Designing leisure products for people with dementia: developing ''the Chitchatters'' game

A thematic review on therapeutic toys and games for the elderly with Alzheimer's disease

PURPOSE

Alzheimer's disease (AD) is a common and devastating neurological ailment that affects millions of the elderly worldwide. Therapeutic toys and games have emerged as potential non-pharmacological interventions for AD. However, despite a growing number of documents on the subject, research on the future direction of therapeutic toys and games for AD remains scarce. To address this gap, this study aims to (1) map the future trends of therapeutic toys and games for AD and (2) identify the categories and design characteristics.

MATERIALS AND METHODS

Using a thematic review framework, a systematic literature search was conducted in two electronic databases (Scopus and WoS) using established criteria. Thematic analysis was done using ATLAS.ti 23 to identify prominent themes, patterns and trends.

RESULTS

A total of 180 documents were found. Twenty-five articles met the inclusion criteria. A thematic review of these 25 articles identified 13 initial codes, which were been clustered into four themes: detection and evaluation; intervention; toy/game category; and design characteristics. The word "Cognitive" appears most frequently in documents according to word cloud.

CONCLUSIONS

Therapeutic toys and games are used to detect and as an intervention for AD. Most of the current studies focused on specific cognitive functions. More research is needed about play therapy for neuropsychiatric symptoms. This thematic review also proposed a conceptual framework for designing toys and games tailored to the needs of the elderly with AD, offering valuable insights to future researchers focusing on this domain.

Homing wellness: can narrative design transform living spaces for people with dementia into engaging environments enabling communication?

Interactive design is an emerging trend in dementia care environments. This article describes a research project aiming at the design and development of novel spatial objects with narrative attributes that incorporate embedded technology and textiles to support the wellbeing of people living with dementia. In collaboration with people with dementia, this interdisciplinary research project focuses on the question of how innovative spatial objects can be incorporated into dementia long-term care settings, transforming the space into a comforting and playful narrative environment that can enhance self-esteem while also facilitating communication between people living with dementia, family, and staff members. The research methodologies applied are qualitative, including Action Research. Participatory design methods with the experts by experience-the people with dementia-and health professionals have been used to inform the study. Early findings from this research are presented as design solutions comprising a series of spatial object prototypes with embedded technology and textiles. The prototypes were evaluated primarily by researchers, health professionals, academics, and design practitioners in terms of functionality, aesthetics, and their potential to stimulate engagement. The research is ongoing, and the aim is to evaluate the prototypes by using ethnographic and sensory ethnography methods and, consequently, further develop them through co-design workshops with people living with dementia.

Reflecting on Living Labs as Multi-Stakeholder Collaborative Networks to Evaluate Technological Products for People Living with Dementia

Dementia is a growing societal challenge putting pressure on care systems across Europe. Providing supporting technology for people living with dementia, referring to both people with dementia and their caregivers, is an important strategy to alleviate pressure. In this paper, we present lessons learned from the Interreg NWE Project Certification-D, in which we evaluated technological products with people living with dementia, using a Living Lab approach. Living Labs were set up in five different countries to conduct field evaluations at the homes of people living with dementia. Via an open call products from small to medium enterprises across northwestern Europe were selected to be evaluated in the Living Labs. In this paper, we describe the setup of and reflection on Living Labs as multi-stakeholder collaboration networks to evaluate technological products in the context of dementia. We reflect on the experiences and insights from the Living Lab researchers to execute and operate the Living Labs in such a sensitive setting. Our findings show that Living Labs can be used to conduct field evaluations of products, that flexibility is required to adopt a Living Lab in various care settings with different stakeholder compositions and expertise, and that Living Lab researchers serve as both a linking pin and buffer between people living with dementia and companies and thereby support the adoption of technological products. We close the paper with a proposal of best practices to encourage inclusivity in, and scalability of, Living Labs in the context of dementia.

