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Les technologies d’assistance à la vie autonome est aujourd'hui nécessaire pour soutenir les personnes ayant des besoins spécifiques dans leurs activités de la vie quotidienne, mais leurs développements demeure limités malgré les enjeux liés à l’accompagnement des personnes âgées et dépendantes. Par ailleurs, l'élaboration de plateformes technologiques durant la dernière décennie s'est principalement concentrée sur la dimension technologique, en négligeant l'impact des facteurs humains et des besoins sociaux. Les nouvelles technologies, telles que le cloud et l’Internet des objets (IoT) pourraient apporter de nouvelles capacités dans ce domaine de recherche permettant aux systèmes de traiter les activités humaines selon des modèles orientés vers l'usage (ie. la fragilité) dans une approche non invasive.Cette thèse se propose d'envisager un nouveau paradigme dans les technologies d'assistance pour le vieillissement et le bien-être en introduisant (i) des métriques de la fragilité humaine et (ii) une dimension urbaine dans un cadre d'assistance ambiant (extension de l'espace de vie de l'intérieur vers l'extérieur). Elle propose une plateforme basée sur l’Informatique dans le cloud (cloud computing) pour une communication transparente avec les objets connectés, permettant au système intégré de calculer et de modéliser différents niveaux de fragilité humaine. Cette thèse propose d'utiliser des données hétérogènes en temps réel fournies par différents types de sources (capteurs intérieurs et extérieurs), ainsi que des données de référence, collectées sur un serveur de cloud de raisonnement central. La plateforme stocke les données brutes et les traite à travers un moteur de raisonnement hybride combinant à la fois l'approche basée sur les données (apprentissage automatique), et l'approche basée sur la connaissance (raisonnement sémantique) pour (i) déduire les activités de la vie quotidienne, (ii) détecter le changement du comportement humain, et enfin (iii) calibrer les valeurs de fragilité humaine. Les valeurs de fragilité peuvent permettre au système de détecter automatiquement tout changement de comportement, ou toute situation anormale, qui pourrait entraîner un risque à la maison ou à l'extérieur. L'ambition à long terme est de détecter et d'intervenir pour éviter un risque avant même qu'un médecin ne le détecte lors d'une consultation. L'objectif ultime est de promouvoir le paradigme de la prévention pour la santé et du bien-être.Cette thèse vise à concevoir et développer une plateforme intégrée, personnalisée, basée sur le cloud, capable de communiquer avec des capteurs intérieurs non invasifs (par ex. mouvement, contact, fibre optique) et à l'extérieur (par ex. BLE Beacons, smartphone, bracelet..). La plateforme développée comprend également un classificateur de mobilité du comportement humain qui utilise les capteurs internes du Smart Phone pour calibrer le type de mouvement effectué par l'individu (p. ex. marche, vélo, tram, bus, et voiture). Les données recueillies dans ce contexte servent à construire un modèle multidimensionnel de fragilité basé sur plusieurs éléments standardisés de fragilité, à partir d'une littérature abondante et d'un examen approfondi d’autres plateformes. La plateforme et les modèles associés ont été évalués dans des conditions réelles de vie impliquant les utilisateurs et les aidants par le biais de différents sites pilotes à Singapour et en France. Les données obtenues ont été analysées et publiées dans de nombreuses conférences et revues internationales.La plateforme développée est actuellement déployée en situation écologique dans 24 habitats individuels. Cela comprend cinq chambres en EHPAD, et neuf maisons sont situées en France, en collaboration avec une maison de retraite (Argentan-Normandie) et à Montpellier en collaboration avec Montpellier Métropole. Entre autre dix appartements privés sont situés à Singapour en collaboration avec un Senior Activity Center. / Ambient Assisted Living is nowadays necessary to support people with special needs in performing their activities of daily living, but it remains unaltered in front of the necessity to accompany aging and dependent people in their outdoors activities. Moreover, the development of multiple frameworks during the last decade has mainly focused on the engineering dimension neglecting impact of human factors and social needs in the design process. New technologies, such as cloud computing and Internet of Things (IoT) could bring new capabilities to this field of research allowing systems to process human condition following usage oriented models (e.g. frailty) in a non-invasive approach. This thesis proposes to consider a new paradigm in assistive technologies for aging and wellbeing by introducing (i) human frailty metrics, and (ii) urban dimension in an ambient assistive framework (extending the living space from indoors to outdoors). It proposes a cloud-based framework for seamless communication with connected objects, allowing the integrated system to compute and to model different levels of human frailty based on several frailty standardized items, and leveraged from an extensive literature and frameworks reviews.This thesis aims at designing and developing an integrated cloud-based framework, which would be able to communicate with heterogeneous real-time non-invasive indoor sensors (e.g. motion, contact, fiber optic) and outdoors (e.g. BLE Beacons, smartphone). The framework stores the raw data and processes it through a designed hybrid reasoning engine combining both approaches, data driven (machine learning), and knowledge driven (semantic reasoning) algorithms, to (i) infer the activities of the daily living (ADL), (ii) detect changes of human behavior, and ultimately (iii) calibrate human frailty values. It also includes a human behavior mobility classifier that uses the inner smartphone sensors to classify the type of movement performed by the individual (e.g. Walk, Cycling, MRT, Bus, Car). The frailty values might allow the system to automatically detect any change of behaviors, or abnormal situations, which might lead to a risk at home or outside.The proposed models and framework have been developed in close collaboration with IPAL and LIRMM research teams. They also have been assessed in real conditions involving end-users and caregivers through different pilots sites in Singapore and in France. Nowadays, the proposed framework, is currently deployed in a real world deployment in 24 individual homes. 14 spaces are located in France (5 privates rooms in nursing home and 9 private houses) in collaboration with a nursing home (Argentan-Normandie and Montpellier). 10 individual homes are located in Singapore in collaboration with a Senior Activity Center (non-profit organization).The long-term ambition is to detect and intervene to avoid a risk even before a medical doctor detects it during a consultation. The ultimate goal is to promote prevention paradigm for health and wellbeing. The obtained data has been analyzed and published in multiple international conferences and journals.

Made available in DSpace on 2016-08-10T10:54:59Z (GMT). No. of bitstreams: 1 PEDRO URIEL GONCALVES LIMA.pdf: 785716 bytes, checksum: 2b01eb823bb69a2ffb205c6f57db876a (MD5) Previous issue date: 2016-03-11 / With the advent of the Psychiatric Reform and the enactment of Law 10.216 - 12 establishing a new vision for the treatment of people with mental illness, the implementation of Psychosocial and Therapeutic Residences Care Centers have been imposed as support for the new model of care for these patients. Through Satisfaction Assessment Scales Brazilian was aimed in this study to evaluate the degree of satisfaction of residents and staff of these homes, to reflect whether such dwellings or not brought benefits proposed by the Law. It was found that only 1.9% of the professionals they said very dissatisfied with the service, the majority, 62.7%, are satisfied with the work they do. With regard to residents, some data draw attention, such as 44.4% feel respected by professionals, 66.7% feel that professionals understand well your problems. After analyzing the verbal material collected in interviews of professionals and residents, it was possible to understand the dissatisfaction of professionals as to salary issues and incentives for training, and realize how much the occupant is received by the service. / Com o advento da Reforma Psiquiátrica e a promulgação da Lei 10.216-12 que instituiu uma nova concepção para o tratamento de pessoas com doenças mentais, a implantação dos Centros de Atenção Psicossocial e Residências Terapêuticas se impuseram como respaldo para o novo modelo de atendimento a estes pacientes. Por meio de Escalas Brasileiras de Avaliação da Satisfação objetivou-se neste estudo avaliar o grau de satisfação de moradores e funcionários dessas residências, para refletir se tais moradias trouxeram ou não benefícios propostos pela Lei. Foi constatado que apenas 1,9% dos profissionais se disseram muito insatisfeitos com o serviço, a maioria, 62,7%, estão satisfeitos com o trabalho que realizam. Com relação aos residentes, alguns dados chamam a atenção, tais como 44,4% se sentem respeitados pelos profissionais, 66,7% sentem que os profissionais compreendem muito bem seus problemas. Após analisar o material verbal coletado nas entrevistas dos profissionais e dos moradores, foi possível compreender as insatisfações dos profissionais quanto a questões salariais e incentivos à qualificação, além de perceber o quanto o morador é acolhido pelo serviço.

