INTRODUCTION

How can we deliver quality care to a rapidly growing population of

older adults - historically the most expensive demographic to treat
- while reducing the nation's healthcare costs? We believe the
solution must include three components: an emphasis on
prevention rather than treatment; a shift in the focus of care from
expensive clinical settings to the home; and a shift of some
responsibility for care from formal providers to individuals and their
family and friends. This solution can be enabled by a range of
proactive computing technologies in the digital home. These digital
home technologies have the potential to improve public health and
significantly lower the healthcare bill while enabling seniors to "age
in place," maintaining their independence and deferring more
costly institutional care as long as possible.

And it will be quite a generation. The worldwide population of those

over 65 is predicted to reach 761 million by 2025, more than
double what it was in 1990. Assuming current trends continue, this
century will see the first time in human history that the old
outnumber the young.

Meeting the needs of those with the chronic diseases of aging—

heart disease, Alzheimer's, and so forth—is a labor-intensive chore
we increasingly cannot afford. Health care consumes 15 percent of
the U.S. gross national product, up from 5 percent in 1960. In
Japan and Europe, which manage care more frugally, the share
has in most cases already passed the 10 percent mark. And the
numbers continue to rise. We will have to find clever ways to
economize on labor, the most expensive element in health care

Improving Care, Reducing Cost

World countries has the potential to improve the quality of care for
its aging population while saving billions of dollars annually in
healthcare costs, through home-based technologies that focus on
prevention and early detection of health problems; improved
compliance with care plans; monitoring of older adults in their
homes, and emergency response in the event of a fall or other
health crisis. Together, these technologies could enable seniors to
age in place in their home environment¹, maintain their
independence, and defer more costly care in emergency rooms
and institutional settings for as long as possible. Intel is investing in
the digital home, proactive computing and other enabling
technologies to help translate this vision into reality.

Manufacturers of pacemakers are already beaming out data from

the devices in the hope of picking up early trouble signs, so as to
keep people out of the hospital. Meanwhile, electronics giants are
working to pepper the home with a network of wirelessly linked
sensors slapped on nearly everything from coffee cups to
bathroom doors. They are learning to probe the network remotely
to monitor patients with dementia and other ills of aging and use
the information to help the patients' families care for them. The
next generation of older people may live in a world where every
beat of their hearts and every ordinary thing they do is watched,
analyzed, and evaluated for signs of trouble. Orwellian as it may
seem, such care may actually be less intrusive than the
alternative: the loss of independence that follows when people
must leave their own homes for nursing homes.

Improving Life and Industry with Wireless Sensors

The key is wireless sensor networks, an intriguing new technology

model in which behavioral and biological data is collected and
analyzed for customized proactive computing applications. As the
name implies, proactive computing aims to anticipate people's
needs and take action to meet those needs on their behalf,
relieving people of tedious data entry.

Intel has taken the initiative to invest in research and development

of sensor networks, recognizing this technology as crucial to
addressing the pending global age wave and public health crisis.
Experts predict that the worldwide elderly population will grow
dramatically as the post-World War II baby boom generation
reaches retirement age. In the United States alone, the cost of
caring for older adults is expected to escalate sharply in 2010,
when 76 million baby boomers begin to reach age 65¹. Cognitive
and physical decline are also concerns. The Alzheimer's
Association, for example, reports that more than 4 million
Americans have the disease - a number that's projected to triple to
14 million by 2050 as the elderly population continues to increase.

Sensor networks hold promise for meeting these challenges

because they have the potential to revolutionize healthcare, but
Intel also sees the technology as having broad application in
virtually all aspects of life and industry. Intel envisions a proactive
computing world in which a multitude of unseen, connected
computing nodes automatically acquire and act on real-time data
about a physical environment, helping to improve lives, promoting
a better understanding of the world and enabling people to
become more productive.

Prevention of disease comes from unglamorous things like

encouraging people to eat properly and to exercise, changes in
habit that are famously hard to effect. The single best aid to such
behavior modification is a support group, and there is some
evidence that such groups can be bound more tightly together with
technology.

