Motivation for the ASSIST project

The United States is about to experience the greatest demographic change in its history. Most of this change will occur over the next 30 years, as 77 million baby boomers cease to work and pay payroll taxes and instead start to retire and collect benefits.

The problems arising from this change in demographics include spiraling health care costs and shortages of trained nurses and doctors \cite{Zarit1998}. The percentage of elders in the population will increase dramatically as the first segment of the baby boomer cohort becomes 65 in 2011 \cite{Hobbs2002}. Many of these elders will want to remain in the home, but with aging come higher rates of functional and cognitive deficits \cite{Gist2004} that, in many cases, result in limitations in at least one activity of daily living [Kassner, 2006]. Demographics for veterans follow similar patterns; there are 9.8 million veterans over 65 in the 2000 census (Older Americans 2000 Update, 2006), and those 85 and older will almost triple from 510,000 to 1.3 million by 2010 \cite{Atizado2004}. As the Veterans Adminstration (VA) shifts the locus of care to the community, gaps already exist regarding access by veterans to non-institutional care. At the same time, veterans are more likely to be older, disabled and have lower income than the general population \cite{Atizado2004}.

overtaxing of the traditional “mainframe” approach to medical services

It is likely that technologies for the home can help to relieve the inevitable stress on the medical infrastructure and to extend the period of time that elders can live independently. First and foremost, these technologies include assistance in the activities of daily living (ADL)—technologies that enhance safety and security, assistance in daily medical compliance, help with client calendars and daily chores such as household cleaning and grocery shopping. Second, elders are susceptible to isolation as they become less mobile[Pin et~al., 2005; Michael et~al., 1999]. Devices that facilitate communication and social elationships between peers, families, and the surrounding community can help these clients remain onnected socially. Third, the dearth of trained physicians and nurses together with a diminished capacity to travel independently means that more of this population must receive regular medical checkups in their homes by physicians that make virtual house calls rather than in a centralized facility. Technologies in the home that create an appropriate interface between the medical industry and the elderly client can help to make efficient use of the medical infrastructure and improve the frequency of care and oversight.

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