Performance-based IADL evaluation of older adults with cognitive impairment within a smart home: A feasibility study.

Introduction: Mild cognitive impairment (MCI) is characterized by subtle deficits that

functional assessment via informant-report measures may not detect. Sensors can

potentially detect deficits in everyday functioning in MCI. This study aims to establish

feasibility and acceptability of using sensors in a smart home for performance-based

assessments of two instrumental activities of daily living (IADLs).

Methods: Thirty-five older adults (>65 years) performed two IADL tasks in a smart

home laboratory equipped with sensors and a web camera. Participants’ cognitive

states were determined using published criteria including measures of global cognition

and comprehensive neuropsychological test batteries. Selected subtasks of the IADL

assessmentwere autonomously captured by the sensors. Total time taken for each task

and subtask were computed. A point scoring system captured accuracy and number of

attempts. Acceptability of the smart home setup was assessed.

Results: Participants with MCI (n=21) took longer to complete both tasks than participants

with healthy cognition (HC; n = 14), with significant time differences observed

only in "Cost calculation." Completion time for IADL tasks and scores correlated in the

expected directionwith global cognition. Over 95% of the participants found the smart

home assessment acceptable and a positive experience.

Discussion: We demonstrated the feasibility and acceptability of the use of unobtrusive

commercially available sensors in a smart home for facilitating parts of the objective

assessment of IADL in older adults. Future studies need to identify more IADLs

that are suitable for semi-automated or automated assessments through the use of

simple, low-cost sensors.