• **The Medical Component**

RO-SmartAgeing is a solution that could help in treating and understanding the needs of elderly patients with mental illness or behavioral difficulties. The medical component gathers several Withings devices: the MoveECG smartwatch, Sleep Analyzer device, thermometer, Smart Scale or BPM, as well as integrating a gait band for fall detection and prevention, together with a memo for current activities and a messages service for maintaining strong communication between the elderly, physician, family members and other medical specialists. *The RO-SmartAgeing smart devices* and their capabilities associated with mental or behavioral aspects are described below:

a. *MoveECG smartwatch*: Electrocardiogram (ECG) monitoring and heart rate

The human brain is the most important part of the nervous system. Thus, a reduced heart rate variation is correlated to stress or mental health issues, resulting in loneliness, anxiety, and self-criticism [71,72]. At the same time, an increased heart rate variation implies a solid ability to tolerate stress. However, a high heart rate variation is prone to heart disease. The MoveECG smartwatch is developed to continuously monitor the heart rate, providing real-time data streaming. The smartwatch can be easily placed on the patient's wrist, allowing the continuous transmission of the heart rate and accurately monitoring the ECG when it is needed. This allows healthcare providers to interfere in any emergency related to significant alterations in the patient's heart rate. Meanwhile, measuring the ECG can be of extreme help in order to determine if a patient suffers from depression or bipolar disorder [73].

#### b. *Withings Sleep Analyzer: Sleep tracker*

The connection between sleep and mental health is considered bi-directional, as low quality of sleep can lead to poor mental health and vice versa [74]. Early waking in the morning, augmented by low energy, distraction, sadness, or loss of appetite, may suggest symptoms related to depression. On the other hand, an incapacity of sleeping or a major decrease in sleep associated with a high level of activity implies several signs of maniacal behavior. Anxiety is also related to sleep problems, represented by awakening, increased sleep onset latency, and low quality of sleep. Sleep deprivation is also related to obsessive– compulsive disorder, as well as detecting sudden awakening through panic episodes during sleep may indicate symptoms of panic disorder. In this context, the Withings Sleep Analyzer can detect any signs related to the movements, sleep cycles, and sleep score (duration, recovery, the number of interruptions, regularity, or time to sleep). The installation of the Sleep Analyzer is firstly based on placing it entirely under the mattress in order to be positioned underneath the chest of the sleeping person. After plugging it into an outlet using the provided adapter, it starts to measure the relevant parameters, making the proper evaluation the next morning. The heart rate is also measured using the Withings Sleep Analyzer as it is an essential parameter to be monitored while sleeping, as it indicates the time covered in the deep sleep phase as well as keeps good management of the heart health.

#### c. Withings Thermo: body *temperature*

Temperature is another parameter relevant to monitoring the mental health of the elderly. Studies [75] have shown that stress can induce an increase in body temperature. Psychogenic fever can be induced by any kind of stress, a continuous fear of COVID-19 being one cause of social stressors that can eventually trigger a febrile response, significantly impacting the health of the elderly. The Withings thermometer is capable of accurately measuring body temperature and sending the data immediately to the RO-SmartAgeing dashboard. The thermometer is easy to use as it only requires a slide over the patient's forehead. It measures the temperature at the temporal level, considering that the temporal artery is considered the best place to detect any changes in the body temperature. If there are any significant variations being measured (a temperature higher than 37.5 ◦C), an alarm is triggered in order to alert the healthcare specialists.

#### d. *Chest band: accelerations and position*

Mobility is linked to the symptoms related to schizophrenia or other neurodegenerative disorders. The risk of falling is also enhanced by mental health issues, but the lack of mobility worsens health problems, reducing social interactions and leading to depression or other mental or behavioral conditions [76]. The RO-SmartAgeing chest band proposes a smart device that could track the position of the elderly. The chest band is placed on the patient's body at the chest level, in order to detect imbalances, movements, positions, and eventual falls, based on accelerations. It can also detect any changes in posture, identifying early the possibility of falling, triggering an instant alarm on the RO-SmartAgeing dashboard. In this sense, the chest band can sustain a social life for the elderly, helping them toward continuous monitoring of eventual falls or movements.

e. *Withings Body+ Smart Scale*: weight and other body composition parameters

Changes in eating habits directly influence weight loss/gain, which can often be correlated with depression [77]. A continuous decrease in weight is interpreted as a diagnostic for depression; depressive people not having a normal appetite due to the lack of pleasure from eating. On the other hand, an increase in weight can be another aspect of depression as the elderly are more likely to not engage in physical activities because of tiredness or age-related aspects even though they consume a large amount of food for their own comfort. In this situation, there is the need to continuously monitor the body composition parameters in order to track any substantial change in weight loss/gain. The Withings Body+ Smart Scale can monitor a wide range of parameters related to the human body composition and transmit the data through the RO-SmartAgeing dashboard to be seen by the health providers in order to take necessary actions: change the patient's environment, current activities memo or treatment plan according to the measured values and diagnostic.

#### f. *BPM Core:* systolic and diastolic blood pressure

Anxiety associated with the COVID-19 pandemic has proven to have symptoms in blood pressure. Several studies [78,79] have shown an increase in the value of home monitoring systolic blood pressure among the elderly, leading to a much greater risk of cardiovascular issues. Thus, RO-SmartAgeing can help in preventing anxiety aspects in older adults through the easy use of BPM Core. The BPM is placed on the patient's arm and can wirelessly transmit the data to the RO-SmartAgeing system, allowing the healthcare providers to see the home-monitoring of blood pressure variation values over a certain period to detect any significant changes that can occur at the mental level of the patient.

In addition to the smart devices capable of gathering health data for the evaluation and monitoring of mental, behavioral, or emotional features related to the elderly in the context of the COVID-19 pandemic, there are two functionalities of the RO-SmartAgeing system that can improve an elderly patient's quality of life, through *monitoring the current activities* and maintaining a social life by keeping up with the other related users through *messages*.

#### - *Current activities memo functionality*

In the context in which an elderly patient is prone to problems related to cognitive degeneration and mental imbalances, monitoring the current activities can provide support for maintaining a good social life and self-care, and improve the quality of life.

Generating alerts in case of non-compliance/omission of a recorded activity implies sending reminders for administering pills or respecting the provided treatment. The RO-SmartAgeing functionality of the memo for current activities allows personalized recommendations for the patient's care in terms of sustaining their activities in order to maintain efficient healthcare and good quality of life, as mental and physical health are essential in pursuing a healthful lifestyle to reduce any risks of diseases. Keeping and maintaining an organized schedule for activities can improve the endurance of a person in terms of cardiological functionality, respiratory system, muscular strength, or body composition.

In addition to this, mental health is also sustained through physical activities, having a great impact on boosting the patient's emotional, social, and psychological wellbeing [80].

#### - *Messages functionality*

Keeping efficient communication between the patient and the physician is mandatory in terms of the post-COVID-19 pandemic, as there is the need to remotely correspond with medical professionals, caregivers, or other medical specialists when any healthcarerelated problems may appear. For example, the caregiver, as an authorized user of the RO-SmartAgeing system and being responsible for the elderly person, can send a message, in real time, to the physician if there are any issues regarding the health or the wellbeing of the patient. Once any messages are received by the physician, any further clinical investigations can be based on the measured health data or on the activities the patient is doing.
