Assistive Technology for People with Dementia

1. Assistive Technology for People with Dementia Presenters: Claire Morrisby (Occupational Therapist, Alzheimer’s Australia WA) Caroline Rey (Occupational Therapist, ILC WA)

2. Outcomes • Understand what Assistive Technology (AT) is • Ethical framework for the use of AT • Understand the application of AT to people with dementia

3. What is AT? “any item, piece of equipment, product or system whether acquired commercially, off the shelf, modified or customised, that is used to increase, maintain or improve functional capabilities of individuals with cognitive, physical or communication disabilities” Mary Marshall (2000)

4. Defining dementia as a disability Most disabled people [sic] . . . will tell you that despite what everyone thinks, the disability itself if not what makes everything different. What causes the difficulties are the attitudes society has about being disabled, attitudes that make a disabled person embarrassed, insecure, uncomfortable, dependent. Of course, disabled people [sic] rarely talk about the quality of life. But it has precious little to do with deformity and a great deal to do with society’s own defects. (pg. 6, Weisgerber, 1991.)

5. Why is it important to support the person with Dementia • Social justice: Recognising the importance for persons with disabilities of their individual autonomy and independence, including the freedom to make their own choices (HEROC) • Wellbeing: cognitive and emotional state indicated through willingness to initiate contact, demonstration of affection, self respect etc. (Kitwood & Bredin, 1992) • Quality of life: broader consideration, includes sense of control; inclusion ; reciprocity ; meaningful activities ; feeling safe and secure; maintaining self-esteem ; and maximising physical wellbeing through effective health care (Bamford & Bruce, 2000)

6. Why should we use AT to support people with Dementia • For the person with dementia • Promote autonomy and Independence • Reduce risk • Provide enabling environments • Promote wellbeing • Benefits for carers and community • Resources can be used in other ways • Reduce caring burden

7. Ethical considerations • The more invasive/restrictive the technology, the greater the ethical consideration • AT should not be primarily be used to reduce human contact • Where possible, consent should be sought from the client • Take a person centred approach to technology intervention • What are the alternatives? • What are the likely consequences of not using technology?

8. How we assist clients to select the appropriate products

9. Considerations when assessing client

10. Frank’s Parents • 92 and 94 year old couple • Both have early stage Dementia, father has moderate hearing impairment • Services daily (16hrs per week) • Live in own home • Son (Frank) made appointment at ILC to look at medication reminders

11. Options for Frank’s Mother • Takes 4 meds per day • Currently uses a Blister Pack • Jadco Clock – to orientate her to date and time.

12. More options for Frank’s Mother • TabTimer Med-e-lert Pill Dispenser: This level of reminder was not necessary, not portable enough. • Tabtime Super 8 Medication Organiser: takes 4 doses a day, could open easily, liked time display, portability.

13. Options for Frank’s Father

14. Jim and Barbara • Jim (86) and Barbara (82) live together on a semi rural block in the Perth hills • 4 sons and daughters live within 30 minutes of them • Barbara has moderate dementia with delusions and anxiety and is about to be discharged from OAMH • Jim has osteoarthritis and can no longer get around their steep block easily • Neither Jim or Barbara drive, rely on family and community bus for transport

15. Jim and Barbara cont. • Barbara can no longer use a phone and is adamant that there is nothing wrong • Barbara likes to spend her days in their extensive garden but doesn't generally go beyond the gate The family would like to know that Mum and Dad are safe at home, and that they can call for help if needed

16. Options The family would like to know that Mum and Dad are safe at home, and that they can call for help if needed

17. Options: other items that may help The family would like to know that Mum and Dad are safe at home, and that they can call for help if needed

18. Mary • Mary has progressive dementia and high blood pressure • Lives with daughter but she works during the day. Carer 2hrs per day. • Needs reminding to take meds and to take them with food • Needs reminder to check blood pressure twice weekly

19. Options for Mary

20. Telehealth options for Mary SimpleMed (Novitatech) - medication dispenser that provides visual and auditory reminders. If a dose is missed the monitoring service calls carer or client. Discussed DocoboHealthHUB (Silverchain) for monitoring vital signs, medication compliance, etc

21. Mary - Leisure Mary also has difficulty using a standard TV remote. She enjoys watching TV and listening to music.

22. Mary - Leisure cont… • Talking photo album (or “ talk to me photos” or “pictello” apps on iPad) • “ Pictures to Share” books

23. Leisure cont… • Talking books – Kindle or iPad(Mary will need assistance to use). • Provided information on talking books from libraries and Association for the Blind.

24. James • James is 72 and lives in a high care dementia specific unit • Spends most of day in chair, appearing unengaged • Has difficulty with expressive language • In the afternoon James walks the corridors, he often walks into other residents rooms and moves things around • Staff encourage him to stay in the lounge or his room, to respect others privacy

25. Sensory stimulation • Broda Auto Locking Glider • Vestibular stimulation- little strong evidence, anecdotally supported. • Requires careful prescription as has had adverse effects • Weighted blankets

26. Sensory Stimulation • Doll/mechanised pet therapy • Other tactile stimulation • Caleb's baskets • Sensory boards/mats/cushions • Fiddle twiddles

27. Betty and Paro video

28. Communication for James • Principles of good communication: • Awareness of individual’s needs/ capacities • Hearing • Level of cognitive impairment • Other factors i.e. Stroke • ESL • Understanding of environment • Use of whole communication (body language, visual cueing etc)

29. Telecommunications • Fotodialer: a telephone accessory that uses a photo album and a speed dialer to make calls. • Oricom Care80 Amplified Phone with Picture dialling:a corded phone with six large one touch picture memory buttons

30. Telecommunciations (cont) • DoroHandlePlus 334 Mobile Phone: four large, high contrast buttons labelled A to D • iNo phone – large, contrasting backlit buttons and a backlit screen for the display of numbers and text in a large format. SOS button on the back.

31. iPad Apps • VoCal Lite reminders • Tell me When App • Simple calendar – bold display with date and time

32. More iPad Apps • Interactive picture apps: aquariums etc • Pictello: create talking photo albums and books

33. What are your thoughts? Tell us what you think about emerging technologies, like the iPad, being used for people with Dementia? Other Questions?

34. Resources www.ilc.com.au www.alzheimers.org.au/Western-Australia.aspx www.safe2walk.com.au

35. References Bamford, C., & Bruce, E. (2000). Defining the outcomes of community community care: The perspectives of older people with dementia and their carer. Ageing and Society, 543-570. Kitwood, T., & Bredin, K. (1992). Towards a theory of dementia care: Personhood and wellbeing. Ageing and Society, 269-287.Weisgerber, R. S. (1991). Quality of life for persons with disabilities. Gaithersberg, MD: Aspen.