signal. This has been shown in a previous study [30] where a wireless sensor network system has been used at a cardiologic intensive care unit (CICU) for collecting and monitoring, round the clock, cardiologic activities in-patients. WSNs were connected to the patients and thus bio-signals have been collected in real time. This study has shown the feasibility of using WSNs and WBNs in home automation.

### 3. Research questions, hypotheses, and scopes

The main objectives behind the research questions are on one hand to investigate the tendency toward homecare regarding the nursing care homes and care workforce shortage and on the other hand to additionally investigate challenges and issues people are facing in homecare. Homecare is when family members care for their sick member at home. The needs in terms of appropriate solutions to overcome challenges and issues faced by caring for patients in homecare are assessed.

#### 3.1 Questions

Q1: What is the tendency for homecare regarding the current nursing care crisis facing HIC?

Three nursing care options are noticed in Germany: (i) nursing care residences with 24 h registered care services and (ii) homecare with the assistance of ambulant nursing staff for a couple of hours per day. Many families hire care personnel from abroad (e.g., Yugoslavia, Budapest, and Ukraine), mostly with beginner's skills or no skills at all to care for their sick parents. Family members also care for the patient following medical instructions, (iii) regarding nursing care homes practiced fees, many families send their sick parents abroad in East European countries.

Q2: What challenges and issues are facing homecare?

Caring for a patient in homecare can be challenging for family members since many patients request round the clock nursing care. This is a full-time job. This study aims at investigating the challenges and issues that can be faced in such a situation.

Q3: Is it worth caring for dementia patients in homecare instead of at nursing care home?

Dementia patients are forgetful. They can forget to take food and drink water. They could forget to turn off a furnace or turn on a heater. Regarding these issues, it is worth assessing how to handle dementia patients.

Q4: What is the quality of life (QoL) of patients treated in homecare?

2.3.3 Wireless sensor networks (WSNs) and body area networks (BANs)

based automatically and seamless be measured.

Healthcare domain specific IoT architecture (source: [27]).

Internet of Things (IoT) for Automated and Smart Applications

Figure 3.

78

Wireless sensor networks (WSNs) find their use in smart home automation application since a while. They are used for medical application and devices to measure the patient's vital parameter. Bio-signals like body temperature, blood pressure, pulse oximetry, ECG, and breathing activity can autonomously and event-

Many studies investigated the patient's QoL in nursing homes. Measuring or assessing the QoL level of patients in homecare is not achieved. This study aims at assessing it.

numerous other papers through its references. Appropriate papers were thus found

IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient…

Papers were sought on three major bases: (i) home automation for medical applications, energy, security in the smart home, and trends in the smart home at cities. Beyond the technical part, papers dealing with the nursing care home, homecare, quality of life in nursing residences, and user satisfaction toward the nursing care are the main expressions used to find papers in the better academic

and used for the purpose of this study.

DOI: http://dx.doi.org/10.5772/intechopen.86247

1 Design of an IoT smart home system

2 A systematic review of the smart home literature: A user perspective

3 Implementation of Smart home automation system on FPGA board using IoT

4 Smart home technologies in everyday life: do they address key energy challenges in households?

81

Table 1 summarizes the important papers reviewed.

Pos. Title Abstract Year of

This paper basically deals with the design of an IoT smart home system (IoTSHS) which can provide the remote control to smart home through mobile, infrared (IR) remote control as well as with PC/laptop.

To facilitate the implementation and adoption of smart home technology, it is important to examine the user's perspective and the current state of smart homes. Given the fast pace with which the literature has been developing in this area, there is a strong need to revisit the literature. The aim of this paper is to systematically review the smart home literature and survey the current state of play from the users' perspective.

There has been a rapid introduction of network-enabled digital technologies in home automation. These technologies provide a lot of opportunities to improvise the connectivity of devices within the home. Internet helps to bring in with an immediate solution for many problems and also able to connect from any of the remote places which contribute to overall cost reduction and energy consumption. Intelligence based on microprocessors is used by home automation to incorporate electronic structures in the household.

This paper interrogates their contribution to the ambitious carbon emission reduction efforts required under the 1.5 \_C mitigation pathway set by the Paris Agreement and their suitability for energy poverty alleviation goals. In publication

2018 [31]

2019 [11]

2018 [32]

2018 [32]

Reference

literature database.

Q5: How to assess the factors impacting the health-related QoL for homecare? There are well-established metrics for assessing the level of QoL in the nursing context though patient in homecare is exposed to additional environmental means. Therefore, it matters to investigate the impact of the QoL of other members on the QoL of the patient. Furthermore, can noise negatively impact the QoL in homecare? A grand-mutter (an elderly) will not be disturbed by a crying grand-child. It is, therefore, important to analyze which criteria are contributing to measuring the QoL in the case of homecare.

