[Wherton 08] - IDRG 05.18.10

J. Wherton and A. Monk, "Technological opportunities for supporting people with dementia who are living at home," International Journal of Human-Computer Studies, vol. 66, 2008, pp. 571-586.

• abstract
  • grounded theory analysis of interview transcripts with dementia patients + caretakers; discussed ADLs: dressing, taking medication, personal hygiene, preparing food, socialising; design challenges for flexible prompting systems sensitive to intentions, capabilities, values of users;

• intro
  • problem domain - users w/ impaired episodic memory, parallel deficits in exec. function; past efforts to address this area in pervasive computing + sensing have involved computer vision, RFID tags; affecting ADLs
  • exec functioning: sequencing, omissions, action additions, concurrent task performance;
  • impairment to attentional control processes - problems more likely w/ novel procedures; occupational therapy solution: procedural memory stimulation, environmental cues to support action, independence achieved through environmental manipulations, making task-relevant items more visible
  • stress need of naturalistic methods of assessment
  • temporal and spatial orientation: visual cues - flowcharts, calendars; reality orientation therapy - use of large signposts, signs on drawers and cupboards + verbal prompts + cues; extended w/ use of technology - large digital clocks; ENABLE project: activity compass, portable orientation + GPS, verbal prompts to return home;
  • prompting actions: prompt at designated times to support schedule keeping, sensors to guard against accidents;
  • less clear what people w/ dementia and their caregivers want from the technology - what tasks are most important to them? what difficulties are most hard to find non-technological workarounds for? what tasks would their caregivers rather not do for the people they care for?

• study rationale + method
  • 2 small sample interview (opportunistic) - #1 w/ OTs and care workers (20 participants - 11 in focus group, 9 interviews); #2 w/ 18 participants (8 PwDs, 10 caregivers) in home environments; studies not methodologically equivalent, but maximally informative; grounded approach to characterise data - to elicit ideas for technological interventions; concepts grouped to from main categories and component sub-categories (axial coding)

• results - study 1 - fig. 1
  • problems in the home: daily activities (dressing, medication, food/drink, washing, toilet), risks (cooker safety, wandering), interpersonal interaction (communication, recognising people);
  • underlying deficits: sequencing (initiating and ordering actions, problem solving), learning (appliances, surroundings), memory/orientation (forgets events, forgets to do things, orientation to time/place, recognising objects)
  • consequences: PwD: physical wellbeing (safety, security, health), control (personal space, achievement, social isolation), caregiver: patient-caregiver relationship: relationship (interaction, frustration), care demands (constant supervision, anxiety)
• results - study 2 - fig. 2
  • problems in the home: daily activities (dressing, medication, food/drink, washing, toilet), domestic (washing-up, locking-up, ironing, cleaning), leisure (TV, loss of interests) (not mentioned in study 1), interpersonal interaction (conversing, telephone, appointments);
  • situated factors: verbal cues (prompts, notes), visual cues (display items, items visible), familiarity (surroundings, appliances, routines);
  • underlying deficits: sequencing (formulating procedures, becomes motionless), memory/orientation (forgets events, forgets to do things, locating items, knowing the time, finding their way)
  • consequences: PwD: physical wellbeing (safety, security, deterioration), control (personal space, stress, filling time - boredom), caregiver: patient-caregiver relationship: relationship (confrontation, frustration), care demands (tiredness (not among professional caregivers), worry)

• discussion
  • high-level characterisation of results useful for engineers and others new to the area
  • extracted parts of the transcript: suggestions for technological interventions

• discussion - dressing
  • no existing products to help one get dressed
  • provide prompts?
  • how to monitor state of dress of PwD? RFID tags?
  • have items been put on appropriately? appropriate choice of clothes for season / occasion?

• discussion - medication
  • tools exist to automatically dispense medication appropriately
  • has medication been swallowed?
  • call-centre operative to call throughout the day?
  • ripe for future research
  • intelligent toilets for monitoring medication compliance?