Active Involvement of People with Dementia: A Systematic Review of Studies Developing Supportive Technologies

Although there are promising benefits of supportive technology in dementia care, use of these technologies is still limited. It is challenging for researchers and developers in this field to actively involve people with dementia in development. This review updates and builds on existing knowledge by including a contemporary and relevant perspective. This perspective was gained by including search words and search databases from the field of Human Computer Interaction (HCI) and Design, as these fields were expected to supply novel insights in the complex task of actively involving people with dementia in developing supportive technologies. A total of 49 out of 3456 studies were included which describe the development of a great variety of technologies. Often people with dementia were involved in the generative or evaluative phase of the development. Interviews and observations were most commonly used methods. In seven articles the people with dementia were co-designers. This literature review reflects that people with dementia can influence the development of technology in regards to content, design, and even the initial idea, although the impact on how they experience their own involvement remains largely unknown. There is a lack of specific knowledge on appropriate methods and materials for active involvement of people with dementia in supportive technology development, even when including articles from the field of HCI and Design. Future research is needed to further appreciate and improve the desired role of people with dementia in meaningful technology development.

Personalising Management of Behavioural and Psychological Symptoms of Dementia in Nursing Homes: Exploring the Synergy of Quantitative and Qualitative Data

Researchers have been exploring how to manage Behavioural and Psychological Symptoms of Dementia (BPSD) in a personalised way, meanwhile, assistive technologies have been developed to collect a variety of personal data. This urges more research in investigating the combination of: data collected by the care team, which are mainly qualitative; and data collected by assistive technologies, the majority of which are quantitative. Previous studies, however, have yet to explore if and how a combination of quantitative and qualitative data could facilitate the care team to better understand each resident with dementia in the nursing home context for personalised BPSD management. Guided by a Research through Design approach, a prototype for collecting and visualising the quantitative and qualitative data towards personalised BPSD management was developed together with the care team. Via developing this prototype, knowledge was gained in what types of data could be combined for personalised BPSD management in nursing homes, what are their values, how to collect and present them, and how to introduce them in the working routine of the care team for analysis. The main findings suggest that the types of data to be collected could be unique for each resident with dementia; the quantitative and qualitative data are of value to each other during data collection and analysis; data collection should be quick and standardised yet flexible for the care team; the overview page is vital for data presentation; and user scenarios could be created to nudge the care team to analyse the data at certain points of their working routine. In general, a combination of qualitative data and quantitative data could help the care team to discover more insights about each resident with dementia and thus improve the current practice of personalised BPSD management.

Engaging in Preferred Computer Activities and Cognitive Outcome

Valuing an individual's choice in activities is important in person-centered dementia care. This study examined changes in cognitive function among long-term care residents with dementia, following engagement in preferred computer activities. Over a seven-week period, a total of 585 observational activity-monitoring logs from 26 participants were collected. The most frequently selected computer activities were playing computer games and watching audio-visual media. Cognitive function significantly improved more in participants who spent more than 580 minutes on computer activities than those who spent less. A regression analysis showed that time spent in playing computer games was the only predictor to explain changes in cognitive function. The findings suggested that engaging in preferred computer activities may not only be meaningful and enjoyable but also promote cognitive function.

Engaging people with dementia in designing playful and creative practices: Co-design or co-creation?

Stimulating active, social interactions for people with dementia is an important and timely challenge that merits continuing attention in design research. The idea of using participatory co-design to engage people with dementia is attracting increased interest. In this paper, we draw on our qualitative study that used a playful, participatory arts approach to explore the ways co-design could be implemented in a group of 12 people with dementia and their carers, and developed practical recommendations, in the form of a set of playing cards, for other researchers and caregivers to work in similar ways. The emphasis is on the value of play and playfulness, providing a ‘magic circle’ (Huizinga, 1955) that fosters the required conditions for a co-creative, co-design space. This aims to encourage social interaction between people with dementia, to stimulate imagination and creativity; and engage even the most the reticent, less confident members. Our observations, however, suggest that the exact notion and nature of co-design within the context of working with people with dementia is unclear. We critically explore whether such participatory creative practices that engage people with dementia can be considered as purely co-design. In conclusion, we argue that such interaction is better described as co-creation and that this definition can still embrace considerable contribution and involvement by people with dementia in a co-design process.

Computer Activities for Persons With Dementia

PURPOSE OF THE STUDY

The study examined participant's experience and individual characteristics during a 7-week computer activity program for persons with dementia.