In comparison with the national U.S. population, African American aged adults are less likely to reside in assisted living facilities (ALFs). At present, little qualitative data exist concerning how African American aged adults perceive living at home as opposed to living in an ALF. Using a phenomenological approach, this study explored how African American aged adults who live at home feel about residing in ALFs. The research questions focused on aged adults' perceptions, beliefs, and attitudes about ALFs and the conditions that may prevent African American aged adults from living in ALFs. A conceptual framework based on the Purnell Model of Cultural Competence was used to interpret study results regarding the cultural beliefs of African American aged adults. Data was collected through in-depth interviews with a purposive sample of nine African American adults aged 70 years and older who live at home and have not resided in an ALF. The data was managed through the NVivo 12 Plus program software, which assisted in providing inductive content analysis. The findings in the study revealed that the majority of the participants did not have knowledge about ALFs services however, the participant's attitudes to consider residing in ALFs were positive. There were some trust issues with the participants, indicative of a cultural heritage of beliefs and perceptions, as the participants stipulated they would reside in an ALF with support of family to monitor their care. The research study may contribute to a positive social change for African American aged adults by supporting an increased in knowledge and understanding of ALFs and increase the likelihood of African American aged adults residing in an ALF.

The aim of our study is to examine experience of the quality of life for elderly people with assisted living from their own, and caretakers, perspectives. We also aim to examine how elderly people in assisted living, and caretakers, experiences that they could affect the elderly people´s quality of life.   The study is based on a qualitative method and the data is collected by interviews with four recipient of care and three care takers.   The result shows that there are many factors that have an importance when it comes to quality of life for the recipient of care. It has shown in the study that the recipient of care and the caretakers put emphasize in the same factors. These factors are health, the affect of assisted living, happiness, relationships and self-determination. The result has shown that the assisted living has a major importance when it comes to the quality of life for the recipient of cares.

Leveraging our experience with the traditional approach to ambient assisted living (AAL) which relies on a large spread of heterogeneous technologies in deployments, this thesis studies the possibility of a more "stripped down" and complementary approach, where only a reduced hardware subset is deployed, probing a transfer of complexity towards the software side, and enhancing the large scale deployability of the solution. Focused on the reasoning aspects in AAL systems, this work has allowed the finding of a suitable semantic inference engine for the peculiar use in these systems, responding to a need in this scientific community. Considering the coarse granularity of situational data available, dedicated rule-sets with adapted inference strategies are proposed, implemented, and validated using this engine. A novel semantic reasoning mechanism is proposed based on a cognitively inspired reasoning architecture. Finally, the whole reasoning system is integrated in a fully featured context-aware service framework, powering its context awareness by performing live event processing through complex ontological manipulation. the overall system is validated through in-situ deployments in a nursing home as well as private homes over a few months period, which itself is noticeable in a mainly laboratory-bound research domain

