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## About this book

This book explores how human factors and ergonomic principles are currently transforming healthcare. It reports on the design of systems and devices to improve the quality, safety, efficiency and effectiveness of patient care, and discusses findings on improving organizational outcomes in the healthcare setting, as well as approaches to analyzing and modeling those work aspects that are unique to healthcare. Based on papers presented at the AHFE 2019 International Conference on Human Factors and Ergonomics in Healthcare and Medical Devices, held on July 24–28, 2019, in Washington, DC, USA, the book highlights the physical, cognitive and organizational aspects of human factors and ergonomic applications, and shares various perspectives, including those of clinicians, patients, health organizations, and insurance providers. Given its scope, the book offers a timely reference guide for researchers involved in the design of medical systems, and healthcare professionals managing healthcare settings, as well as healthcare counselors and international health organizations.

## Table of Contents

### Correction to: Advances in Human Factors and Ergonomics in Healthcare and Medical Devices

In the original version of the book, the following corrections have been made

Nancy J. Lightner, Jay Kalra

### Towards a Deeper Understanding of Conceptual Models that Incorporate Patient Safety

Over the past decades, researchers, clinicians, and engineers have introduced many different conceptual models that incorporate patient safety. These models share similarities in some dimensions but may differ in others. A hermeneutic and natural language processing approach was utilized to interpret relevant literature on this subject. This descriptive account provides philosophical considerations that help to frame understanding of these models. The aim is to facilitate greater understanding of safety in health care.

Timothy Arnold, Helen J. A. Fuller

### An Interactive Device for Reducing Risk of Infusion Therapy and Blood Transfusions

Administration of high-risk medications and transfusion of blood components are routinary medical procedures that can be potentially harmful to patients due to a set of multifaceted factors, such as, conservation of the medical product, poor asset tracking, and human errors. Although they represent a very small percentage of adverse events, errors and complications associated with transfusion and infusion therapy can cause major morbidity and death.In the recent years, several reporting initiatives and intervention measures led to the adoption of dedicated processes and tools designed for preventing errors, reducing the associated potential damage, and increasing patient safety. Nevertheless, statistics and reports of incidents demonstrate that infusion and transfusion therapies still demand more effective solutions. In this paper, we introduce an innovative interactive system that aims at reducing risk by taking into consideration human factors that are involved at bedside, such as, fatigue, stress, attention, and cognitive load. Specifically, the proposed solution consists in an attachment that locks a medical container in the prescription phase and prevents access to its content and administration unless all the safety conditions as met. In addition to enforcing safety with a physical barrier, it operates as a visual management tool throughout the process and, specifically, at bedside, where most incidents occur.

Nicholas Caporusso

### Medical Error Disclosure - A Canadian Perspective in Improving Quality of Health Care

Disclosure of an adverse event is an important element in managing the consequences of a medical error. The objectives of this study was to review and compare the disclosure policies implemented by individual health care authorities and hospitals in western Canada. The evaluation of the policies of individual health authorities was carried out based on the inclusion of various guidelines including avoidance of blame; support to the staff; an apology or expression of regret; avoidance of speculation; some form of patient support; and education/training to health care workers. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure with other related fields. We suggest that the disclosure policies can provide framework and guidelines for appropriate disclosure that can lead to practices that are more transparent.

Jawahar (Jay) Kalra, Maria Gabriela Campos-Baniak, Avani Saxena, Zoher Rafid-Hamed

### Pattern of Postural Sway of Diabetic Peripheral Neuropathy People

Diabetic peripheral neuropathy can cause a loss of sensation in the feet, leading to impaired stability of body balance, and resulting in a risk of falls or slips. In the literature, a considerable number of studies have reported that people with diabetic peripheral neuropathy tend to have trouble keeping posture stable when the equilibrium of body balance is disturbed, even when standing quietly. In general, many studies found differences of postural stability between people with diabetic peripheral neuropathy and without neuropathy. However, little research has been done to find a difference of sway patterns between them. The objective of this study was to characterize the pattern of body sway for finding an effect of peripheral neuropathy on postural control when the stability of posture was disturbed. Pattern of body sway was investigated in terms of placement of center of pressure over the four quadrants during several time intervals such as quiet standing before a perturbation, during the perturbation, and after the perturbation. No significant difference of patterns of body sway was found between diabetic people with and without peripheral neuropathy during quiet standing and for most of considered perturbation directions at low velocity of perturbation. However, when the velocity of perturbation increased, a significant difference of placement of center of pressure was found from the third and fourth quadrants.

