Gianluigi Riva assesses frailty in older people
Gianlugi M. Riva, fellow of the Baffi Centre, is also the principal investigator of the research project entitled “EMA_FRAILTY - Ecological monitoring for the assessment of frailty in older people”. Mariateresa Maggiolino and Maria Lillà Montagnani collaborate with him in the project. We have asked dr Riva some questions about it.
When have you started this research project?
We started to discuss the idea in 2024 in the context of international collaborations born during the COST Action GoodBrother, which addressed the thematic area of privacy in Ambient Assisted Living (AAL) technologies, such as, video cameras, sensors, smart mirrors, and wearables. The project puts together international scholars and professionals from different geographical areas and background to address from any perspective the emerging issues connected with Artificial Intelligence usage in AAL technologies for fragile people (elder, disabled people, individuals with mental health issues) assisted in their own smart-home. Bocconi addresses the legal and ethical part of the project, analysing the data protection issues connected with smart technologies in healthcare and private settings.
Who is funding this research project?
The project is funded by the THCS (Transforming Health and Care System) programme with national contributions from the competent ministries of the partners involved in the project. For Italy, the project has been funded by the Ministry of University and Research: "Financed by MUR - Project "EMA_FRAILTY - Ecological monitoring for the assessment of frailty in older people" THCS24_00052 - CUP J43C25000130001".
The European Partnership on transforming health and care systems (THCS) is a Cofund action under the Horizon Europe Programme designed to support coordinated national and regional research and innovation programmes along with capacity building, networking, dissemination, and other key activities to support health and care systems transformation.
THCS core activity is the fund of research and innovation projects through joint transnational calls involving a large number of Research and Innovation Funding Organisations on common priorities and topics.
The Partnership instrument is open to all EU Member States, as well as to countries associated to Horizon Europe. It is also open to non-EU countries that can participate at their own costs. THCS Consortium includes Ministries representatives, Research and Innovation Funding Organisations and Research Performing Organisations.
The Partnership also encourages engagement with other relevant Ministries not partners in this action and involves other key actors from civil society and end-users, research and innovation community, innovation owners, health and care systems owners/organisers and health and care agencies.
The Partnership’s governance structure enables an upfront strategic steering, effective management and coordination, daily implementation of activities and ensures the use and uptake of the results. The governance leaves sufficient space for involving the key stakeholders, including but not limited to R&I community, patients and citizens, health and care professionals, formal and informal care organisations, and innovation owners.
European Commission is directly involved in the governance of the Partnership and contributes by co-funding 30% of all eligible costs.
Who are the members of the research team?
Research teams from Universidad de Alicante (UA), who leads the consortium, ISABIAL (Fundación de la CV para la gestión del Instituto de Investigación Sanitaria y Biomédica de Alicante), SGH Warsaw School of Economics (SGH), Fundatia Ana Aslan International (ANA) and Bocconi University collaborate on different aspects – technical, medical, economic, social and legal-ethical - on privacy-by-design and user-centred design for smart environments. Bocconi University and SGH also cooperate on FutuRes (Horizon Europe) and CIVICA (Erasmus+), addressing ageing policies and societal transitions.
What are the research questions?
The project answers 4 research questions:
What are the most effective technological and methodological approaches to integrating real-time health monitoring systems into the daily lives of older adults? This question explores the integration of AAL systems in a non-intrusive way that respects older adults' daily routines and privacy, aiming to identify the best practices in technology deployment and data management.
How accurately can real-time data from AAL systems estimate frailty in older adults, and how can this data be used to improve their quality of life and independence? This question investigates the effectiveness of continuous monitoring data in accurately estimating frailty. It focuses on whether real-time data can provide reliable assessments that help maintain or improve older adults' quality of life and independence.
What are the legal, ethical, and privacy implications of deploying AAL technologies, and how can these elements be effectively addressed to manage systems, devices, and data processing’s compliance while ensuring user trust and service acceptance and reliability? This question addresses the concerns surrounding the use of technology in sensitive areas, such as personal health monitoring in interconnected environments, focusing on developing strategies to manage data ethically and legally.
What socioeconomic models support the sustainability of AAL systems within existing health and care frameworks? Investigate AAL systems' cost-effectiveness and potential to be sustainably integrated into health and care services, considering long-term benefits versus initial costs.
Why this topic matters for people?
The EMA_FRAILTY project is driven by the need to address critical healthcare challenges faced by the ageing population, particularly the condition known as frailty. Frailty significantly impacts the quality of life and independence of older adults, making them more vulnerable to health issues. Current healthcare systems often struggle to detect and manage frailty early, leading to a reactive approach rather than proactive care. With the ageing global population, there is an urgent need for innovative solutions that can detect and manage frailty early. Frailty affects a significant portion of older adults, yet it is often not addressed until severe health issues arise. The project aims to introduce a proactive, personalised, and preventive approach to healthcare for older adults, reducing the burden on healthcare services and enhancing their quality of life.
