Published on: January 31, 2021
by Women’s Brain Health Initiative:
Eating is an essential activity that provides not only nourishment, but also pleasure and an opportunity for social interaction. Most of us eat three (or more) times each day. Sometimes we dine out at restaurants, but much food preparation and consumption take place at home. The ability to plan and prepare meals is something that we may take for granted when we are young and healthy, but it can be an especially daunting undertaking for older adults who are experiencing cognitive decline.
Although it may seem at first glance that making meals is a simple endeavour, it actually requires complex cognitive capacities to handle the many steps involved – for example, thinking about what you will make, checking to see if you have the correct ingredients on hand (and perhaps making a grocery list if you need to get additional items), going to the grocery store, making sure that you have enough money to pay for those items you want to purchase, measuring ingredients, using a knife, stove, and other kitchen tools safely, cooking for the appropriate amount of time, and cleaning the kitchen.
For individuals struggling with cognitive decline, there are many potential challenges throughout the meal planning and preparation process. Some of the mistakes that might be made along the way are frustrating, but harmless (e.g. forgetting to buy the ideal spice or overcooking a dish). However, many potential mistakes can result in serious harm to the individual and/or damage to the home (e.g. walking away from the kitchen while something is cooking on the stove and possibly starting a fire, or leaving water running in a plugged sink and potentially causing a flood).
Often, when an older adult begins to struggle with any of the steps of meal planning and preparation, the “solution” is to stop her or him from cooking altogether and have prepared meals brought to the home. While this approach does address the safety concerns around meal preparation, it dramatically reduces the person’s independence, completely denying her or him access to a valuable activity that can provide cognitive stimulation, enjoyment, and a sense of accomplishment.
With some assistance, individuals with cognitive difficulties can often continue participating in meal preparation. Unfortunately, many older adults live on their own and do not have access to help every time that they need to prepare food. It is often not financially feasible or practical for caregivers or health professionals to be present multiple times each day to oversee the process, but it is possible that technology may be able to provide the frequent help that is required.
There is currently technology available to help with safety in the kitchen in simple ways, such as devices that can automatically shut off a tap that has been left running, or a stove that has been left on too long. More complex technology is in development, too.
With nearly $200,000 in funding support from Brain Canada in partnership with the Alzheimer’s Association, Dr. Nathalie Bier and colleagues have been working on a technology tool they call “COOK” (Cognitive Orthosis for Cooking) to help people with cognitive impairment plan and prepare meals independently and safely.
A national non-profit organization headquartered in Montreal, Brain Canada enables and supports innovative brain research across the country. Since 2011, it has had a major partnership with the Government of Canada, through Health Canada, which has provided $160 million to match donations from Brain Canada’s private and non-federal partners, such as the Alzheimer’s Association.
This commitment by the federal government empowers Canada to excel as a global leader in the quest to understand the brain and brain disorders.
COOK is just the latest example of how innovative research can have real world applications, even in the short term. The technology offers support on a touch-screen device that is typically placed next to the stove, providing guidance through the various tasks required to prepare a meal, while watching for and correcting any risky behaviours.
COOK uses two systems: a cognitive assistance system and a security system. The cognitive assistance system supports complex meal preparation with explicit guidance, as well as simple meal preparation without specific guidance. Complementary tools such as meal planning, grocery-list preparation, and matching spices to several types of foods are also provided. The security system collects information from sensors that monitor a variety of factors, including the temperature of the stove top, the presence of the person near the stove, and the opening of the oven door. If the system detects a critical error or dangerous situation, it can automatically turn off the stove and call for assistance.
“COOK is unique in that it provides support in two ways, helping with the cognitive aspects of cooking, as well as safety,” said Dr. Bier, an Associate Professor at Université de Montréal. COOK was originally designed with (and for) people with traumatic brain injury living in a group residential setting. Since the system worked so well for them, the researchers wondered if the tool might also help other individuals who struggle with independent food preparation, like older adults.
Brain Canada powers the next phase of COOK
Dr. Bier and her colleagues began studying cognitively healthy older adults and discovered that they, too, could benefit from COOK. They then turned their attention to older adults experiencing cognitive decline. Findings to date suggest that COOK is a promising technology for older adults with mild cognitive impairment (MCI) and dementia.
The researchers first examined whether older adults experiencing cognitive difficulties could learn to use a tablet and cell phone applications and found that they could. Although this was not a direct study of the COOK technology, this research demonstrated that even with the presence of a cognitive deficit, older adults can effectively use touch-screen technology.
Next, the researchers conducted focus groups with 24 occupational therapists (OTs) to gather their opinions about COOK’s potential to help older adults with MCI and dementia. In these focus groups, COOK was described to the OTs and accompanied by a video that demonstrated the technology in action. Overall, the OTs thought that COOK had great potential to support the independence and safety of older adults experiencing cognitive decline when preparing meals. They suggested, though, that it would be a more appropriate tool for individuals with MCI (as opposed to those with Alzheimer’s disease), because those with MCI have better learning abilities.
More recently, Dr. Bier and her team have begun conducting a usability study in the laboratory, which is set up like an apartment with an operating kitchen that has COOK installed. There, individuals actually prepare (or simulate preparing) a meal using the COOK technology. So far, over ten OTs have participated, and they expressed more excitement about COOK after using the technology than they did in the focus groups.
The researchers plan to have five individuals with MCI and five individuals with Alzheimer’s disease, as well as six caregivers, try COOK in the laboratory as well. To further assist with finetuning COOK for adults with cognitive deficits, the researchers also conducted real-world observations of 24 such individuals in their homes and community (for example, during their trips to the grocery store). Valuable new insights were gained by evaluating the difficulties encountered during meal preparation in a residential environment, providing the researchers with greater guidance about the type of assistance required.
Once this component of the research has been completed, the technology will be further modified based on participant feedback. “The research we’ve completed so far suggests that COOK has strong potential to help older adults with MCI and dementia prepare meals safely in their own homes,” said Dr. Bier. “Meal preparation is critical to independence, which is something that’s of great importance to people as they age. Most people want to live in their own home and take care of their own needs independently for as long as possible. COOK can help with that.”
COOK is still in development, but there is a good chance that the technology could be available for real-world use in the next few years. Exactly how long it will take for COOK to be widely available depends on factors beyond the researchers’ control. “Our focus as researchers is on developing assistive technologies, not marketing and selling what we create,” explained Dr. Bier. “We work with a not-for-profit start-up that focuses on taking technology developed by researchers and figuring out how to get it into the marketplace. How long that will take depends in part on funding. How much will the technology tool cost, and who will pay for the tool and the occupational therapist time that will be needed to teach clients how to use it? These are questions that still need to be answered.”
To learn more about Dr. Bier’s work, visit https://braincanada.ca/funded_grants/assistive-technology-for-cognition-to-increase-safety-at-home/
* The views expressed herein do not necessarily represent the views of the Minister of Health or the Government of Canada.
Source: MIND OVER MATTER V11
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