• discussion - food and drink
  • cooker safety (i.e. leaving on the stove)
  • cooking tasks too complex to manage alone
  • problems in making a hot drink - for oneself and for visitors (self-esteem issue and sense of personal role + status)
  • safety:
    • cooker: lockable gas shut-off for detecting emergencies in kitchen such as extreme temperature? - rely on automated feedback from PwD / caregiver;
    • can pervasive computing techniques be used to infer how an incident arose and choose between alternatives
    • call centre operator?
    • dangerous for use w/ some PwDs
  • prompting + preparing:
    • no commercially available systems for prompting through process of multi-step task such as making a hot drink; clear objective for research
    • RFID utensils? large screen in kitchen cupboards?
    • how to detect completed actions? how to prompt?
  • measuring quantities (i.e. baking)?

• discussion - washing
  • automatic water shut-off?
  • system exists for prompting through hand-washing process? detecting when actions out of sequence;
  • showering? bathing? brushing teeth? grooming?

• discussion - toilet
  • massive research agenda here - flexible automated systems that are acceptable to PwDs;

• discussion - possibilities for support w/ technology:leisure + interpersonal interaction
  • difficulty in recognising and communicating w/ others - detrimental effect on social interaction and maintenance of social networks;
  • PwDs show decline in personal interests
  • limitations on socialising and entertainment lead to feeling of loneliness and boredom
  • design issue: safety has been higher priority than product development;
  • recreationally oriented technology - "social memory aid"
  • MS SenseCam - life-logging
  • leisure and socialising: have not yet found a niche for older people or PwDs

• discussion - possibilities for support w/ technology: preventing and mitigating consequences
  • devices may alert a call centre or relative if they leave the dwelling
  • uncertain about guests: if nervous about a caller, householder can alert the call centre who can advise them what to do and if necessary record the ensuing conversation;
  • recording the activities of elder living alone using sensor technology - provide peace of mind for extended family living in a remote home?
    • reducing the anxieties of informal caregivers when PwD is left alone
  • communication rather than monitoring? more acceptable way of providing assurance needed by PwD and caregiver - privacy for ageing in place

• discussion - constraints on design
  • PwDs and technology
  • adapting to new appliances, environments, routines
  • problems w/ novelty - optimise user familiarity, make perceptually similar to other devices, attaching device to appliances already owned by PwD - familiarity can only be achieved up to a certain point;
  • evidence that people w/ severe dementia can cope w/ novel interactions and technology
  • present affordances for action - do what the message says, touch this picture), does not require learning of multi-step procedures; provide visual cues; Norman: different visual representations can implicitly guide the user's actions and can be justified by psychological theory;
  • exploit visual and tactile cues?

• conclusion
  • collection of challenges to tech. designers
  • contextual account of everyday problems; captures POV of PwD and informal caregivers

• IDRG discussion points:
  • curb-cut effects?
  • opportunities for haptics? affect loop? large-screen displays? table-top displays? robotics? mobile devices? machine learning? intelligent user interfaces?
  • implications w.r.t. privacy for ageing in place?
  • avoiding call-centre interventions?

[Moffat 10]

[Zhai 04]

• comment: from Karyn Moffatt's thesis: documents user performance differences between five wordings of speed/accuracy task instructions for a Fitt's-like task.

• J. Birnholtz and M. Jones-Rounds, "Independence and Interaction: Understanding Seniors' Privacy and Awareness Needs For Aging in Place," Proceedings of the 28th international conference on Human factors in computing systems - CHI '10, 2010, p. 143.

• J. Bauchet, H. Pigot, S. Giroux, D. Lussier-Desrochers, Y. Lachapelle, and M. Mokhtari, "Designing judicious interactions for cognitive assistance," Proceeding of the eleventh international ACM SIGACCESS conference on Computers and accessibility - ASSETS '09, 2009, p. 11.

• M.L. Lee and A.K. Dey, "Providing good memory cues for people with episodic memory impairment," Proceedings of the 9th international ACM SIGACCESS conference on Computers and accessibility - Assets '07, 2007, p. 131.

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• A. Mihailidis, J. Boger, M. Canido, and J. Hoey, "The Use of an Intelligent Prompting System for People with Dementia," interactions, 2007, pp. 34-37.