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.