Byungjoon B. J. Kim

### Quality Assessment and Management: An Overview of Concordance and Discordance Rates Between Clinical and Autopsy Diagnoses

Autopsy diagnoses have traditionally been used as the “Gold Standard” for determining the cause of death. The purpose of this study was to use autopsy to determine the rate of concordance and discordance between clinical diagnoses and post-mortem findings in patients admitted to the hospitals of the Saskatoon Health Region. A retrospective record review of the medical and autopsy charts was carried out by three independent observers for all the deceased adult in-patients admitted during 2006 to 2008. In accordance with selection criteria, 102 (59 males; 43 females) cases were assessed. The concordance rate between clinical and autopsy diagnosis was found to be 86.3%. The discordance rate was 12.7% and in 1.0% was inconclusive. We encourage residents and physicians to continue using autopsy as an important tool to extend our understanding of disease processes.

Jawahar (Jay) Kalra, Daniel Markewich, Patrick Seitzinger

### Comparative Assessment of the Risk of Manual Patient Handling Between Standard Methods and Job Analysis

Some tasks performed by healthcare workers, such as the manual patient handling, may lead to musculoskeletal disorders. Exposure to biomechanical overload includes patient handling operations, the pulling and pushing of beds/stretchers (considering the extra weight of the patient. Theese actions could be evaluate thanks to the Snook Ciriello method (ISO 11228). The Center for Ergonomics of the University of Michigan has developed a software able to evaluate the biomechanical overload, which takes into consideration postures or the manual lifting of loads for each task, i.e. the 3DSSPP (Static Strength Prediction Program). The occupational specialist can apply the Job Analysis to determine which tasks should be performed by the worker without being overloaded. Therefore guaranteeing the correct positioning of staff even those affected by musculoskeletal disorders.

Pier Luigi Pavanelli, Silvio Falco, Giovanni La Valle, Cristiano Roscio, Giulia Ricciardi

### Electronic Health Records in Hospitals: Preventing Dosing Errors in the Medication Administration Context

Medication errors are among the highest contributors to complications during a hospital stay. Dosing errors have an impact on the detrimental effects of a medication error. While clinical decision support systems have targeted prescribing errors, the system design challenges associated with dosing error prevention in the medication administration context is not well understood. This paper presents an overview of the effectiveness of current systems used in the medication delivery process. The system enhancement strategies to improve dosing error detection and prevention in the medication administration context should consider the medication safety loopholes in the electronic health record (EHR).

Sevgin Hunt, Joyram Chakraborty

### Satisfying Product Features of a Dementia Care Support Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults

Dementia is a large economic, social and health concern with the aging population. One of the best ways to care for people living with dementia is to keep them at home in a familiar environment. Smartphone applications may provide assistance to patients and caregivers. An open web-based survey was answered by 104 individuals older than 50 years. Participants rated eight features of a potential dementia care support app according to the Kano technique. Out of the eight product features investigated, six were positively associated with an application (wandering detection, weather and other threat detection, notifications and voice prompts, location sharing, emergency services contact, and medical records). The median for the amount people were willing to pay per month was 25$(CanD) with a third quartile of 50$ (CanD). The results show which features should be included in an application to have maximum acceptance and usability and how much potential users are willing to pay on a monthly basis a dementia care support smartphone app.

Robert Chauvet, Peter Rasche, Zavier Berti, Matthias Wille, Laura Barton, Katharina Schäfer, Christina Bröhl, Sabine Theis, Christopher Brandl, Verena Nitsch, Alexander Mertens

### Designing Hospital Wayfinding Systems, Touchscreen Kiosks, Environmental Cues and Mobile Apps: An Evaluation of a Mobile Wayfinding Application

This paper is part of a larger body of work researching wayfinding systems in large, complex, hospital environments. The focus of this second phase of research was to discover usability issues that impact the effectiveness of a mobile wayfinding application used by a large multi-building hospital complex, as well as provide informed recommendations to enhance users’ navigation performance. Four researchers conducted a heuristic analysis composed of twenty dimensions across six categories including language, effectiveness of wayfinding instructions, consistency between the environment and application, interface interaction, accessibility and cognitive workload. Primary recommendations consisted of adding a universal search option, orienting navigation cues to user view, and providing assistance to find a help desk. Results from this paper will provide a guideline for the development of mobile wayfinding applications for large hospitals and similar settings.

