Zachary Beattie1,2,3, Lyndsey M Miller1,4, Carlos Almirola5, Wan-Tai M Au-Yeung1,2,3, Hannah Bernard1,2,3, Kevin E Cosgrove1,2,3, Hiroko H Dodge1,2,3, Charlene J Gamboa6, Ona Golonka1,2,3, Sarah Gothard1,2,3, Sam Harbison1,2,3, Stephanie Irish1,2,3, Judith Kornfeld1,2,3, Jonathan Lee1,2,3, Jennifer Marcoe1,2,3, Nora C Mattek1,2,3, Charlie Quinn1,2,3, Christina Reynolds1,2,3, Thomas Riley1,2,3, Nathaniel Rodrigues1,2,3, Nicole Sharma1,2,3, Mary Alice Siqueland1,2,3, Neil W Thomas7,8, Timothy Truty6, Rachel Wall1,2,9, Katherine Wild1,2,3, Chao-Yi Wu1,2,3, Jason Karlawish10, Nina B Silverberg11, Lisa L Barnes6, Sara Czaja5,12, Lisa C Silbert1,2,3,9, Jeffrey Kaye1,2,3. 1. Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, Oregon, USA. 2. National Institute on Aging, Layton Aging & Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA. 3. Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA. 4. School of Nursing, Oregon Health & Science University, Portland, Oregon, USA. 5. Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA. 6. Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA. 7. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 8. Bruyère Research Institute, Ottawa, Ontario, Canada. 9. Department of Neurology, Portland Veterans Affairs Medical Center, Portland, Oregon, USA. 10. Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 11. Division of Neuroscience, National Institute on Aging, National Institute of Health, Bethesda, Maryland, USA. 12. Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weil Cornell Medicine, New York, New York, USA.
Abstract
INTRODUCTION: Future digital health research hinges on methodologies to conduct remote clinical assessments and in-home monitoring. The Collaborative Aging Research Using Technology (CART) initiative was introduced to establish a digital technology research platform that could widely assess activity in the homes of diverse cohorts of older adults and detect meaningful change longitudinally. This paper reports on the built end-to-end design of the CART platform, its functionality, and the resulting research capabilities. METHODS: CART platform development followed a principled design process aiming for scalability, use case flexibility, longevity, and data privacy protection while allowing sharability. The platform, comprising ambient technology, wearables, and other sensors, was deployed in participants' homes to provide continuous, long-term (months to years), and ecologically valid data. Data gathered from CART homes were sent securely to a research server for analysis and future data sharing. RESULTS: The CART system was created, iteratively tested, and deployed to 232 homes representing four diverse cohorts (African American, Latinx, low-income, and predominantly rural-residing veterans) of older adults (n = 301) across the USA. Multiple measurements of wellness such as cognition (e.g., mean daily computer use time = 160-169 min), physical mobility (e.g., mean daily transitions between rooms = 96-155), sleep (e.g., mean nightly sleep duration = 6.3-7.4 h), and level of social engagement (e.g., reports of overnight visitors = 15-45%) were collected across cohorts. CONCLUSION: The CART initiative resulted in a minimally obtrusive digital health-enabled system that met the design principles while allowing for data capture over extended periods and can be widely used by the research community. The ability to monitor and manage health digitally within the homes of older adults is an important alternative to in-person assessments in many research contexts. Further advances will come with wider, shared use of the CART system in additional settings, within different disease contexts, and by diverse research teams.
INTRODUCTION: Future digital health research hinges on methodologies to conduct remote clinical assessments and in-home monitoring. The Collaborative Aging Research Using Technology (CART) initiative was introduced to establish a digital technology research platform that could widely assess activity in the homes of diverse cohorts of older adults and detect meaningful change longitudinally. This paper reports on the built end-to-end design of the CART platform, its functionality, and the resulting research capabilities. METHODS: CART platform development followed a principled design process aiming for scalability, use case flexibility, longevity, and data privacy protection while allowing sharability. The platform, comprising ambient technology, wearables, and other sensors, was deployed in participants' homes to provide continuous, long-term (months to years), and ecologically valid data. Data gathered from CART homes were sent securely to a research server for analysis and future data sharing. RESULTS: The CART system was created, iteratively tested, and deployed to 232 homes representing four diverse cohorts (African American, Latinx, low-income, and predominantly rural-residing veterans) of older adults (n = 301) across the USA. Multiple measurements of wellness such as cognition (e.g., mean daily computer use time = 160-169 min), physical mobility (e.g., mean daily transitions between rooms = 96-155), sleep (e.g., mean nightly sleep duration = 6.3-7.4 h), and level of social engagement (e.g., reports of overnight visitors = 15-45%) were collected across cohorts. CONCLUSION: The CART initiative resulted in a minimally obtrusive digital health-enabled system that met the design principles while allowing for data capture over extended periods and can be widely used by the research community. The ability to monitor and manage health digitally within the homes of older adults is an important alternative to in-person assessments in many research contexts. Further advances will come with wider, shared use of the CART system in additional settings, within different disease contexts, and by diverse research teams.
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