Cognitive Support for Dementia
Assistive Technology, Cognition, Dementia, Grounded Theory Analysis, Risk
Dementia is a term referring to a collection of neuropsychological symptoms sufficient to disrupt activities of daily living (ADL). At the early stages, deficits in episodic memory (memory of experienced events) and executive functioning (problem solving, attention, sequencing) impede on ADL performance and heighten risks within the home. Ubiquitous computing and artificial intelligence provides new opportunities for designing assistive environments for the cognitively impaired (see for example Mihailidis, 2004). Based on the perspectives of professional carers, the present study summarises the problems of dementia in the home. In accordance with cognitive theory, this helps design assistive technologies that are both useful and appropriate for the users.
Nine semi-structured interviews and one focus group were conducted with professional carers and Occupational Therapists. The interview protocol centred on the problems of dementia in the home and likely reasons for referral into institutional care settings. Transcripts were analysed using Grounded Theory Analysis (GTA) in accordance with Strauss and Corbin (1990). This identified ten main categories that could be summarised under three separate themes: (i) Problems in the Home, (ii) Underlying Deficits, and (iii) Consequence'.
Problems in the Home include: daily activities (dressing, taking medication, preparing food/drink and toileting), risks (cooker safety and wandering), and interpersonal activity (communication and social identification).
The Underlying Deficits include sequencing (initiating and ordering actions within an activity), memory and orientation (memory of prospective and retrospective events, as well as general orientation to person, object, place and time), and learning (difficulty to adapt to new technology and environments).
The Consequences relate to the wellbeing of both patients and caregivers. For the patient, consequences centred on physical wellbeing (safety, security and health) and control over their daily lives (personal space, sense of accomplishment, and social isolation).For the caregiver, the consequences related to the patient-carer relationship (interaction and frustration) and the pressure of the care demands (constant supervision and anxiety).
Understanding how dementia impacts on daily life is an essential part of the design process. Categories relating to problems in the home propose activities that need to be enabled, as well as risks to be prevented. The underlying deficits, in conjunction with cognitive theory, suggest strategies of providing cognitive support. Finally, the consequences highlight aspects of independence (for both patient and caregiver) that should be addressed. These issues must be considered if the technology is to promote independence effectively.
Mihailidis, A., Barbenel, J. C., and Fernie, G. (2004) The efficacy of an intelligent cognitive orthosis to facilitate handwashing by persons with moderate to severe dementia. Neuropsychological Rehabilitation, 14 (1/2), 135-171
Strauss, A., and Corbin, J. (1990) Basics of qualitative research. London: Sage
Joe Wherton (York)
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