Using wireless sensors to track the routine activities of daily life—

how people dress, what they cook in the morning, how well they
drive their cars—might make for a mundane set of data. But such
data can greatly help in the diagnosis of neurological disorders
such as Parkinson's or Alzheimer's disease. Parkinson's can so far
be diagnosed only through behavioral changes, principally
changes in gait. Wireless networks can also bring a measure of
independence to the lives of people suffering from cognitive
decline

Proactive Computing Applications for the Aging

Many companies are exploring a variety of proactive computing

applications that could assist the aging in the digital home
environment. As the name suggests, proactive computing is
designed to anticipate people’s needs and take action to meet the
needs on their behalf. The input for proactive computing
applications is real-world data gathered by wireless sensors. Intel
Research Berkeley is developing tiny sensors or "motes" which
can be used to gather both behavioral and biological data for
customized proactive health applications.

Researchers at Intel Research Seattle and the University of

Washington have built a prototype that can infer a person's
activities of daily living (ADLs). By placing sensor tags on everyday
objects such as a toothbrush or coffee cup and using tag readers
to track the movement of tags, we can determine, for example,
whether a person has brushed his teeth or taken medication. The
long-range goal is to develop computerized assistants to help
seniors and their caregivers manage ADLs so that seniors'
independence is compromised as little as possible.

Through the Intel Research Council, which funds university

research worldwide, Intel is supporting dozens of researchers who
are testing new home health and aging-in-place technologies. For
example, one prototype system analyzes sensor data from
drawers, medicine cabinets, pill bottles - wherever medications are
stored - and delivers timely reminders via cell phone, TV, or
whatever device is preferred or nearby. Two other projects:
wearable wireless sensor networks that could alert caregivers to a
senior's fall, and sensors in footwear which could monitor a
person's gait for irregularity and prevent a crippling fall (and a
costly hospital stay or premature move to a care facility). Such
proactive intelligent systems could reduce healthcare costs by
billions of dollars annually.

Using wireless sensors to track the routine activities of daily life—

how people dress, what they cook in the morning, how well they
drive their cars—might make for a mundane set of data. But such
data can greatly help in the diagnosis of neurological disorders
such as Parkinson's or Alzheimer's disease. Parkinson's can so far
be diagnosed only through behavioral changes, principally
changes in gait. Yet to get a really early diagnosis would require
noticing quite subtle distinctions

Sensor networks are powerful new tools that can assist with care
giving across the continuum of care. They could be used to
monitor the safety of an older adult in the home, allowing a family
caregiver to take a nap or a break and ultimately, prevent burnout.
The digital home network could be accessed through the Internet,
enabling adult children to check in remotely to assess the well-
being of an aging parent far away. Wireless sensors and mobile
computing devices in skilled nursing facilities could automatically
capture diagnostic and behavioral data, thus freeing an over-
burdened nursing staff to spend more quality time with residents,
reducing data entry errors, and providing real-time feedback to
facility managers about the health of their residents, staff, and their
overall facility.

Variety of technologies in the digital home will enable older adults

to age in place, improving the quality of their lives and reducing
healthcare costs by deferring expensive institutional care. Existing
telemedicine technologies can access data from the digital home
network, enabling virtual exams in the home. Proactive computing
technologies under research at Intel and elsewhere will reduce
costs further by enabling the aging to be proactive about caring for
themselves. A network of sensors throughout the digital home will
track and monitor health status and activities of older adults,
providing input for proactive applications that will offer a variety of
assistance, from reminders to take medications to help in
completing cooking tasks and accessing social support. Seniors
will access the network using a variety of familiar interfaces, such
as telephones and televisions; they will not need to learn new
technology to receive assistance. Such proactive systems will also
enable adult children to assess the health and well-being of their
aging parents remotely through private, secure Internet
connections and will provide on-site caregivers with the social
support they need to avoid burnout—a common problem among
caregivers of older adults.
Inside Sensor Network Technology

Wireless sensor networks represent an entirely new way of looking

at computing. In a sensor network, dozens, hundreds or even
thousands of tiny, battery-powered computers, often called
"motes," are scattered throughout a physical environment. Silently
and wirelessly, each mote in this ad hoc network collects data, for
instance, monitoring light, temperature, humidity, vibration or other
environmental factors. The mote relays the collected data to its
neighboring motes and then to a specified destination where it is
processed. This sensory input, when gathered from all the motes
and analyzed by more traditional computers, paints a
comprehensive, high-resolution picture of the surroundings in real
time.