Q6: Can the technology assist to overcome homecare-related challenges and issues?

Round the clock care cannot be achieved by one person. It is a challenge. Previous studies have shown evidence for using the technology in healthcare to deliver care at remote, to monitor 24 h a day intensive care patients, etc. Many works have been achieved regarding mental health sensing and assessment, etc. In the present context, this study aims at investigating how home automation supported solution can assist in homecare and overcome challenges and issues faced.

#### 3.2 Hypotheses

H1: The tendency to care for patients in homecare is on increase since the nursing crisis.

The study would like to verify if the nursing crisis has impacted the family member behavior.

H2: Smart automation home technology assists in homecare and impacts the QoL of both family members and the patient.

H3: Smart home automation enables to combine occupation (job) and caring adequately (efficiently and effectively) for a patient at home.

#### 3.3 Scopes

Measuring the quality of services of nursing/care homes is out of the scope of this study, whereas only assessment of the patient's QoL in homecare before and after using the proposed solution constitutes the scope of the present work.

#### 4. Methodology and data

This section presents the conducted literature review on the smart home automation for healthcare purposes. Additionally, data have been collected using semi-structured interview methodology with the objectives to answer the research question and verify the hypotheses.

#### 4.1 Literature review

#### 4.1.1 Paper sampling

In order to conduct a quantitative and qualitative literature review, papers have been sampled using snowball technology. Each found paper provides with

IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient… DOI: http://dx.doi.org/10.5772/intechopen.86247

numerous other papers through its references. Appropriate papers were thus found and used for the purpose of this study.

Papers were sought on three major bases: (i) home automation for medical applications, energy, security in the smart home, and trends in the smart home at cities. Beyond the technical part, papers dealing with the nursing care home, homecare, quality of life in nursing residences, and user satisfaction toward the nursing care are the main expressions used to find papers in the better academic literature database.

Table 1 summarizes the important papers reviewed.


Many studies investigated the patient's QoL in nursing homes. Measuring or assessing the QoL level of patients in homecare is not achieved. This study aims at

Internet of Things (IoT) for Automated and Smart Applications

Q5: How to assess the factors impacting the health-related QoL for homecare? There are well-established metrics for assessing the level of QoL in the nursing context though patient in homecare is exposed to additional environmental means. Therefore, it matters to investigate the impact of the QoL of other members on the QoL of the patient. Furthermore, can noise negatively impact the QoL in homecare? A grand-mutter (an elderly) will not be disturbed by a crying grand-child. It is, therefore, important to analyze which criteria are contributing to measuring the

Q6: Can the technology assist to overcome homecare-related challenges

Round the clock care cannot be achieved by one person. It is a challenge. Previous studies have shown evidence for using the technology in healthcare to deliver care at remote, to monitor 24 h a day intensive care patients, etc. Many works have been achieved regarding mental health sensing and assessment, etc. In

H1: The tendency to care for patients in homecare is on increase since the

The study would like to verify if the nursing crisis has impacted the family

H2: Smart automation home technology assists in homecare and impacts the

H3: Smart home automation enables to combine occupation (job) and caring

Measuring the quality of services of nursing/care homes is out of the scope of this study, whereas only assessment of the patient's QoL in homecare before and after using the proposed solution constitutes the scope of the present work.

This section presents the conducted literature review on the smart home automation for healthcare purposes. Additionally, data have been collected using semi-structured interview methodology with the objectives to answer the research

In order to conduct a quantitative and qualitative literature review, papers have

been sampled using snowball technology. Each found paper provides with

the present context, this study aims at investigating how home automation supported solution can assist in homecare and overcome challenges and

assessing it.

and issues?

issues faced.

3.2 Hypotheses

nursing crisis.

3.3 Scopes

member behavior.

4. Methodology and data

4.1 Literature review

4.1.1 Paper sampling

80

question and verify the hypotheses.

QoL of both family members and the patient.

adequately (efficiently and effectively) for a patient at home.

QoL in the case of homecare.


4.2 Data gathering and analysis

DOI: http://dx.doi.org/10.5772/intechopen.86247

Selected literature among the sampling.

Table 1.

4.2.1 Data collection approach

operative data privacy regulation in the country.

4.2.1.1 Quantitative data collection approach

services in any nursing were collected.

quality of life.

