Research and Design of Smart Care-Giving Clothing for Disabled Elderly

Consumer evaluations of category products are a high quality source of reference data for product development planning [9]. Traditional evaluation data collection methods easily tend toward incomplete data sources and inadequate sample sizes, which in turn can lead a partial product development [10]. The development of big data and intelligent data analysis techniques has helped researchers to collect and process larger volumes of product evaluation text data more effectively. The researchers used ROST-CM6 software, version 5.8.0.603, developed by the ROST team at Wuhan University, China, to perform word frequency and sentiment analysis for the evaluation of health smart clothing category items for the elderly. The data sources selected for this study were available Chinese mainstream online public media news and the content of user discussions on major online social media platforms. The search keyword combinations were ’elderly’, ’caring’, ‘smart clothing’ and ‘smart wearable’. A time range was set before October 2021. The researcher entered the 2159 texts automatically obtained by the intelligent algorithm into the ROST-CM6 software to process and analyse. Finally, the related product evaluation's word frequency and sentiment analysis results were achieved.

Words related to product function accounted for 21% in total; words related to product use scenarios for 16% in total; words related to product technology for 12% in total; and words related to product materials and components accounted for 9% in total. The top 15 high-frequency words and their frequencies are shown in Table 1. It is clear that the function and usage scenario of smart care-giving clothing for the disabled elderly are the two most popular points of concern. The results of the sentiment analysis of the category product evaluation show that positive attitude takes up 71.51%, intermediate attitude 11.43% and negative attitude 17.06%. This shows that society and consumers are generally positive and optimistic about smart care-giving clothing for the disabled elderly; but there are still some users who present a wait and see attitude or have a negative attitude towards these products. Further analysis reveals that the negative sentiment mainly focuses on the function and structure of the product. The top 15 negative emotion high-frequency words and their frequencies are shown in Table 2.

Guided by the results of the knowledge mapping and category product evaluation analysis, the researchers conducted and recorded individual interviews with a total of 10 experts consisting of one professor, two associate professors, and seven doctoral students in the fields of design and textile science at Jiangnan University, China, for the target users and usage scenarios of smart care clothing for the disabled elderly. The average duration of the experiment was 30 minutes for each expert interviewed. Two researchers (two of the authors) were present during the interviews as experiment facilitators and recorders, respectively, and joined the discussion at the end of each session. The interview questions are shown in Table 3. After a basic collation of the audio data received from the open-ended focus interviews, the researchers conducted an in-depth coding analysis of the data on the NVivo12 software platform, distributed by QSR Australia, through a rooted theory research approach. Three user category codes and 15 usage scenario codes were filtered using a minimum word frequency threshold of five times, as shown in Table 4.

In addition to the individual interviews, the researcher organised a joint user needs focus group interview with those 10 industry experts. The interview was based on Norman's Emotional Hierarchy Theory [11], which explores three dimensions: perceived understanding (instinctive level), usage scenarios (behavioural level) and lifestyle change (reflective level). In the interview, the researchers selected five secondary elements and 14 tertiary elements to form a hierarchy of demands for smart care-giving clothing for the disabled elderly, shown in Table 5.

A Likert scale questionnaire was generated from the focus group interviews and administered to 90 randomly selected households of disabled elderly people in Wuxi, China. The participants of this questionnaire survey came from the elderly communities in the Binhu district, Xinwu district and Xishan district, Wuxi City, China. We numbered a total of 125 target families, and then used the random number table to generate 90 random numbers. The families corresponding to the generated serial number became the research group. The questionnaires were completed by their caregivers, taking into account the bias of the questionnaire due to physical or cultural cognitive problems of the disabled elderly people. A total of 84 questionnaires were successfully returned and 3 invalid questionnaires excluded, resulting in a total of 81 valid questionnaires. Based on the hierarchical structure of the elements, the researchers used hierarchical analysis to determine the influence of the weights of the elements of each criterion level on the target level and finally synthesized the weights, shown in Table 6. As a result, the researchers constructed a system of key user requirements, in which the core elements are C14 comfort, C12 abnormal alarm, C31 independent dignity, C11 continuous monitoring, C13 mobile terminal, C24 daily mimicry, and C23 familiarity with semantics; the peripheral elements are C15, C25, C32, C33, C22, C21 and C34.

As the range of movement of the disabled elderly is relatively small, they are often assisted by their caregiver in their daily activities. Therefore, the design and structure of the clothing should be designed to be easy to put on-take off and for privacy coverage. In this study, the researcher used velcro instead of buttons, and the left and right cuffs and trousers can be opened and closed with a double-ended zip for putting on-taking off easily, as shown in the Figure 4. The trouser is designed with space for a catheter in the crotch to facilitate care-giver assisted toileting, bag use and cleaning care. The back of the trousers is hollowed out at the hip and has an external cover fabric which is attached with velcro tape. The cover fabric is used to cover the urinary catheter and private areas and is removable so that it can be replaced and washed at any time, as shown in the Figure 5. The overall structure of the clothing is designed to look the same as normal clothing, protecting the elderly's self-esteem and reducing the burden on caregivers.

