INTRODUCTION At present, the number of senior
citizens in the world tends to increase every year. As reported by the World
Bank the number of senior citizens in the world is around 0.5 billion people or
8.2% and around 74.3% of them have hypertension [1]. In the same way, the
number of Thai senior citizens tends to increase. According to the National
Statistical Office, the number of senior citizens in Thailand is around 10
million people or 14.9% [2]. The number of senior citizens shows that
Thailand’s society will become a senior’s society soon. From the information of
Thai Health Promotion Foundation, senior citizens in Thailand is around 4.1
million people or 41.0% who have high blood pressure or hypertension [3]. High
blood pressure is the most common risk factor to other diseases such as stroke,
kidney disease, paralysis, and so on. Therefore, high blood pressure is a very
important disease that needs to be treated. Nowadays, there are many medical
devices that can use to monitor people health in ever day life such as heart
rate monitor, glucose monitor, blood pressure monitor, pedometer and weighing
scale. Blood pressure monitors are also now available to use anywhere.
Accordingly, senior citizens can use these devices to measure blood pressure at
home. The hypertension patient should measure the blood pressure and take care
oneself at home that is the best way to measure blood pressure [4] [5].
Moreover, most of people do not know the factors that impact the value of blood
pressure such as body mass index (BMI), eating too much sodium, eating too less
potassium, alcohol addiction, smoking, lack of physical activities, stress and
taking the medicine according to the doctor. Thus, they should know more the
basic knowledge of hypertension. In 2016, smartphone owner in Thailand is about
24 million people and about 2.5% of them are senior citizens [6]. Recently,
Thai people are increasingly interested in selfcare but most user interface of
self-care applications are not friendly for senior citizens e.g. small text,
small button [7]. The main objective of this research work is to design and
develop a self-care android application for senior citizens with hypertension
to guide, track and treat hypertension and to reduce the risk of having other
incurrent diseases. Hence, this oHealth application will be a useful tool for
senior citizens with hypertension to take care of themselves.
BACKGROUND AND RELATED WORK A.
Senior Citizens The definition of senior citizens from the United Nations is
people who are more than 60 years of age. The senior citizen can separate into
4 types which are the young – old (60 to 69 years old), the middle-aged old (70
to 79 years old), the old-old (80 to 90 years of age), and the very old-old (90
to 99 years old). At present, the number of senior citizens in Thailand tends
to increase every year. When seniors get older, health problems occur with them
in many ways [1]. B. High blood pressure (Hypertension) Normally, blood
pressure when the heart pump blood (systolic) is below 120 mmHg and blood
pressure when the heart relaxed (diastolic) is below 80 mmHg. Blood pressure
can be changed over time, especially when people sleep, wake up, exercise,
stress, or exited. But it will be back to normal blood pressure when people
finish their activities. If people finish their activities, but the blood
pressure still higher than 120/80 mmHg. This means people can have high blood
pressure (Hypertension) [8].
High blood pressure can divide into three levels,
which are prehypertension (120-139/80-89 mmHg), high blood pressure stage 1
(140-159/90-99 mmHg), and stage 2 (more than 160/100 mmHg) [4]. There are two
types of high blood pressure, which consist of primary and secondary high blood
pressure. More than 90% of hypertension patients have primary high blood
pressure. It is the most common type that occurs in people. And another 10%
have secondary high blood pressure. There are many causes, factors and
treatments of primary and secondary high blood pressure as summarized in Table
1 [8] [9] [10].
High blood pressure can divide
into three levels, which are prehypertension (120-139/80-89 mmHg), high blood
pressure stage 1 (140-159/90-99 mmHg), and stage 2 (more than 160/100 mmHg)
[4]. There are two types of high blood pressure, which consist of primary and
secondary high blood pressure. More than 90% of hypertension patients have
primary high blood pressure. It is the most common type that occurs in people.
And another 10% have secondary high blood pressure. There are many causes,
factors and treatments of primary and secondary high blood pressure as
summarized in Table 1 [8] [9] [10].
From the observation, most existing applications do
not provide medicine reminder, BP reminder, knowledge, treatment, and daily
emotion features in their applications. Accordingly, oHealth was proposed in
order to provide all of alternative features from every application that are
suit for users. Furthermore, oHealth has design that supports senior citizens
directly, such as use minimalist design, provide large icons, avoid the use of
irrelevant information, and maximize contrast and avoid use of excessively
bright colors [17]. D. Blood pressure devices In the present, there are many
blood pressure devices that can connect with smartphones, such as Welch Allyn
767, Omron M7, Withings, iHealth BP7, QardioArm, etc. According to the
comparison of four smartphone compatible blood pressure monitors research [18],
BP5 device can measure with higher accuracy than the other devices. Blood
pressure 5 (BP5) produced by iHealth Labs, Inc., can work with both Apple and
Android devices by connecting via Bluetooth V3.0. This device can measure blood
pressure and pulse. The pressure accuracy of BP5 is minus 3 and plus 3 mmHg.
The pulse accuracy of BP5 is minus 5 and plus 5 percentages. The range that BP5
can measure blood pressure is around 0 to 300 mmHg. E. High blood pressure data
set A data set from the Statistical Society of Canada is used learning and
classifying hypertension levels. Thirteen variables relevant to hypertension
causes and factors are selected for analysis which are systolic blood pressure,
gender, marital status, smoking status, age, weight, height, body mass index
(BMI), exercise level, alcohol use, stress level, hypertension level and salt
(NaCl) intake level from food [19].
The oHealth system architecture
as shown in Fig. 1 has five main actors. The first actor is senior citizens
with hypertension who can use oHealth by connecting with Wi-Fi or a mobile
Internet data in Android device. The second actor is the administrator who
maintains the database on Azure SQL Database cloud server. The third actor is
doctor, assistant, and family members who receive history data and blood
pressure analysis report of senior citizens. The fourth actor is BP5 device
which can measure blood pressure. The last actor is azure machine learning
which gets all the collected data and analyze hypertension levels for the user.
The oHealth application requires the user to register as a member by providing
their personal information and log-in. The application offers six main
features. The first feature is user profile, which keeps senior’s information.
The second feature is measure blood pressure, which measures blood pressure by
connecting blood pressure device. The third feature is knowledge, which gives
knowledge about hypertension, food, exercise, and medicine. The fourth feature
is treatment, which records food dairy, medicine intake, and exercise for using
in hypertension analysis and treatment. The fifth feature is reminder, which
uses to set reminder to measure blood pressure and take medicines in each day.
The last feature is analysis, which analyzes hypertension levels with azure
machine learning system by using Multiclass Logistic Regression algorithm [20]
to create a predictive model and shows the result to the user. The analysis
results and history data can be shared to doctors, assistant, or family
members.