Tech Tools - Supporting Independence, Quality of Life & Safety

by Women's Brain Health Initiative:Dementia is a progressive disease that, over time, makes everyday activities increasingly difficult, and sometimes unsafe. Cognitive assistive technologies are devices or systems that help improve independence, safety and quality of life for individuals with cognitive difficulties. Although many assistive technology devices are electronic, the term encompasses both high-tech and low-tech options.Existing Technology to Assist with Daily ActivitiesAs dementia progresses, a person’s ability to keep track of time is often affected, leading to confusion and anxiety. A digital clock with large font is easier to read and understand than an analog clock. Even better are clocks designed specifically for dementia, which display the month and day of the week. Some clocks also show if it is morning, afternoon or night, to provide even more context to the day.Adapted phones are available that are easier for someone with dementia to use. These typically have pre-programmable buttons for frequently called phone numbers. Some allow photographs to be placed on the pre-programmed buttons making it clear whom you are calling when you press each button.There are a variety of tools available to provide automated reminders or prompts to individuals with dementia. Some are recorded verbal messages, sometimes in a caregiver’s voice, while others are alarms or visual messages that pop up on a smart phone or tablet. These reminders can be programmed to play at a particular time (for instance, to remind someone to take medication) or can be played when a motion sensor is activated (for instance, a sensor located near the front door could provide a reminder to lock the door).There are also several options for helping someone with dementia take the correct medications or vitamins at the right time each day. In the early stages of dementia, these medication aids can be simple, such as a pillbox with individual sections for days of the week and times of day. As the disease progresses, there are high-tech options that automate the pill dispensing process, such as an alarm that goes off when medication needs to be taken and the correct compartment opens. Some devices can send an alert to the designated caregiver if the medication is not taken or if the device has stopped working, requires new batteries, or needs to be refilled.Some technology is designed to improve the safety of individuals with dementia, to help them maintain independence and live at home longer. Safety-focused devices include:Motion-sensor lights that turn on and off automatically as a person enters and leaves a room can help prevent falls at night while eliminating the need to keep track of and use light switches, an overwhelming task for some individuals with dementia.GPS (global positioning systems) locating devices designed specifically for individuals with dementia can provide support and safety when they are out walking alone. These devices come in different styles, including a phone-like device worn around the neck, lockable watch, and shoe insole. The exact services provided by each device vary but can include real-time location viewable on an online map, geofencing (pre-set safe zone and alerts sent to a caregiver if the person wearing the device wanders outside the boundary), two-way voice communication, and panic button. (See “The Road Less Traveled: The Impact of Dementia on Independent Mobility” in the third issue of Mind Over Matter® magazine for more information about GPS devices and dementia.)To help prevent wandering, there are movement sensors — such as pressure mats in bed or on the floor, or socks with integrated sensors — that send alerts to caregivers when someone with dementia moves in a particular way. For example, these devices can send a warning to a caregiver via a mobile app when the person gets out of bed at night or steps on a mat placed by the front door indicating that he or she may be heading out. Another movement sensor is designed to detect if someone has fallen.There are even devices that can automatically shut off a tap that has been left running, or a stove if it has been left on.Assistive technology is also being used to enhance social and leisure activities, such as sensory and mental stimulation games and puzzles, digital photo frames for reminiscing, and video calling for maintaining relationships.Choosing Cognitive Assistive TechnologyThere is no “one-size-fits-all” assistive technology for individuals with dementia. A good example is motion-sensor lights — these can be very helpful to some, yet alarming or frightening to others. Although dementias all involve a pattern of increasing mental decline over time, the impact varies significantly from person to person. Therefore, the technology that is suitable for one person may not work at all for another. In addition, what works for one person at a particular point in time is likely to change as the disease progresses.Degree of memory loss is only one aspect that impacts the suitability of a given technology. Other considerations include the person with dementia’s ability, confidence and interest in using a particular technology, as well as how much support will be required by caregivers for a certain tool to be effective and whether that support is available. Experience has demonstrated that the earlier an assistive device is introduced, the more likely it is to be successful.Cognitive assistive technology should always be selected based on what is best for the person with dementia. When choosing assistive technology, be sure to involve the person with dementia in the decision-making process as much as possible. The tools selected should support the person, not restrict him or her. Assistive devices should not be used by caregivers to monitor individuals without their consent, or as a replacement for human interaction.Given the potentially short span of usefulness and the cost (especially of some of the more high-tech devices), you may want to consider renting cognitive assistive technology if that option is available.Technology in DevelopmentMany research projects are underway that are focused on assistive technologies for older adults with dementia. At the University of Toronto’s Intelligent Assistive Technology and Systems Lab (IATSL), for example, researchers from multiple disciplines are collaborating to develop technologies that will help those with dementia participate fully in their daily lives.Dr. Alex Mihailidis is the Director of IATSL, an Associate Professor in the Department of Occupational Science and Occupational Therapy and Institute of Biomaterials and Biomedical Engineering at the University of Toronto, and the Principal Investigator and a joint Scientific Director of the AGE-WELL network. One of the projects Dr. Mihailidis’s team is working on is known as COACH (Cognitive Orthosis for Assisting Activities in the Home). COACH uses computer vision and artificial intelligence techniques to provide reminders for common care activities.“When the system is used to help with handwashing, the bathroom is equipped with sensors that can detect if important steps are missed, such as turning on or off the water, or using soap,” explained Dr. Mihailidis. “Depending on what it detects, COACH can provide a low-guidance oral prompt, a high-guidance oral prompt, or if the person needs even more assistance it will provide an oral prompt along with a video demonstration on a screen positioned near the sink.” Other potential COACH responses are to do nothing and continue to observe the user, or to call a caregiver to intervene. COACH may sound very futuristic and expensive but, as Dr. Mihailidis advised, this type of system “uses very little hardware and installation is not complicated, so it’s realistic that this technology may be suitable for eventual use in a home environment.”“When developing technology to help individuals who have dementia, it is crucial that the end product be user-friendly,” emphasized Dr. Mihailidis. “That means it must be unobtrusive, able to accommodate high levels of customization, and not require feedback such as a button press, since that cannot be reliably expected from someone with dementia.”Iatsl is a unique place where researchers in engineering, computer science, occupational therapy, speech-language pathology, and gerontology are working together to create solutions, such as coach, to improve the lives of those with dementia. Without a doubt, the collaboration of their time, resources and efforts, will go a long way to supporting independence, quality of life, and safety for dementia patients in both the short and long term.Source: MIND OVER MATTER