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


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 • November 2018

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