Christy Harper, Tyler Duke, Andrea Crosser, Angie Avera, Spencer Jefferies

### Determining Patient’s Interest in Patient Portal Use in a Primary Care Clinic to Improve Portal Adoption

Patients accessing their personal health information has the potential to improve their healthcare decision-making. Despite the potential benefits of patient portals and government reform, adoption has been poor. The objective of this project is to determine patients’ awareness of their patient portal and their interest in portal functionalities to assist with increasing patient portal adoption. Forty-two patients completed a 9-item survey at a primary care clinic. Descriptive statistics were used to summarize the data. 83% of patients were interested in having access to their health information. 55% were aware of the patient portal and only 35% were signed up. The main reason for not signing up was unawareness of service (35%). Majority of participants (77%) were most interested in viewing personal health information and 50% were interested in secure messaging. These results provide valuable information about patient’s interest in accessing the patient portal and provides information on functionalities of interest.

Martina A. Clarke, Kelly C. Karls

### The Challenge of Designing New Work Systems Towards Effective e-Health Interventions

The design of novel mobile applications for healthcare improves the access, convenience, education, care-quality/effectiveness. To increase the cost-value of integrated healthcare system, new health-related work design should be developed. As the patients are more informed and take an active control decision about their healthcare options, they force the healthcare systems to redesign and change inevitably. The patient empowerment lies to the access of different clinical outcomes information: diseases reliable information, available treatments and management of therapeutically outcomes. This needs to be aligned with caregivers, providers and financiers. Our overall objective is to understand how Portuguese population will respond to eHealth technology design and development for information exchange within healthcare systems and how the healthcare systems cope with new work systems design. Four core interactive work design features were identified that may mediate the effects of intervention in the healthcare outcomes: Social context and support, Contacts with intervention, Tailoring, and Self-management.

Isabel Duarte de Almeida, Maria João Lima Delgado

### Research on the Construction Method of the Hospital Information System Hourglass Model

The informatization construction of modern health care has gradually shifted from “hospital informatization” around 1993 to “health care intelligentization”. The studies on Hospital Information System (HIS) are carried out from multiple perspectives: research review, theoretical proposal and case application. Based on user experience elements and Actor-Network Theory, the construction method of HIS “hourglass model” is proposed. The hourglass model consists of three parts: the upper structure composed of the hospital ethnographic research and the definition of medical staff’s requirements, the connected pipeline structure composed of HIS architecture design, and the lower structure composed of HIS interaction and visual design and HIS design evaluation. By expounding the complete development process of the nurse station service system, the reproducibility of the hourglass model construction method is proven, and the three structures of the hourglass model are refined, providing reference solutions for the subsequent development and research of agile projects.

Shifeng Zhao, Jie Shen, Zhenhuan Weng

### An Empirical Study of Information Visualization for Decision Support in an Emergency Department Information System

Emergency departments collect large amounts of data to make decisions regarding patient care. Implementation of decision support tools with information visualization (IV) techniques in Emergency Department Information System (EDIS) is difficult to achieve and thus an evaluation of the techniques is needed. The purpose of this study is to conduct a usability study of various IV techniques in EDIS and provide recommendations for developers. Fifty-nine participants were recruited in this study. Results indicate the density chart, tree map, and network diagram have lower times, higher usability scores, and lower mental workload ratings than the 3D scatter plot, scatter plot matrix, and parallel coordinates. Findings of this study can provide insights for the development of information visualization tools to support decision making in an emergency department information system.