83

4.2.1.2 Qualitative data collection approach

A semi-structured interview was conducted. Patients living at home as well as at

interviewed. The data collection was carried anonymously in accordance with the

The data collection method has included questionnaires with a mixture of closed-ended (yes or no questions) and open-ended questions. Nursing home residents and patients in homecare were interviewed. Data were thus collected about nursing place tendencies and health-related as well as patient's quality of life with regard to the residence place: nursing home or homecare. No data on the quality of

Quality of experience (QoE/QoX) or the satisfaction level is commonly based on a subjective appreciation of the quality of services. Patient's quality of life can be subjective somehow. For example, two distinct persons can differently

appreciate noise or the presence of other people. Some elderly can feel uncomfortable when the nurse is a foreigner and ignore some elementary cultural rules. Therefore, nursing home residents were especially interviewed about their feeling, about what makes them feel uncomfortable in order to detect the impacts on their

An important point was to determine their subjectivity level toward what makes them feel uncomfortable. Furthermore, test participants were asked

nursing care home, care and nursing staffs, and people on the street were

Pos. Title Abstract Year of

IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient…

efficient means to provide automated communication among distributed ubiquitous devices in a standardized manner, but none have been adopted universally. In an effort to present the technologies used in the M2M and home integration environment, this paper presents the home area network elements and definitions and reviews the standards, architectures, and initiatives created to enable M2M communication and integration in several different environments, especially at the smart home domain. This paper points out the differences between them and identifies trends for the future.

publication

Reference


IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient… DOI: http://dx.doi.org/10.5772/intechopen.86247

#### Table 1.

Pos. Title Abstract Year of

Internet of Things (IoT) for Automated and Smart Applications

5 Environmental impacts and benefits of smart home automation: life cycle assessment of home energy management system

6 A review of smart homes present state and future challenges

7 Home automation networks: A survey

82

contrast to aspirational claims for a 'smart utopia' of greener, less energy-intensive, and more comfortable homes currently present in market and policy discourses, we argue that SHTs may reinforce unsustainable energy consumption patterns in the residential sector, which are not easily accessible by vulnerable consumers, and do little to help the 'energy poor'secure adequate and affordable access to energy at home.

This paper discusses the life-cycle environmental impact of home energy management system (HEMS), in terms of its potential benefits and detrimental impacts. It is the expectation that adapting smart home automation (SHA) would lead to reduced electricity usage in the household and overall environmental advantages.

In the era of information technology, the elderly and disabled can be monitored with numerous intelligent devices. Sensors can be implanted into their home for continuous mobility assistance and nonobtrusive disease prevention. Modern sensorembedded houses, or smart houses, cannot only assist people with reduced physical functions but help resolve the social isolation they face. They are capable of providing assistance without limiting or disturbing the resident's daily routine, giving him or her greater comfort, pleasure, and well-being. This article presents an international selection of leading smart home projects, as well as the associated technologies of wearable/implantable monitoring systems and assistive robotics. The latter are often designed as components of the larger smart home environment. The paper will conclude by discussing the future challenges of the domain.

Home automation networks provide a promising opportunity in designing smart home systems and applications. In this context, machine-to-machine (M2M) networks are emerging as an

publication

Reference

— [33]

2008 [10]

2017 [20]

Selected literature among the sampling.

#### 4.2 Data gathering and analysis

A semi-structured interview was conducted. Patients living at home as well as at nursing care home, care and nursing staffs, and people on the street were interviewed. The data collection was carried anonymously in accordance with the operative data privacy regulation in the country.

#### 4.2.1 Data collection approach

#### 4.2.1.1 Quantitative data collection approach

The data collection method has included questionnaires with a mixture of closed-ended (yes or no questions) and open-ended questions. Nursing home residents and patients in homecare were interviewed. Data were thus collected about nursing place tendencies and health-related as well as patient's quality of life with regard to the residence place: nursing home or homecare. No data on the quality of services in any nursing were collected.

#### 4.2.1.2 Qualitative data collection approach

Quality of experience (QoE/QoX) or the satisfaction level is commonly based on a subjective appreciation of the quality of services. Patient's quality of life can be subjective somehow. For example, two distinct persons can differently appreciate noise or the presence of other people. Some elderly can feel uncomfortable when the nurse is a foreigner and ignore some elementary cultural rules. Therefore, nursing home residents were especially interviewed about their feeling, about what makes them feel uncomfortable in order to detect the impacts on their quality of life.

An important point was to determine their subjectivity level toward what makes them feel uncomfortable. Furthermore, test participants were asked

about any discomfort the system has caused to them as well as if they feel observed or patronized.
