Educating Individuals With Dementia: Perspectives for Rehabilitation Professionals

Evaluation of the feasibility of an error-minimized approach to powered wheelchair skills training using shared control

BACKGROUND

Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population.

OBJECTIVE

The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT.

METHODS

A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinical outcomes).

RESULTS

Twenty-five older adults with cognitive impairment participated in the study. Technical issues were encountered in 14.5% of training sessions. Participants receiving 6 sessions of training adhered better to the treatment than those receiving 12 sessions. All participants learned the skills required for PWC use with minor errors, regardless of the training method or dose. Co-pilot participants and trainers reported feelings of safety and training benefits with the use of shared control technology.

CONCLUSIONS

Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required.IMPLICATIONS FOR REHABILITATIONShared control teleoperation technology may be used to augment learning in older adults with cognitive impairments.Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research.Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.

Differences in Transitional Care Provided to Patients With and Without Dementia

Older adults with dementia experience more care transitions than those without dementia yet are routinely excluded from transitional care studies. The purpose of the current study was to understand the transitional care delivered to older adults with dementia compared to those without dementia. The medical charts of 210 patients (126 with dementia, 84 without dementia) 70 years and older hospitalized at a single hospital were reviewed for evidence of transitional care, including discharge planning, patient education, and follow-up appointments. Patients with dementia were significantly less likely to receive education related to their follow-up needs, whom to contact after discharge, medication regimens after discharge, and symptoms after discharge than patients without dementia. Caregivers to patients with dementia have previously reported a desire for more education and information from hospital providers so they can advocate for patients in aftercare; therefore, nurses and social workers should consider providing education regardless of a patient's dementia diagnosis. [Journal of Gerontological Nursing, 45(8), 15-22.].

Feasibility RCT protocol evaluating a powered-wheelchair training program for older adults

Background.

Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs.

Purpose.

The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology.

Method.

A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected.

Implications.

Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments.

Learning and using technology in intertwined processes: A study of people with mild cognitive impairment or Alzheimer’s disease

People with mild cognitive impairment and Alzheimer’s disease are likely to be challenged by the multitude of everyday technology in today’s society. The aim of this study was to explore how they try to prohibit, avoid or solve problems in everyday technology use, maintain skills, and learn to use new technology. To explore how the participants applied and reasoned about using everyday technology in real-life situations interviews were conducted while the participants used their own technology in their homes. Interviews were conducted with 20 participants with mild cognitive impairment ( n = 10) or Alzheimer’s disease ( n = 10). The analyses were inspired from grounded theory and resulted in one core category and three sub-categories that represent sub-processes in the core. The core finding presents a continuous, intertwined process of learning and using everyday technology, highlighting how the context was interwoven in the processes. The participants used a rich variety of management strategies when approaching technology, including communication with the everyday technologies on different levels. The findings underscore that it is important to support continued use of everyday technology as long as it is valued and relevant to the person with mild cognitive impairment or Alzheimer’s disease. The intertwined process of learning and using everyday technology suggests how support could target different sub-processes.

Perceived barriers to self-management for people with dementia in the early stages

People with dementia in the early stages currently experience a care gap, which self-management may address. We explore perceived barriers to self-management. Using a systematic approach (logic mapping), 19 participants (people with dementia, carers, health care professionals and charity representatives) described self-management barriers facing people living with dementia. Thematic content analysis revealed six main themes: the lived experience of dementia, diagnosis, role of carer/family, impact of health care professionals, organisation of health services and societal views. People with dementia were seen as passive recipients of care, unable to self-manage owing to the impact of dementia on cognitive abilities. The need for interventions that are largely emotion focused, encourage activity maintenance and improve quality of life are described. Barriers to self-management exist at multiple levels, suggesting a whole-systems approach is required.