Quaneisha Jekins-Penha, Steven Jiang

### Are Teachers More Affected by Burnout than Physicians, Nurses and Other Professionals? A Systematic Review of the Literature

This article answers a main research question: Are teachers more affected by burnout than physicians, nurses and other various professionals? In order to answer this research question, a systematic literature review was conducted. All the articles included in the analysis used the Maslach Burnout Inventory (94 studies, 121 samples). Results show that occupations are impacted differently by burnout in the three sub-dimensions (emotional exhaustion, depersonalization and lack of accomplishment).

Myriam Squillaci Lanners

### Evaluation of the Impact of the Ergonomics of Technical Systems on the State of Health of a Human Operator with Regard to His Functional Reserve

The paper studies the impact of the ergonomics of technical systems on the emergence and development of occupational diseases of a human operator, taking into account the functional reserve of his body. In view of the complexity of the analytical description of the interaction mechanisms of the human-technical system, a methodology for the synthesis of hybrid fuzzy decision rules, focused on solving poorly formalized problems, was chosen as the mathematical apparatus of research.

Riad Taha Al-Kasasbeh, Nikolay Korenevskiy, Aikeyeva Altyn, Maksim Ilyash

### Low Back Pain and Work Ability Among Thai Nurses

The work ability (WA) of nurses is of concern in several countries, including Thailand. Low back pain (LBP) is a major occupational health problem among hospital nurses and it impacts the nurses’ work ability. Limited research concerning the relationship between LBP and WA in hospital nurses has been conducted in Thailand. The aims of the present study were to study the levels of intensity of LBP during the previous seven days and the previous 12 months and the WA level of nurses in order to examine the relationship between individual factors, work factors, and the intensity of LBP and WA, and to determine whether individual factors, work factors, or the intensity of LBP could predict the WA of 312 nurses working in the general hospital under study. A self-reported questionnaire that was confirmed for its quality and that was composed of individual factors, work factors, LBP complaints, and the work ability index (WAI), was used for collecting the data, which were analyzed using descriptive statistics, correlation, and multiple regression. The results showed that the nurses had intensity of LBP during the previous seven days and the previous 12 months at a moderate level. More than half of the nurses had WA at a moderate level. Back muscle exercise was seen to be positively related to WA (r = 0.157, p < .05). The intensity of LBP during the previous seven days and the previous 12 months was inversely related to WA (r = −0.211, p < .05 and r = −0.239, p < .01). Further, the intensity of LBP during the previous 12 months and the back muscle exercise were seen to be important predictors of the WA among the nurses (p < .05). Hospital administrators can use the findings of this study to promote WA among nurses.

Chuliporn Sopajareeya

### Understanding the Challenges to the Safe Delivery of Care in the Mexican Healthcare System

Safety and quality challenges have been identified by national and global organizations highlighting the need for health sector improvements in Mexico. The current research investigates healthcare workers’ perspectives of factors affecting their job performance and wellbeing, ability to provide effective care and overall patient safety culture within a public hospital in Guadalajara. A total of 30 hospital staff took part in a card sorting task to elicit the perceived impact of eight pre-identified organizational factors. Results showed that healthcare workers identified the top contributory factors as ‘Finance/budget’ and ‘Resources’. ‘Staff numbers and competency’ was chosen for having more significant impact in delivering safe and effective healthcare, while ‘Communication’ was perceived to have more impact on the way their do their job. The findings from this study helped to identify areas for future applied research projects and provisional direction to the Hospital Quality Managers for targeted improvements projects.

Carlos D. de-Leon Zuloaga, Carlos Aceves-Gonzalez, Elvira Perez Vallejos, Rosa Rosales-Cinco, Alexandra Lang, Sue Hignett

### Development of a Sleep Monitoring System by Using a Depth Sensor: A Pilot Study

Sleep is an essential part of health and longevity persons. As people grow older, the quality of their sleep becomes vital. Poor sleep quality can make negative physiological, psychological, and social impacts on the elderly population, causing a range of health problems including coronary heart disease, depression, anxiety, and loneliness. Early detection, proper diagnosis, and treatments for sleep disorders can be achieved by identifying sleep patterns through long-term sleep monitoring. Although many studies developed sleep monitoring systems by using non-invasive measures such as body temperature, pressure, or body movement signal, research is still limited to detect sleep position changes by using a depth camera. The present study is intended (1) to identify concerns on the existing sleep monitoring system based on the literature review and (2) propose to developing a non-invasive sleep monitoring system using an infrared depth camera. For the literature review, various journal/conference papers have been reviewed to understand the characteristics, tools, and algorithms of the existing sleep monitoring systems. For the system development and validation, we collected data for the sleep positions from two subjects (35 years old man and 84 years old women) during the four-hour sleep. Kinect II depth sensor was used for data collection. We found that the averaged depth data is useful measure to notify the participants’ positional changes during the sleep.

