There is a lack of elegant and effective product design for seniors, especially for those with age-related handicaps. Compression stockings are an example of this. They are often designed without senior accessibility in mind and are one of the first products that force aging patients to rely on outside help like a compression sock dressing service. We created indi during our studies in Germany to address the lack of suitable compression stockings for seniors and others with mobility impairments so that users will regain their independence with a well-designed stocking.
In discussions with the German Red Cross home nursing service, we learned that around one in four or five visits is for the sole reason of assistance in putting on or taking off compression stockings. Based on prices charged in Bavaria, Germany, we determined that utilizing a compression stocking service leads to annual costs of €7168 for the patient or the insurance company. So the issues connected with compression stockings are: high personnel cost, difficult application, cost of service, and psychological strain for patients who are relying on others daily for help.
Most compression socks are not designed with seniors in mind: they require strength, dexterity, and mobility, all of which deteriorate with age. Our compression sock utilizes a two-piece design where no force is needed to pull the stocking parts on and limits the need to bend past the foot when taking the stocking off. To apply the correct pressure, a BOA closure is located on the top of the stocking to tighten the cuff after donning indi.
A BOA fastener is very easy to operate and requires a low level of fine motor skills and strength. In addition, this fastener is not prone to faults. This fastener can also be easily washed without causing any damage because it is primarily developed for outdoor use. The BOA closure uses an internal torque-wrench to ensure that the stocking is never over-tightened.
In order to help patients correctly use and oversee their compression sock usage, indi has incorporated a few simple sensors to measure whether the pressure of the stocking is correctly applied and whether or not it has been worn for the right duration. The patient can also choose to share this data with their doctor, who can scan the NFC chip and determine correct treatment for the individual, based on their usage.
One of the most common problems is that seniors can not reach down to or past their feet, which makes taking off traditional stockings difficult. Our stocking includes a removal tab, where the senior can stick a long shoe-horn (which most seniors already have) in and push the stocking down off the foot, after loosening the BOA closure.
Indi solves many problems. Seniors enjoy a life with more or regained independence through a well designed compression sock without the financial and psychological burden of a dressing service. This saves time for the caregivers as well and ensures that seniors live at home longer.
Humans are living longer than ever before and the upcoming elderly population is one of the largest in history. Paired with low and declining fertility rates, in many first world countries, seniors will make up 1/3 of the population. Countries and businesses are not changing quickly enough to address the new demands of the aging market, leaving many seniors to depend on outside assistance for tasks that could be solved with well designed products or systems.
Relying on external care means waiting: waiting for the Red Cross to show up and dress you before you start your day, waiting for someone to walk over and help you reach an item you dropped, or waiting on a family reunion so your grandchild can disable the advertisement blocking your phone screen. You save time when you do something on your own, but you also want to be able to do things on your own efficiently. Most products are not designed to help seniors get something done quickly… or the products do not exist at all. Ms. N. has Parkinson's disease and has trouble grabbing objects out of her reach with her lack of mobility. She uses a back scratcher with telescope-neck to coax objects into her reach. It takes a painfully long time but she swears she has found no other fitting solution. This is the case for many tasks. Getting dressed alone can take up to half an hour, while many seniors told us that compression socks alone cost them 30 minutes every morning. Of course, many things do slow down with age, but spending half an hour just to pull compression socks over your legs shows a problem in the design of the product and not just user error or frailty.
Completing tasks independently is important for maintaining or benefitting mental health. Many seniors avoid moving to a retirement home because becoming reliant on others comes with a loss of self, independence, confidence. Reliance in old age is a highly stigmatized phase of life where patients feel they are a societal burden, old, frail, and weak. The fact that badly designed or absent products cause people to enter this reliant stage of life is astounding.
Compression stockings are often the first reason why people become dependent on external help in their older years. We interviewed Ms. J who told us she had been putting on her own compression socks for a decode but just does not have the strength anymore. Ms. J is not a frail old woman. She manages a large, tidy house in her mid 60s but she now waits every morning for the German Red Cross to visit her and apply the stockings for her. This is a financial burden as well as a psychological one. Based on red-cross pricing, we found that a compression stocking dressing/undressing service costs over 7,100 euros a year in Germany for the patient or for their insurance company.