Fig. 4

Fig. 5

The sensors used in this research are as flexible, thin and small as possible to ensure the comfort of clothes. The temperature and humidity on the body surface of various parts of the human body are different. In order to ensure the validity of the data measured, the researchers set the temperature and humidity sensor in the armpit close to the left chest where sweat glands are dense and the temperature is close to the body temperature. The power supply, development board and data wireless transmitter are all integrated into the left chest by welding in order to reduce the length of the connection wires. The sensors that cannot be integrated in the left chest position are connected via KTFB275/2 washable textile yarn. Based on the user requirements for a core element of daily mimetic appearance, the researcher made a concealed three-dimensional pocket for all electronic components to be integrated. After integration, the electronic components are designed to facilitate disassembly. The textile yarn connecting electronic components is directly woven on the clothing with a clothing pattern similar to the design semantics of the elderly. The combined design of electronic components and clothing is shown in Figure 6. The appearance of a model wearing smart clothes is shown in Figure 7.

Fig. 6

Fig. 7

The disabled elderly person requires regular body checks by their caregivers to confirm their health status because of their lack of perception, expression or mobility. The body check activity here includes all the behaviors of state confirmation by touching the disabled elderly's body in daily life. Studies have shown that reducing the number of body checks and attendance at the clinic can improve the quality of life and health of patients [19]. Reducing the frequency of body checks is effective in improving the quality of life of the elderly while ensuring their health status, and also greatly enhances their experience of independence and dignity.

The researchers recorded the body check times of 8 participants in a single day when they were wearing the care-giving clothing and ordinary clothing. As shown in Table 9, compared with the ordinary clothing experimental group, wearing care-giving clothing reduced the body check times of the disabled elderly in a single day by 42.31%. According to the descriptions of the experimentees and their caregivers, the real-time monitoring of health data by the smart care-giving clothing was the main reason for the decrease in the number of examinations.

It is common for the disabled elderly to suffer from a decline in physical function and mobility, such as incontinence, urinary bag assistance, lying in bed, and difficulty in lifting and turning on their hands and knees [20]. Problems with perception and expression also result in the need for caregivers and medical staff to frequently remove parts of their clothing to examine the body. Therefore, the ease of putting on-taking off clothing has become an important factor in the quality of life of the disabled elderly and the workload of caregivers. The experiment recorded the time that it took for the participant to be assisted in putting on and taking off the care-giving clothing and ordinary clothing in each of the six representative daily scenarios. The experimental results from Table 10 show that the effective time to put on and take off care-giving clothing in the six representative daily scenarios was less than that of ordinary clothing. The total putting on and taking off clothing time of the care-giving clothing was reduced by 51.67% compared to the ordinary clothing in the six scenarios, which greatly saved the daily workload of the disabled elderly and their caregivers. This is due to the convenience of putting on and taking off as well as the detachable structure of the modular unit.

The number of discomforting behaviours per day was recorded for each of the 8 experimentees wearing normal clothing and the care-giving clothing. The results showed that the average uncomfortable behaviour times of the eight participants wearing ordinary clothing was 2.63 in a day. While the results of the care-giving clothing group was 1.88, a 28.52% decrease compared to the normal clothing, showing a significant effect. When the disabled elderly person is wearing care-giving clothing and their body surface temperature fluctuates or they sweat excessively, the caregiver can be alerted by the mobile to provide timely and effective care for the elderly person, such as seeking medical treatment, adding clothing, removing clothing or cleaning the body to make them feel comfortable. This is the main reason for the reduction in the number of uncomfortable behaviours.

In the study of the disabled elderly, caregivers as the actual implementer of care-giving behaviours, play a very important role in the process of caring for disabled elderly people. Either the children of the disabled elderly or professional caregivers may feel anxious in the process of caring for an elderly person with dementia due to various factors. Considering that the reduction of caregiver anxiety is one of the important objectives of this study, the researchers recorded 24-hour anxiety scores of the caregivers of the eight participants. The test participants recorded their anxiety level on a scale of 0–100% for every two hours of care-giving work during a single day. 0% means no anxiety at all and 100% - anxiety at the limit of their tolerance. The results are shown in Figure 9. From the experimental results, it can be learned that the average anxiety of caregivers decreased by 74.37% per day. When the disabled elderly was not wearing smart care-giving clothing, the average anxiety level of the caregivers was higher, and the anxiety of the nighttime caregivers was the heaviest; when the disabled elderly were wearing smart care-giving clothing, the average anxiety of the caregivers was lower and showed a flat decline. On detailed inquiry, this was related to caregivers gradually adapting to and confirming the utility of the smart care-giving clothing in the process of use.

Fig. 9