Jangwoon Park, Jungyoon Kim, Jaehyun Park, Alaa Sheta, Christina Murphey, Dugan Um

### Quantitative Evaluation of Pulse Diagnosis Using Capillary Blood Flow of Images

In this research the purpose is to evaluate pulse diagnosis in “medical medicine” from a scientific point of view. Also it is scientifically assessing the relevance of the pointed out diet contents and pulse diagnosis. By evaluating and examining above, evaluating the usefulness of pulse diagnosis to health.

Yumie Osada, Fuminori Matsuura, Yoshinori Hirano, Xiaodan Lu, Tomoko Ota, Hiroyuki Hamada, Noriyuki Kida

### Finding Health Care Usability and Safety Issues in Consumer Product Reviews

Multiple techniques exist for eliciting usability and safety information related to product design. These methods work well for some types of use scenarios but have limitations. This work proposes a supplemental method of obtaining information relevant to usability and safety by systematically evaluating consumer reviews of medical devices using Natural Language Processing (NLP) techniques. Results include valuable information about categories of use, user priorities, and sources of user confusion. This project described a new method for gathering information from end users of medical devices. The information extracted may be useful to clinicians, manufacturers, and patient educators.

Helen J. A. Fuller, Timothy Arnold

### Preventing Chemotherapy-Induced Onycholysis with the Use of an Active Local Cooling Device

Chemotherapy-induced onycholysis is a severe form of nail toxicity, characterized by partial or complete detachment of the nail from the nail bed. This medical condition is caused by the presence of taxanes in the patient’s blood while undergoing chemotherapy and is observed in 0 to 44% of cancer patients. The taxanes limit rapid cell reproduction, treating cancer, but also bring deterioration to the nail and nail bed structure. Cryotherapy is currently used in the form of passive cooling for the prevention of onycholysis. Ice gloves are cryotherapeutic applications that are used during chemotherapy to prevent nail toxicity. Although they are significantly effective, they cause extreme cold and pain. In this research, the effectiveness of a five-finger active cooling device was examined to control the blood flow at the distal phalanges at one hand, while increasing the patient’s comfort.

Muriel De Boeck, Jochen Vleugels, Marc Peeters, Guido De Bruyne

### Multi-frameworks Development for the Medical Device Design Process as a Critical Factor for Innovation

The process of innovation in the design of medical devices is complex. The analysis of the user, the disease stage of the patient and the fact that all clinical histories are different generates a series of variables that are a challenge for any Medical Device designer. The traditional industrial design uses frameworks to control information and visualize future scenarios to understand the user experience; this allows the designer to anticipate behaviour and design the object according to the needs of the users. Industrial design framework and medical device design framework differ significantly since the design of medical devices requires the analysis of multi-frameworks for a single object. This generates a very complex brief for any designer. This theoretical work argues that prior knowledge of the multi-framework in the design process of medical devices might help the designer to visualize the spectrum of the problem and focuses its efforts on reducing frames.

Fabiola Cortes-Chavez, Alberto Rossa-Sierra, Elvia Luz Gonzalez-Muñoz, Carlos Aceves-Gonzalez, Paulina Manzano-Hernandez, Maria Giovanna-Trotta

### Research on Sleeping Posture Recognition Method Based on Pressure Sensor

Using the structure of the butterfly pillow is the most simplest identification method, combined with the pressure sensor. The resistance value of the pressure sensor is obtained by analog-to-digital converter (A/D). The change of resistance of pressure sensors under different sleeping postures is analyzed, then pattern matching system is used to realize pattern matching and sleep position recognition. The recognition rate of sleeping position in the NISS is 95.6%, and the recognition rate in ISS mode is 92.5%. The recognition method proposed in this paper does not interfere with the user’s normal sleep experience. Combining the existing technology and methods to optimize the recognition of sleeping posture, the recognition rate of sleeping posture is still very high,which can help people with poor sleep to greatly optimize the sleep quality.

