Dementia care


sensors. Assistive technology appears to be beneficial in improving cognitive function, supporting short term memory and improving medication adherence. It has been suggested that such devices could enable individuals to stay in their own homes for longer and reduce the need for service support.7


Some systems are based on the observe-monitor-alarm model, which highlight potential trip, slip and fall risks. The effectiveness of a multisensory environment in people’s own homes was explored by Riley-Doucet et al,8


the technology made people calmer and more relaxed and reduced stress, it did


Table 1. Behavioural, cognitive and communication indicators


Key signs and symptoms Key impairments of deterioration: behavioural/ in dementia


cognitive/communication interventions


Interaction fluctuations in integrated and assistive devices and appliances.


Short term memory, CCTV monitoring which includes both encoding and


It is imperative these should information retrieval be differentiated from


Difficulty learning


outcomes relating to care new skills management or comorbid conditions (such as depression or pain)


Change in gait and posture Mobility and joint problems


Poor peripheral and central vision


Confusion, disorientation and Memory loss getting lost


Wandering and walking aimlessly


(short term) Dyspraxia


Memory loss leading


Gait sensors and accelerometers Visual cuing


Physiotherapy Physical education


Way finding Way finding and navigation sensors,


to dysfunctional spatial spatial memory orientation


Trips and falls General deterioration


prompts and cognitive mapping


Gait sensors and


of movement, arthritis, accelerometers not motor neuron dysfunction,


autoimmune dysfunction physiological root Apraxia (disorder of motor planning and clumsiness)


and recommend training or


rehabilitation, for example, to encourage greater flex of hips to cater/compensate for weak ankles


Clumsiness, knocking objects Executive dysfunction Way finding and over


including planning, Incoherent and intermittent Aphasia


verbal expression or lack of (inability to speak) communication


sequencing, monitoring management and decision making


Picture exchange Talking Mats


Note: Talking Mats is a low technology communication framework that was developed at the University of Stirling to help people express their views. Using picture symbols and a textured mat, it enables people to indicate their feelings by placing the relevant image below a visual scale


22 signposting and clutter


only predict falls, but determine the


of physiological and behavioural symptoms


Assistive technologies and design


but while


not provide respite from caring. Mainly due to a lack of rigorous testing of many off the self assistive technology devices, it is more difficult and less cost effective for individuals to integrate them into their everyday lives. Installation can also be costly.9


Apart from a prohibitively


high purchase price, operation, repair and maintenance costs can also be a major impediment to reliable operation. This is particularly true given the gradual decline in wellbeing and cognitive abilities seen in people with dementia, which are also part of the aging process. These include deteriorating sight, hearing and fine/gross motor co-ordination due to underlying medical conditions such as arthritis and joint and muscle dysfunction, which lead to mobility problems alongside cognitive capacity and memory loss.


Training issues as well as socio- economic factors suggest the need for interactive learning and devices that can be adapted to improve functionality and meet the changing needs of people with dementia. Most technology is piloted on a limited scale without assessing long term efficacy in a real life situation, which can have a significant impact on development costs.


Navigation and orientation The visio-spatial environment is critical in dementia care due to declining memory function and wellbeing. In cases of cognitive impairment, neurodegeneration leads to the decreased ability to encode and retrieve new information, resulting in spatial memory impairment. Such impairment primarily affects way finding, navigation and orientation, ie knowing where you are and remembering where you are going. Disorientation can make it difficult for someone with dementia to lead an independent life.10


Four prerequisites for successful way finding were identified by Marquardt11


as:


the ability to process spatial information; the ability to process sensory information (ie visual olfactory, auditory and tactile); the ability to navigate; the ability to process, encode and retrieve/recall sensory information. The condition is multi-dimensional and multi-faceted both in terms of its causes and the symptoms experienced. Given the deterioration seen in people with dementia due to the aging process alongside visual and sensory impairments, physical and cognitive abilities can be hindered and become significantly limited and reduced. Various interventions to improve way


www.thecarehomeenvironment.com • November 2018


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