Dementia care

Assistive monitoring and way finding strategies

Dr Ghasson Shabha, Dr Bisola Mutingwende and Dr Kristi Gaines, describe their recent work to investigate the latest developments in incorporating assistive technology and way finding design strategy in to residential care homes and specialist health facilities

This article will consider the cognitive impairments that are associated with dementia, focusing on the operational challenges involved in caring for people with the condition. The aim is to develop an holistic context-based monitoring system that focuses on wellbeing and environmental safety and initiating an action plan to alert care staff when a safety threshold has been breached. This might include controlling hot and cold water valves and operating fall censors, smoke and fire alarms. It will also assess the efficacy of key technologies and design interventions in managing daily living activities in various settings. Dementia is a debilitating multi- facetted neurocognitive impairment and it is estimated that the condition affects more than two-thirds of care home residents in the UK. Key features of dementia include: memory loss; aphasia (inability to speak); apraxia (disorder of motor planning and clumsiness); agnosia (inability to recognise shapes, objects and individuals); and executive dysfunction, which affects planning, sequencing, monitoring and decision making. Other cognitive impairments include spatial disorientation attributed primarily to memory loss1

and dyspraxia, which is

a form of development co-ordination disorder affecting both fine and gross motor skills and is characterised by poor eye contact and visio-spatial dysfunction.2 While development co-ordination disorder is often regarded as an umbrella

term to cover motor co-ordination difficulties, dyspraxia implies additional problems in relation to planning, organising and carrying out movements in the right order in everyday situations. It can also affect articulation and speech as well as perception and thought. Dementia-specific changes in orientation strategies are attributed to a loss of planning ability and spatial understanding, which can result in a person with the condition getting lost in unfamiliar surroundings. A lack of orientation strategies can lead to a loss of direction in the wider built environment.3,4 Such deterioration is detailed in stage three of the Global Deterioration Scale.5

Dementia-specific changes in orientation strategies are attributed to a loss of planning ability and spatial understanding, which can result in a person with the condition getting lost in unfamiliar surroundings

November 2018 •

Cognitive impairments associated with dementia affect the activities associated with daily living and occupational performance both indoors and in the wider built environment. This is particularly true in relation to way finding, navigation and orientation. They therefore significantly increase the risk of a trip or fall. It is estimated that one-third of people aged over 65 and half of those aged over 80, fall at least once a year and falls are the most common cause of death from injury in the over 65s.6

Assistive technologies A wide range of assistive technologies have been developed over the past 10 years. These include any item, piece of equipment or system that is used to increase, maintain and improve functional capabilities and independence in people with cognitive, physical or communication difficulties, from jar openers to bath seats and stair lifts. Assistive technology that is linked to a telephone network is described as ‘telecare’, which suggests that monitoring is undertaken over a distance using smart


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