Huabing Wang, Changyuan Wan

### A Guide to Drive Medical Devices Development Through Human Factors Inclusion: Building a Value Proposition for Local Projects

A fundamental factor in flourishing societies is being able to provide healthcare access for every person [1]. However, the material resources such as medical equipment and infrastructure available in the public sector of developing countries impose limits to the healthcare services, directly impacting the quality of medical care provided to the population [2]. Therefore, it is crucial to provide tools that promote the development of medical equipment in a local way focused on responding to specific contextual needs. Following the hypothesis that the consideration of user requirements accompanied by socio-cultural context factors can positively impact the effectiveness of medical devices in a specific context, a methodological model based on design thinking tools is proposed to drive human factors inclusion from the conceptual stages of medical devices as the central axis of an innovation process.

Ilse I. Reyes, Gloria A. Mendoza Franco, Ángel L. Rodríguez Morales

### Invasive Medical Device for Cardiovascular Surgery

The identification of the biological requirements of the most complicated mechanism as the human body, correlated with the possibilities of the current technique, has enabled the successful achievement of an advanced material destined to be used as invasive medical device in cardiovascular surgery. In order to accomplish this type of medical device there is an increasing need for synthetic yarns characterized through: adequate ration resistance/weight, elasticity, flexibility, biocompatibility, chemical inertia etc. To design the fabrics destined for the vascular prostheses, there have been taken into account the minimal requirements for the bio functional characteristics, imposed by clinical usage field, from which there resulted the following: the product geometry imposes the use of the tubular or branched structure; impermeability imposes main parameters of fabric designing (achievement of a structure for which there are used untwisted yarns, the densities of the two systems and the product mass, etc.The level of biomedical and bio functional performances demonstrate that the advanced product developed is suitable to be used in surgical intervention for replacement portion of vascular system with different geometry, in case of thrombosis, occlusion, aneurysm.

Alexandra Ene, Carmen Mihai

### Alterations in Thyroid Function Testing with Aging

In the present study, we investigated if there are any diurnal variations in serum thyroid stimulating hormone (TSH) levels in normal subjects and any alterations in serum TSH, free thyroxine (fT4), and free triiodothyronine (fT3) levels with aging. Our results showed the presence of a circadian rhythm in serum TSH levels in normal subjects (n = 11; 5 males, 6 females; age range 19–46) with no significant changes in fT3 and fT4, indicating that the regulation of TSH is central rather than peripheral. In addition, we examined samples from 1,571 euthyroid outpatients (513 males, 1,058 females; age range 10–90) over a 6-month period. Serum TSH levels in age groups 50–59, 60–69, 70–79, and 80–89 were found to be progressively higher than those in the age group 10–19 with no significant differences between male and female populations. These findings suggest the presence of an alteration in TSH secretion with aging.

Jawahar (Jay) Kalra, Zoher Rafid-Hamed, Patrick Seitzinger

### The Design Adaptation of the Virtual Assistant Anne for Moderate Dementia Patients and Their Formal Caregivers in Protected Environment Tests

Dementia has become a major health problem with an equally important economic impact on our society and enabling patients with dementia and their caregivers to improve their quality of life and dignity is a great challenge. A significant solution to meet the challenge, could be the use of Personal Virtual Assistant (PVA). The aim of this paper is to share the know-how reached in the design and adaptation of the Personal Virtual Assistant “Anne” for moderate dementia patients and their formal caregivers. The paper presents the results of the first iteration of protected environment tests in Italy and Luxembourg.