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-09-21T12:40:48Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Vanessa Vieira França - Dissertação.pdf: 1905878 bytes, checksum: cb054fd34f33546e8d861d9789c0b2d2 (MD5) / Made available in DSpace on 2016-09-21T12:40:48Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Vanessa Vieira França - Dissertação.pdf: 1905878 bytes, checksum: cb054fd34f33546e8d861d9789c0b2d2 (MD5) Previous issue date: 2016-02-25 / CAPES / Serviços Residenciais Terapêuticos (SRT) são casas inseridas na comunidade e que recebem portadores de transtornos mentais, egressos de internações psiquiátricas de longa permanência, sem suporte social e com laços familiares ausentes ou fragilizados. Hoje os SRT vivenciam diversos desafios como: a rede de saúde deficitária e pouco articulada, o envelhecimento da população, dificuldade da equipe de cuidadores com a convivência e manejo mínimo das comorbidades crônicas e psiquiátricas. O objetivo geral dessa dissertação foi analisar as demandas de cuidado dos moradores dos SRT. Para alcançar este objetivo, foram elaborados um artigo de Revisão Integrativa (RI) e três artigos originais: O artigo de RI teve o objetivo de identificar as estratégias utilizadas no processo de desinstitucionalização de pessoas com transtornos mentais em diversos países do mundo. A busca foi realizada nas bases Scopus, Cinahl e Lilacs. Foram incluídos artigos originais publicados entre 2009 e 2014, em inglês, português ou espanhol. Os artigos originais emergiram de um estudo transversal de amostra censitária realizado com 190 moradores de ambos os sexos de 31 SRT de Recife-PE. Foram excluídos moradores em internamento hospitalar ou fora da cidade; impossibilitados de participar do estudo por questões de saúde física ou mental; e que não possuíam curador legal disponível. A coleta de dados foi realizada entre janeiro e julho/2015 no próprio SRT ou nos Centros de Atenção Psicossocial de referência. Foram analisadas as variáveis de perfil socioeconômico, familiar e psiquiátrico, aplicado o Índice de Katz e a escala de Lawton. Para análise foram utilizados o teste de qui-quadrado e a regressão de Poisson com variância robusta. Os resultados da revisão integrativa emergiram da análise de 14 experiências de desinstitucionalização no mundo e evidenciaram as particularidades vivenciadas por diferentes países para realizar a reforma psiquiátrica. Os artigos originais evidenciaram que essa população em sua maioria é composta por homens, solteiros, não escolarizados, com renda entre 1 e 2 salários mínimos e idosos. Para as Atividades Básicas de Vida Diária (ABVD) a maioria dos moradores é independente.A análise multivariada identificou associações entre o estado geral comprometido, mobilidade reduzida e acuidade visual preservada com estados de dependência para as ABVD. Para as Atividades Instrumentais de Vida Diária a maioria foi classificada como dependente este estado esteve mais associada à ausência de renda, tempo do último internamento psiquiátrico superior a 10 anos, estado geral comprometido, acuidade visual preservada e não possuir esquizofrenia 10 paranóide. As demandas de cuidado prioritárias são: inatividade física, edentulismo sem uso de prótese, sobrepeso e obesidade, esquizofrenia residual e o tabagismo. Conclui-se, que o perfil desse morador ainda assemelha-se com o que é encontrado nos hospitais psiquiátricos brasileiros e que suas demandas de cuidado envolvem questões associadas aos longos períodos de internamento psiquiátrico pregresso, afetando negativamente na capacidade funcional deste grupo. É necessária a integração do morador, comunidade, rede de assistência, e em especial da Estratégia Saúde da Família, com o intuito de prevenir agravos e intervir nestas demandas identificadas a fim de prevenir a evolução dos quadros de dependência com o envelhecimento da população. / Residential Therapeutic Services (RTS) are community “assisted living facilities” to assist people with mental disorders or long-term psychiatric hospitalization, and without family or social support. Several challenges face the RTS today including an unorganized and impoverished health network, an aging population, and the coexistence and minimal management of chronic and psychiatric comorbidities. The aim of this thesis was to analyze the care demands of the residents of the RTS. To accomplish this, one Integrative Review article (RI) and three original articles were developed. The RI article aimed to identify selected strategies to deinstitutionalize people with mental disorders in many countries around the world. The search was conducted in Scopus, CINAHL, and Lilacs databases. Original articles that were published between 2009 and 2014 in English, Portuguese, and Spanish, were included. The original articles emerged from a cross-sectional study of the census sample conducted with 190 residents of both sexes of 31 RTS Recife-PE. Residents who were in hospital, out of town, and did not have a legal curator available were excluded. Data was collected between January and July, 2015 in the RTS or reference Psychosocial