What's in a mote? Essentially, the ability to sense, compute and

communicate. Despite their complex functionality, motes have just
three key hardware components: microprocessors, tiny
microelectromechanical systems (MEMS) and low-power radios
(also called transceivers). The microprocessors process the data,
the MEMS sensors provide a broad array of sensory inputs, and
the radios enable the motes to wirelessly transmit their sensor
readings throughout the network.

The next-generation Intel Mote hardware is a modular, stackable design that includes the
following components in a package that is about half the size of the original Berkeley mote.
Intel Research is using the Zeevo* module on the main board (containing an ARM1 core,
SRAM and Flash memory, and Bluetooth* wireless technology), an optional power supply
regulator, and sensor boards. The mote platform can accommodate other features as well,
such as alternate radio, debug and actuator boards. A backbone interconnect provides power
and bidirectional signaling capability.
Intel Mote software is based on Tiny OS, a component-based operating system designed for
deeply embedded systems that require concurrency-intensive operations and which have
minimal hardware resources. The software stack includes an Intel Mote-specific layer with
Bluetooth* support and platform device drivers, as well as a network layer for topology
establishment and single / multi-hop routing. The software will also incorporates security
features, including authentication and encryption in the near future.

New software enables the raw data collected by the sensors to be

analyzed in various ways before it leaves the network, ensuring a
proactive stream of information that can be acted upon in real time.
Standard consumer AA or coin-style batteries keep motes "alive"
for six months to a year, and researchers are exploring other
sources of power to further shrink size and extend longevity.

Although the size, type and configuration of motes in a sensor

network depend largely on the application, common design
constraints include power conservation, compact form factor and
limited memory and storage capacity. Moreover, motes must be
reasonably economical to be suitable for practical applications.
Fortunately, microprocessors, sensors and RF transceivers can be
inexpensively produced in large quantities using conventional
semiconductor manufacturing techniques

The combination of small size, low cost and wireless networking

functionality makes sensor network technology exceptionally
scalable. As price points become more attractive, scientists will be
able to deploy many sensors simultaneously, with better proximity
to the physical phenomena being monitored and more detailed
tracking than has heretofore been possible, leading to ubiquitous
computing.
 The Body Itself now plays host to some sensors. By the end of this month, Medtronic Inc., in
Minneapolis, expects to gain approval to market in the United States a device designed to
alleviate the symptoms of heart failure and warn, through a short-range wireless link to the
Internet, of a patient's declining condition. About 22 million people worldwide suffer from heart
failure, a condition in which the heart beats so weakly or inefficiently that fluid begins to pool
in the lungs. This is the most rapidly growing cardiovascular condition in the world, and about
half of all patients die within five years. Heart failure is the single greatest cause of
hospitalization in the United States, costing some $10 billion a year in direct expenses.

You have to get even closer, with body-borne sensors. Since August 2002, doctors in parts of
the United States have been taking advantage of a system built by Cardio Net Inc., in San
Diego, to discover the presence and nature of their patients' heart problems. Some serious
heart problems affecting older people are transient and infrequent and can go unnoticed even
by the patient. A sudden slowing of the heart rate that leads to a fainting spell, for example,
may last less than a minute and occur only once or twice a week. That's often enough to
make driving a car dangerous but not frequent enough for a doctor to spot during a checkup
or even by using a portable 24-hour electrocardiogram (ECG) recorder, called a Holter
monitor. Another problem, the uncoordinated quivering of the small upper chambers of the
heart, a leading cause of stroke in people over 70, can be both infrequent and without obvious
symptoms. So patient-triggered ECG recorders could miss it.

