A recent article discusses the lack of activity and boredom reported by persons with dementia
( PWD ) in long term care facility (Harmer et al, 2008). Therefore, it is crucial to engage them in meaningful activities as they can increase positive emotions (Leng, 2014) and thereby increasing one’s quality of life, even after the diagnosis of dementia.
With rapidly aging society and shortage of healthcare staffing in Singapore, there has been a growing demand to explore the use of touchscreen technology as a non-pharmacological intervention to engage dementia clients in nursing homes. Since 2012, several nursing homes have piloted iPad projects of various design constructs in hope to improve quality of life of persons with dementia ( PWD ) living in the care home. Based on the literature review on the use of Touchscreen Technology for persons with dementia ( PWD ), there are only a handful of studies available at the moment. On an overview, these studies suggested the potential of iPads in expanding conversations, increasing depth of memories, improved subjective well-being and the well-being of formal caregiver.
Upon implementing iPads engagement projects in several dementia facilities in Singapore, below are my considerations when initiating iPads for dementia clients.
Consideration 1: Subtypes of Dementia
As different subtypes of dementia present different set of clinical symptoms, for a start, it is recommended to consider trialling for clients with Vascular Dementia or Alzheimer’s Disease. Majority of the Vascular Dementia ( VD) clients and Alzheimer’s Disease clients ( AD ) will have visual perceptual skill sets ( an important prerequisite skillset for iPAD interventions ) relatively preserved until later stages of the disease ( McGuiness et al, 2010).
In addition, as long as one is relatively oriented to his/ her sense of space and time, with a reasonable amount of sustained attention span, persons with dementia will be able to meaningfully engage in a simple, highly intuitive, carefully selected game applications upon weeks of graded, consistent exposure to touchscreen interventions.
Consideration 2 : Know your patients, well
A thorough understanding towards persons with dementia is half the battle won. Occupational Therapists can explore using Life History Profile to complement a holistic understanding clients' life histories, likes, dislikes and routines of the client under your care. It would be helpful to gather inputs from family members of person with dementia favorite past times prior to enrollment in your center. With these information at hand, it will be useful to filter the irrelevant apps to the clients and is helpful in facilitating the right selection of applications.
Consideration 3 : Physical and Social Environment
Physical Environment :
Keep the noise level low during touchscreen sessions as environments with high noise level are highly distracting. Quiet environment and sufficient, even lighting are highly recommended.
Social Environment:
Having the right social dynamic is half the battle won too. From our experiences, both individual sessions and group settings are therapeutic. If the client demonstrates a certain preferences to games applications not to the generic liking to other clients, individual setting might be preferred over group session. It is worthy to note that having the right selection of participants is synergistic towards promoting high level of activity engagement while a poor selection of participants might lead to unfavorable outcomes.
Consideration 4: Interface Design and the Best-suited Applications
While there are various screen dimensions, we have trialed 2 dimensions of touchscreen devices, 8 inch and 10.1 inch. Generally, bigger screens are better and promotes better engagement. In regards to the best-suited apps for persons with dementia, with millions of applications available in App store, careful selection of applications are essential to facilitate meaningful engagement among persons with dementia.
Most interfaces of the applications made available in app store are not senior- friendly. Among all, its fast- moving graphics, the use of avatars and voice-overs might not promote engagement. Therefore, from our experiences, general guidelines to facilitate our selection of application includes: clean interfaces, optional features ( flashing/ sound feature etc ) , contrasting colors and lastly but not the least, applications which are relevant to the value system and culture of the users.
Conclusion:
In view of its relatively low-start up costs, highly customize-able, highly versatile, intuitive design and the vast availability of applications, touchscreen interventions have enormous potential in improving quality of lives of persons with dementia in the care homes. As healthcare workers, particularly Occupational Therapists working in care homes, it is about time to explore the use of this intervention in greater depth as we continue to make a difference in the lives of others in our community.
References:
Harmer BJ, Orrell M. What is meaningful activity for people with dementia living in care homes: A comparison of the views of older people with dementia, staff and family carers. Aging Ment Health. 2008 Sep;12(5):548–58.
McGuinness B, Barrett SL, Craig D, Lawson J, Passmore AP. Attention deficits in Alzheimer's disease and vascular dementia. J Neurol Neurosurg Psychiatry. 2010;81(2):157–159.
Leng FY, Yeo D, George S, Barr C. Comparison of iPad applications with traditional activities using person-centred care approach: impact on well-being for persons with dementia. Dementia (London) 2014 Mar 1;13(2):265–73.
Weir AJ, Paterson CA, Tieges Z, MacLullich AM, Parra-Rodriguez M, Della SS, Logie RH. Development of Android apps for cognitive assessment of dementia and delirium.