Most compression socks are not designed with seniors in mind: they require strength, dexterity, and mobility, all of which commonly deteriorate with age. Almost all seniors we spoke with had issues with strength or struggled to bend down and reach their foot. Even just one limitation in the required needs for compression stockings can cause seniors to rely on outside help to put on their compression socks in the morning or take them off in the evening.
Indi utilizes a two-part design to ease dressing and undressing and allow seniors to dress and undress themselves independently. The undersock consists of a compression sock from the toe to the heel. From the heel to the knee, the undersock is a lightweight cotton fabric without compression. The cuff creates compression from the heel to the knee, utilizing a BOA closure so it can be loosened and tightened. This cuff is easily pulled onto the leg in it's loosened form and tightened to the correct pressure using a knob located under the knee. This knob is the BOA closure and it pulls on strings that run down the cuff, tightening it on the leg. This makes it much easier for seniors to put on the stocking, because they do not have to get a compression sock over their heel.
The lower stocking keeps sweat, dandruff and more from the body away from the compression cuff, as this cuff should not be washed. The understocking can then be washed in the washing machine on the hand wash program. The understocking also acts as a cushioning layer to spread the compression from the cuff more evenly across the leg and to cushion pressure-spots, if there should be any from the outer cuff.
Although the compression cuff should not be washed, it is designed so that it can still be washed without breaking. The electronics are cast in silicone and the housing of the battery is waterproof. It can be opened with a special tool at a medical supply store to replace the battery. The metal parts contained in the BOA fastener are made of a material that is corrosion-resistant and lightweight.
Taking off the stocking can be done without bending down- A removal tab is located on the back of the cuff where users can insert the end of a long shoe horn (which most seniors already have) and push the cuff and stocking easily off of the leg.
We came across a different set of problems, once we designed stockings that are easy to apply. Patients did not wear their stockings regularly or applied them with inadequate pressure. To solve this problem, we incorporated technology so the user can track their usage by scanning an NFC chip in the cuff. The app we designed shows the user a quick overview: how much longer they need to be worn daily and if correct pressure was reached while applying the sock. The user can choose to share this data with their doctor to aid in their treatment. The doctor can use the other screens in the app to see a detailed overview of usage by day since the last appointment. The app does not contain identification-specific information, but the data can be exported into the medical system if desired.
Every 15 minutes, the cuff of the compression sock measures whether or not the sock is being worn. This is done with a capacitative sensor that measure through the undersock and detects human presence. This has the advantage that there does not have to be any skin contact and there can therefore be a washable under-sock layer between the sensor in the cuff and the person's leg.
Inside the BOA closure, we designed a mechanism that functions similarly to a torque-wrench. With this function, a pressure can be set my the care-professional and the BOA closure can not be overtightened. As soon as the correct pressure is reached, the mechanism clicks through and continues to click through if the user attempts to tighten further. And not every patient needs the same pressure in their compression sock. Indi is therefore designed for adjustable pressure. To adjust the pressure of the sock, a medical professional tightens or loosens the internal spring, meaning the mechanism releases at a higher force.
The BOA closure is paired with the technology. As soon as the correct pressure is reached, a lever is pushed down and sends a signal to the electronics that correct pressure has been applied for today. Upon release of the BOA closure, the lever is reset to it's original position.
In our interviews we found out that patients usually visit their doctor several times a year, but at least once a year, to check the condition of their legs. For this reason, the battery in the stocking should last for a year and still contain a buffer. The size of the battery is also heavily dependent on how often it is checked whether the patient is wearing the stocking. The final sizing of the electronics is comparable to a toothpick, making the electronics not only cheap but also unobtrusive.
We determined that a compression sock service costs upwards of 7,000 euros a year. We found the individual parts of indi would cost around 50 euros to buy. Even with production and processing costs, the price of indi would fall far below the cost of a dressing service! Indi is a cheaper and desired option that seniors who struggle with regular compression stockings need.