Assistive technology for people with dementia Deborah Brooks, Project Manager Trent Dementia Services Development Centre www.atdementia.org.uk
What is assistive technology?o Assistive Technology (AT) is any product or service designed to enable independence for disabled and older people (Kings Fund consultation, 2001)o Includes a wide range of devices from „low tech‟ items such as calendar clocks to „high tech‟ items such as personal locator devices.o Telecare includes sensors (e.g. smoke, gas, flood or fall detectors) which automatically send a signal to a carer or monitoring centre to provide assistance when it is needed.o “Little plastic things to help NOT symbols of your independence disappearing” (Person with dementia)
Communicationo Programmable telephones and mobiles with large buttons and picture keyso Intercomso Conversation aids
Safetyo Automatic lightingo Gas, CO, smoke, extreme temperature detectorso Flood detectors, water temperature monitorso Movement & fall detectorso Activity monitoring deviceso Personal locator devices
Leisureo Easy to see and use radioo Simplified TV remote controlo Computer aidso Digital reminiscence
Benefits and limitationso Support date and time o May cause confusion or orientation distresso Support medication o May be damaged or broken compliance o Cannot eliminate all risko Reduce the risk of accidentso Improve quality of life and o One size does not fit all – confidence people have different abilitieso Help people to remain living at home for longer o Insufficient carers or care workers to respond to ano Provide reassurance and alert. support for carers o Cannot provide humano Alert a carer or monitoring contact and personal care centre that the person needs assistance. o Not the answer for everyone
Guiding principlesAssistive technology should be:o used to enable and support people with dementia to live more independentlyo considered following a holistic assessment of needo appropriate to the needs, ability, context and choice of the person with dementiao considered alongside issues such as informed consent and the principles of doing ones best for the person, avoiding harm and respecting rights and preferenceso considered alongside the use of other services, not as a replacement for human contact and care
Ethical issueso Are we in danger of doing more harm than good? Will equipment lead to more confusion or distress?o Is it of benefit the person with dementia, e.g. by enabling access to support or help?o Does it support the person‟s rights to self determination, freedom, and choice? E.g. if a sensor mat is used to help monitor falls risk would it be used just to tell the person not to walk or get up?o What are the views of everyone involved about the proposed action and the consequences of doing or not doing it? e.g. Do we agree about the level of risk (actual and perceived)?o How could the technology be used to help a person achieve things they are finding harder to do? How it can raise their quality of life and the quality of their relationships?
Ethical issueso Is the person compromising their safety in order to meet a need? E.g. going out at night because they are looking for social contact or something to do.o Does the situation really call for a technological solution? What are the alternatives? E.g. provide someone to walk with or something to occupy their time better.o Is the person with dementia at the centre of any decisions? The default position should be that they can give consent and to seek it.o Capacity to give consent is not something a person either has or does not have. It often depends on the situation and how the issue is presented.
What people say“My dad needs to know that he‟s still in control. I don‟t take things like dad‟s ability to make decisions away from him” (Carer)“I‟ve had professionals tell me trackers take away my civil liberties. What do they know? Its given me back my freedom.” (person with dementia)“Not being able to use technology can have a negative effect on confidence.” (Carer)
Case study 1: Jacko Backgroundo Elderly gentleman with a diagnosis of dementia who had recently been bereaved from his wifeo Number of reports from the neighbours that Jack was found outside during the day and evening in his pyjamas, disorientated and in need of reassuranceo His daughter, who lived outside the area, was visiting for an increased number of occasions during the week and was feeling increasingly distressed.
What happenedo Large print visual signs placed on the back of the front door informing Jack not to leave the house but to call his daughter or wait for the carers to visito Signs not effective in preventing Jack from leaving his home as they would go unnoticedo Consented to a trial of a wander „memo‟ reminder because of the concerns raised by his daughtero Message by his daughter asking Jack to stay indoors and wait for the carers to arriveo Wander reminder positioned at the front door and set on „Auto‟ to action at all times of the dayo Homecare staff able to check this daily so it did not cause any detriment to Jacko No reports from the neighbours that Jack had been seen wandering outsideo Reduced anxiety levels for Jack‟s daughtero Message is updated every 6 weeks to ensure it does not become too familiaro Effective in the short term but will need reviewing at regular intervals to ensure that it is still meeting Jack‟s needs.
Case study 2: KateBackgroundo 62 year old lady who has early onset dementiao Extremely active lady who goes out on a number of occasions each dayo Disorientated to the day and timeo Family have significant concerns that Kate is leaving her home at night and reports from her neighbour confirm thiso On occasions homecare arrive early in the morning and Kate is already out which means she can miss taking her medication and is skipping mealso Risk assessment highlighted an unknown prevalence of Kate leaving her home.
What happenedo „Memo‟ minder trialled in an attempt to reduce Kate‟s night time activityo Recorded with a familiar voice to inform Kate it was night time and not to go outo Programmed on a timer between 8pm and 8amo „Just Checking‟ motion detectors installed to track Kate‟s level of activity and frequency of her outdoor visits day and eveningo Trialled for a month assessment period.o Memo minder caused increased anxiety in Kate who continually turned off the deviceo Homecare workers tried to establish the reminder but she was unable to recall its purpose and threatened to throw it awayo Memo minder was removed once consent was questionedo „Just Checking‟ activity monitors did not cause any anxiety to Kateo Activity data was collected for a montho Information was used to arrange more effectively timed homecare visitso Also showed that Kate did not leave her home after four in the afternoon.
Things to think abouto What are the risks and benefits?o Are there better alternatives?o Will the person have to learn how to use it?o Does the person agree to use it?o How much will it cost?o Who pays for it?o Who will maintain equipment and charge batteries?
Useful resourceso AT Dementia: information about assistive technology for people with dementia, what products are available, where you can get them from and how much they cost www.atdementia.org.uko AT Guide: a self help guide for people with dementia and carers to find advice and product suggestions for everyday activities www.atdementia.org.uk/atguide
o Disabled Living Foundation: equipment for bathing, bedroom, stairs, seating and safety www.livingmadeeasy.org.uko Ricability: reviews of products for older and disabled consumers www.ricability.org.uko Disabled and Independent Living Centres: UK wide equipment advice and demonstrations www.assist-uk.orgo All about equipment: information, advice and links to get equipment www.allaboutequipment.org.uk