Care Centers. The Katz Index and the Lawton scale were applied with the variables of socioeconomic, family, and psychiatric profile. For analysis, were used the chi-square test and Poisson regression with robust variance. The results of the integrative review emerged from 14 deinstitutionalization experiences, and they showed characteristics experienced in different countries in performing the psychiatric reform. The original articles showed that this population is mostly made up of men, singles, unschooled individuals, families with 1 or 2 minimum wage incomes, and the elderly. For Daily Living Basic Activities (DLBA) most residents are independent. A Multivariate analysis identified associations between impaired general health status, the reduced mobility, and the visual preserved acuity with dependency for DLBA. For the Instrumental Activities of Daily Living, most were classified as dependents. This health condition was more associated with lack of income, being a psychiatric inpatient for more than 10 years on the last hospitalization,having an impaired general condition, visual acuity preserved, and not having paranoid schizophrenia. Priority care demands are: physical inactivity, edentulism without use of prosthesis, overweight and obesity, residual schizophrenia, and smoking. It follows that the profile of this resident still resembles what is found in the Brazilian psychiatric hospitals and their care demands involve issues associated with long periods of progress of the last hospitalization in a psychiatric hospital. which adversely affects the functional ability of this group. It requires the integration of the resident, community, health care system, and especially the Primary Health Care in order to prevent injuries and intervene in the claims identified in order to prevent the development of dependence on frames with the aging population.

Avec le vieillissement de la population, le maintien à domicile des personnes âgées est devenu un enjeu majeur pour les pays développés et émergents. Parmi les solutions clés à explorer, les gérontechnologies sont considérées comme des plus prometteuses sans toutefois avoir apporté la preuve de leur efficacité pour l’autonomie domiciliaire, voire même être utilisables et acceptables pour le public visé. Dans ce contexte, une méthodologie de conception centrée-utilisateur a été mise en place pour proposer une plateforme d’assistance domiciliaire multi-tâches et multi-domaines (soutenant à la fois les activités quotidiennes, la sécurité de la personne et de son domicile et le lien social) ciblant un public âgé fragile en perte d’autonomie. Cette plateforme est appelée DomAssist. Sur la base d’une analyse des capacités physiques, cognitives et fonctionnelles en présence (étude 1) et des besoins d’assistance (étude 2) de notre échantillon d’étude, DomAssist a été conçu avec pour originalité une offre de services multi-domaines. En effet, la plateforme s’appuie d’une part sur un système de surveillance d’activités pour délivrer des assistances dites « context-aware » (étude 3) et d’autre part sur un système d’interaction homme-machine unifié et simplifié (étude 4), et ceci tout en promouvant l’auto-détermination (étude 5). Les résultats ont étayé la fiabilité du système de surveillance d’activités, et renforcé le bien-fondé de nos principes de conception concernant le système unifié d’interaction; et le soutien de l’auto-détermination. Notamment un rendu positif concernant l’utilisabilité et l’acceptabilité du système, et un effet bénéfique sur le sentiment de l’autodétermination des utilisateurs âgés ont été obtenus. De là, une dernière étude (étude 6) a évalué les bénéfices apportés après 6 mois d’utilisation de la plateforme, en termes de capacités fonctionnelles des participants fragiles, et de réduction du fardeau de l’aidant. Un effet positif (effet « protecteur » observé par les aidants professionnels) de DomAssist sur le statut fonctionnel des participants équipés (comparé aux contrôles) a été observé ainsi qu’une réduction du fardeau objectif de leur aidant. Au total, les résultats de ce travail pilote sont encourageants et ouvrent de nombreuses perspectives de recherche à fort potentiel d’impact sociétal concernant la problématique du maintien à domicile des personnes âgées / With the increase of life expectancy, aging in place is today a major concern for developed and emerging countries. Among the key solutions to explore, gerontechnologies are seen as the most promising. However, their evidence-based efficacy remains