Vera Stara, Michiel de Jong, Elisa Felici, Daniel Bolliger, Edith Birrer, Viviane von Döllen, Lorena Rossi, Marcel Heerink

### Design and Implementation of Bed-Exit Alarm System for Preventing Elderly Falling

In recent years, with the aging of the population, the increase in the elderly population has brought a greater burden on medical institutions. Therefore, how to reduce the incidence of hospitalization through medical technology will become an important issue for hospitals. In many hospitalization accidents, the greatest threat to the elderly due to falls. Besides immediate dangers, the sequelae will also increase the burden on caregivers and health care. In order to reduce the second-degree injury caused by falls, hospitals or nursing homes often use the bed-exit alarm system to actively inform the nurse or caregiver to help when the patient gets out of bed. However, the false alarm of related products on the market are too frequent, which not only causes the caregivers to be exhausted, but also delay critical rescue opportunities.Based on the above issues, this study will propose two new types of bed-exit alarm systems, one of which is based on the nurse’s clinical care experience, setting up multiple sensing such as infrared, ultrasonic and triaxial accelerometers on the route that patients pass by most often. Another set of bed-exit alarm system uses the infrared array sensor mounted on the headboard of the bed to capture the patient’s thermal imaging, and then uses the support vector machine to analyze the position of the patient on the bed to determine whether the behavior is about to leave the bed. Unlike traditional image processing, this method eliminates the need for edge detection and motion tracking and is immune to ambient light sources.

Ching-Ta Wu, Chien-Hsu Chen

### A Grip Force Training and Testing Device for Old People

Grip force is an important physiological index to reflect people’s healthy status. In this article, we tried to design a grip strength training and testing device for elderly. Through competitive analysis, we found that products in market are not able to record data, show grip force trend, draw users’ attention nor socialize with others. We established old people’s persona and investigated their needs, determined product orientation and main functions. Besides, by portraying their daily activity scenes, we found out several service design touchpoint and discussed solutions according to the touchpoint. The devices were eventually used in three communities and get over 100 people’s data. We have obtained improvement advice to the equipment, and communities has also increased the fitness activities of residents and the monitoring of the health of the elderly.

Ze Bian, Shijian Luo, Yufei Zhang, Ping Shan, Hebo Gong

### Optimized Design of Accompanying Smart Car for the Elderly Based on Humanization Design Methods

The aim of this paper is to design accompanying smart car for elderly people, it is not just a tool to assist them more appropriate to travel but also reducing their psychological burden. This paper uses the method of user-friendly theory and human factor engineering theory. Through observation, interviews and literature analysis, this paper analysis the travel needs and characteristics of studied group deeply. Through market research, the advantages and disadvantages of related product is obtained. As result, considering the design orientation mainly from four aspects of shape, structure, color and ergonomics. In conclusion, this paper introduces the design of companion intelligent vehicle of short distance, and discusses the connotation of elderly-friendliness in product design and its relationship.

Mengyi Cao, Xingyi Zhong, Ting Han

### Design and Strategy of Senior Tourism Under the Background of Population Aging

The world is facing a serious problem of population aging. The research of senior tourism not only can effectively alleviate the urban population expansion, but also can promote the development of the economy in small and medium-sized cities. The main problem of current senior tourism is that single function cannot meet the cultural, medical, life and production needs of old people. A new strategy of senior tourism is proposed with actual design case. The new strategy of senior tourism would put tourism, culture, entertainment, medical, and other functions together. It will extend the elderly industrial chain and integrate different resources.

Hongjun Qiu, Linong Dai

### Design of Waist Wear Products for Warm-Up Training for the Elderly

With the increase of the elderly population, the health status of the elderly is widely concerned. This paper takes the safety of the elderly during the exercise as the main research content. Through field interviews, the demand during exercise and living conditions of the elderly were investigated, and the effect of point massage on prevention and treatment of exercise fatigue was studied by studying a large amount of literature. Finally considering the physiological characteristics of the elderly, the sports needs and the potential safety hazards during the exercise process, the corresponding product design and interface design are proposed.

Qian Ji, Xin Ye, Yiming Zhao

### Measuring Ways Research on Public Facilities of the Elderly’s Physical Flexibility

This research took the old people aged over 60 in southern China as the example, first discussed the physical conditions of the elderly and the problem raising in fitness test, Then make an overview according to the research status and the classification and the problems of the measurement ways for elders’ physical flexibility. The physical conditions of the elderly were learned by tracking their living behaviors. By analyzing the corresponding conditions of outdoor living behaviors and body conditions, the needs of the elderly for measurement of physical flexibility were extracted, which were qualitatively analyzed by combining with Kano model. Finally, the design direction of the public facilities of physical flexibility of the elderly is obtained.

Xing-Rong Wen, Ding-Bang Luh

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