For society, the implementation of the EMA_FRAILTY system promises to improve the quality of life for older adults by enabling them to live independently and safely in their homes for longer periods. The early detection and management of frailty can reduce the incidence of severe health episodes, hospital admissions, and long-term care needs, ultimately leading to significant healthcare cost savings. Furthermore, the project will engage various stakeholders, including healthcare providers, caregivers, and policymakers, to ensure that the system is user-friendly, ethically sound, and scalable across different healthcare settings. In conclusion, EMA_FRAILTY aims to transform health and care practices for the ageing population by leveraging advanced technologies for early frailty detection and management. By aligning with global health objectives and fostering interdisciplinary collaboration, the project seeks to set new standards in aged care, improve health outcomes, and create sustainable, person-centred healthcare solutions.
Which methodology have you adopted?
EMA_FRAILTY employs a comprehensive, interdisciplinary, and intersectoral approach to meet its objectives and tackle research questions. It engages expertise from engineering, gerontology, healthcare, ethics, law, public policy, sociology, psychology, and economics, ensuring a well-rounded understanding and innovative solutions to the complex challenges of ageing and frailty. The project incorporates advanced sensor technologies and data analytics within AAL systems for real-time monitoring of older adults' daily activities and health, crucial for early detection of frailty indicators. Sophisticated machine learning algorithms and data fusion techniques will integrate and analyse data from sensors, wearable devices, and environmental inputs. While validating the system's effectiveness, these efforts aim to enhance future interventions and improve the quality of life for older adults. The project also includes economic and social impact analyses to evaluate the cost-effectiveness and societal benefits of the AAL system, ensuring solutions are economically viable and socially beneficial. To address legal and ethical implications, the project will integrate frameworks of applicable legal regimes, including medical device safety, data protection, and product liability. Tailored audit models based on current standards for Data Protection Impact Assessment (DPIA), Fundamental Rights Impact Assessment (FRIA), and security assessment will ensure regulatory compliance with "by default" and "by design" approaches. Stakeholder involvement is essential, with older adults, caregivers, healthcare providers, and policymakers actively participating. Older adults and caregivers influence the AAL system’s development through participatory design sessions, ensuring it meets their needs. Healthcare providers assist in pilot testing, providing feedback on clinical relevance and usability. Collaboration with policymakers helps align the project’s outputs with public health objectives and regulatory frameworks, aiding technology integration into existing health and care systems.
Stakeholders, including healthcare providers, policymakers, caregivers, and older adults, are actively involved throughout the project. Their contributions inform the design and adaptation of the technology to meet real-world needs and fit within existing healthcare ecosystems. An interdisciplinary and intersectoral team comprising experts in health informatics, gerontology, legal studies, sociology, social policy, health economics, and user experience design reflects the project's comprehensive approach.
What is the state of the project at the moment?
The first year of the project just ended, and it concluded the “startup” process to set all the technical and foundational aspects of the research objectives, among which there are two studies with frail subjects and one pilot app. The legal and ethical part has a pivotal part in the project because compliance and privacy-by-design and default must be ensured from the initial steps, including design and prototyping. This involved the creation of the Data Management policies and the Data Protection and ethical guidelines for the implementation of AAL technologies. We are now in the phase of preparing the integrated Data Protection and Fundamental Rights Impact Assessments.
Is there any conclusion that you can share regarding your research?
Healthcare systems have been impacted severely by Artificial Intelligence and AAL technologies, such as smart mirrors and smart assistant may help both patients, relatives, and caregivers to improve their daily lives. Furthermore, this revolution could change the way we understand health systems, enabling sort of “diffuse hospitalization” by unlocking the healing potential of getting cures administered directly at one’s home. This approach may even disrupt current business models around healthcare services and technologies. Indeed, Ambient Assisted Living technologies offer significant opportunities for healthcare systems by enabling continuous health monitoring, supporting independent living, and facilitating more personalized and preventive care through AI-driven smart environments. However, these benefits are accompanied by substantial legal and ethical challenges, particularly regarding patients and their relatives’ privacy and intimacy, overall data protection and autonomy in decision-making processes. AI-enabled AAL systems rely on the continuous collection and processing of highly sensitive personal and health data, raising concerns about compliance with data protection frameworks such as the GDPR, the validity of informed consent in pervasive monitoring contexts, data minimization, purpose limitation, and accountability for automated decision-making. Furthermore, the extensive use of interconnected devices increases cybersecurity risks and the potential for unauthorized access or misuse of personal information. Ensuring privacy-by-design, transparency, robust security measures, and meaningful user control over health data in this context is therefore essential to fostering trust while enabling the responsible deployment of AI-powered AAL technologies in healthcare. On the other hand, ensuring patients’ dignity and autonomy must be a further pivotal element that, beyond mere compliance with the regulatory requirements, any AAL project must regard as a cornerstone.