to be demonstrated for independent living or even for their usability and acceptance by the targeted old users. In this context, a user-centered conception methodology has been implemented for designing a multi-task and multi-domain (supporting everyday activities, safety, and social participation) assisted living platform targeting frail older adults with functional decline. This platform is named HomeAssist. Based on an analysis of physical, cognitive and fonctional abilities (study 1) and assistive technology needs (study 2) of our sample, HomeAssist has been designed with the originality of providing multi-domain services. Indeed, HomeAssist proposes an activity monitoring system to provide context-aware assistance (study 3), and a unified human-computer interaction system (study 4); while promoting self-determination (study 5). Results underpined the reliability of our activity monitoring system, and reinforced the rationale of our design principles, concerning the unified interaction system and the self-determination support. Notably, positive outcomes in terms of usability and acceptance of the system, as well as benefits concerning users’ feeling of self-determination have been obtained. From this, a last study (study 6) evaluated the benefits from a six-month use of HomeAssist, on functional abilities of frail older adults and caregiver burden. A positive effect of HomeAssist on functional status was obtained (“protective” effect reported by the professional caregivers), as well as a reduction of objective dimension of caregiver burden. Taken together, the results from these pilot studies are encouraging and open numerous research perspectives with high societal impact concerning the promotion of aging in place.

Dans un contexte mondial de vieillissement de la population, de nombreuses recherches sont menées pour améliorer la qualité de vie des personnes âgées résidant en institution, mais peu de ces travaux développent une approche architecturale. Cette recherche a pour but de proposer de nouvelles manières d’aménager ces lieux de vie, en rupture avec les paradigmes dominants du soin et de l’hôtellerie. L’hypothèse générale est qu’un environnement architectural de type domestique (-homelike) permettra aux résidents de se sentir habitants, ce qui devrait favoriser leur bien-être, leur autonomie et le développement d’interactions sociales. Notre procédure s’est basée sur le concept de l’Evidence-Based Psychology (-psychologie fondée sur la preuve), avec un essai randomisé contrôlé. Elle a consisté à réaménager de manière domestique l’espace d’entrée de plusieurs établissements dits « standards », puis à évaluer selon les méthodes de comparaison avant vs après ; établissement réaménagé vs non réaménagé. L’étude a été multidimensionnelle et exploratoire dans ses outils de recherche ; échelles de qualité de vie, cartographie comportementale, entretiens qualitatifs. Ce travail s’inscrit dans le contexte d’un développement récent du doctorat en architecture en France et contribue de fait à la réflexion épistémologique qui l’accompagne. Il permet également pour de faire prendre conscience de l’importance du cadre bâti pour la qualité de vie et met en avant le rôle social de l’architecte. / In a global context of population ageing, many research are conducted to improve the quality of life of older people living in assisted living facilities, but few of these works develop an architectural approach. This research aims to propose new ways to design these places of life, breaking with the dominant hospital and/or hotel models. The general assumption is that an architectural environment with homelike characteristics will allow residents to feel inhabitants, which should promote their welfare, autonomy and the development of social interactions. Our procedure is based on the concept of Evidence Based Psychology, with a randomized controlled trial. The entrance hall of several facilities corresponding to standards were refurbished in a homelike way, and then we evaluated comparing before vs after; refurbished nursing home vs non refurbished. The study was multidimensional and exploratory in its research tools; quality of life scales, behavioral mapping, qualitative interviews. This work take place in the French context of recent emergence of PhD in architecture and contributes de facto to the epistemological reflection that goes with it. It also helps to raise awareness of the importance of the built environment to the quality of life and highlights the social role of architectes.