Called mobile cardiac outpatient telemetry, Cardio Net’s system consists of a small three-lead
ECG monitor, worn either as a pendant around the neck or on a belt clip, and a PDA-like
device [see Illustration, A Networked Heart]. The ECG monitor sends its data via a 900-
megahertz wireless link to the PDA, which evaluates and stores the waveform. If software in
the PDA notices a potentially harmful change, say, a sudden slowing of the heartbeat, it
automatically transmits the relevant data over a cellular network to a monitoring center, which
is staffed around the clock. Computers there, after making a preliminary judgment of the
severity of the problem, determine where to put the event in a queue for the center's clinical
staff to review. If the staff decides the event is routine, the data is just included in a daily
report to the patient's physician. If the event is judged serious, the center alerts the physician
and calls the patient with instructions to proceed to a hospital.

Patients typically wear the device for no more than 10 to 14 days, after which the physician
has enough data to figure out what the real problem is,

The new heart failure device will be compatible with a two-year-old system Medtronic set up
in the United States, called the CareLink Network, that lets doctors keep tabs on patients by
taking data from pacemakers and other devices implanted in their chests [again, see A
Networked Heart]. The patient puts an antenna over his chest to pick up data on fluid buildup,
electrocardiogram and other physiological data, and data on the functioning of the
pacemaker; the antenna then transmits the information over a phone line to a secure Internet
site, accessible only to the patient's doctor. In early studies the device was able to detect the
signs of a dangerous fluid buildup 10 or 11 days before the patient noticed any symptoms.
The hope is that such warning will allow doctors to treat the patient before things get serious,
avoiding hospitalization by, say, adjusting medications.

Heart failure is just the most recent use for pacemakers. The lower chambers of some hearts
are subject to sudden life-threatening storms of quivering, called ventricular fibrillation that set
the different chambers contracting in an uncoordinated fashion. Implanted cardioverter-
defibrillators, or ICDs, use software algorithms to look for signs of trouble in the heartbeat and
deliver an electric jolt to set things right again. A wireless connection to a cardiologist can help
here, too.

About 22 million people worldwide suffer from heart failure

ICDs made by Biotronik GmbH and Co., in Berlin, use an approach to wireless
monitoring that is a bit more hands-off than Medtronic's CareLink [again, see A Networked
Heart]. Without requiring the patient to place an antenna over her chest, the ICD automatically
transmits its data to a special external cellphone, using a 402- to 405-MHz frequency, which
passes through skin and tissue with minimal attenuation. The cellphone then e-mails the data
directly to a monitoring center and from there to the doctor.
 Conclusion

Preparing Today to Meet the Challenge of Tomorrow

Digital home technologies can play a key role in helping to meet

the challenge of caring for an aging population. The digital home
electronics that will be part of people’s everyday lives for other
purposes, such as entertainment and communication, can also be
used to deliver health and wellness applications, allowing older
adults to age in place and reducing U.S. healthcare costs, which
have soared to more than $1.5 trillion annually.

Companies are contributing to the development of the digital home

technologies for aging in place, through R&D investments, funding
of university research, participation in organizations and consortia,
and by catalyzing industry, university and government players to
join in a collective effort to meet the challenge. The involvement of
the federal government - through funding research and breaking
down obstacles to innovation - will be essential to success. By
being proactive today, we can avert a public health crisis tomorrow.

Remote Health Care Monitoring may seem like the best answer to
managing the care of the next generation of older people, but
those in the health care field need some convincing. Medical
practice is conservative and rightly requires evidence that a new
approach to health care will work. And those who pay for health
care—insurers and governments—want to know if it will really save
money, and how much.

Ultimately, we can see sensors built into roads, farms, hospitals,

factories, office buildings, clothing, swimming pools, baby cribs,
vehicles and even bandages - a computing infrastructure that
consumers around the globe can tap into and take for granted.

But research is still in its infancy, and pursuing this goal will require
long-term collaboration among industry leaders, academia and
government. By underwriting sensor network R&D, these entities
will fuel viable and scalable solutions to the cresting age wave and
multiple other challenges faced by numerous industries and
market segments.