DESIGN AND METHODS

The descriptive study with mixed methods design collected 612 observational logs of computer sessions from 27 study participants, including individual interviews before and after the program. Quantitative data analysis included descriptive statistics, correlational coefficients, t-test, and chi-square. Content analysis was used to analyze qualitative data.

RESULTS

Each participant averaged 23 sessions and 591min for 7 weeks. Computer activities included slide shows with music, games, internet use, and emailing. On average, they had a high score of intensity in engagement per session. Women attended significantly more sessions than men. Higher education level was associated with a higher number of different activities used per session and more time spent on online games. Older participants felt more tired. Feeling tired was significantly correlated with a higher number of weeks with only one session attendance per week. More anticholinergic medications taken by participants were significantly associated with a higher percentage of sessions with disengagement. The findings were significant at p < .05. Qualitative content analysis indicated tailoring computer activities appropriate to individual's needs and functioning is critical. All participants needed technical assistance.

IMPLICATIONS

A framework for tailoring computer activities may provide guidance on developing and maintaining treatment fidelity of tailored computer activity interventions among persons with dementia. Practice guidelines and education protocols may assist caregivers and service providers to integrate computer activities into homes and aging services settings.

Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox between needing and accepting help

BACKGROUND

Early individualized interventions for informal dementia caregivers can prevent overburdening in the later stages. However, the needs of early-stage dementia caregivers (EDC) remain largely unknown. This study aimed to explore the needs and wishes and need for care of EDC to maximize the benefit of potential programs for EDC and tailor interventions accordingly.

METHODS

Four focus group interviews with 28 informal caregivers of people with dementia (PwD) were analyzed using inductive content analysis. Both EDC and caregivers in the later stages were included to compare perceived EDC needs from different points in the caregiver career.

RESULTS

Four themes were identified: the early-stage needs paradox, barriers in acceptance, facilitators in acceptance, and a transition from loss to adaptation. The retrospective view provided by later-stage caregivers differed from the view of EDC; EDC struggled with acknowledging needs due to fear of stigma and low acceptance. EDC stressed the importance of acceptance as a prerequisite for adequate adaptation, but were hindered by lack of knowledge, difficulty acknowledging changes, and focus on loss. In contrast, better understanding of the disease, increasing personal time, structuring ones day, and using appropriate humor can reduce negative communication, increase positive encounters and caregiver-confidence, contributing to positive interaction with the care recipient and an increase in well-being.

CONCLUSIONS

Early therapeutic interventions could help caregivers identify their needs, increase knowledge about changes in roles and relationship reciprocity, and focus on enhancement of the positive, intact experiences to prevent caregiver burden.

Innovations in multidisciplinary education in healthcare and technology

The growing importance of technology in health care calls for interdisciplinary study programmes in which students with various backgrounds work together in exploring and designing new solutions for real-life problems. The Centre of Healthcare and Technology of Fontys University of Applied Sciences (Fontys EGT), the Netherlands, is presented as an example of how new initiatives in the field of education at the crossroads of health care and technology can be shaped and implemented in practice. A case study illustrating one of the student projects is provided as an example of the approach to educational innovation and interdisciplinary collaboration.

Preferred computer activities among individuals with dementia: a pilot study

Computers offer new activities that are easily accessible, cognitively stimulating, and enjoyable for individuals with dementia. The current descriptive study examined preferred computer activities among nursing home residents with different severity levels of dementia. A secondary data analysis was conducted using activity observation logs from 15 study participants with dementia (severe = 115 logs, moderate = 234 logs, and mild = 124 logs) who participated in a computer activity program. Significant differences existed in preferred computer activities among groups with different severity levels of dementia. Participants with severe dementia spent significantly more time watching slide shows with music than those with both mild and moderate dementia (F [2,12] = 9.72, p = 0.003). Preference in playing games also differed significantly across the three groups. It is critical to consider individuals' interests and functional abilities when computer activities are provided for individuals with dementia. A practice guideline for tailoring computer activities is detailed.

What can low and high technologies do for late-life mental disorders?

PURPOSE OF REVIEW

To identify and review the latest research in the use of low and high technology in the areas of mood disorders, psychosis, normal ageing, mild cognitive impairment and dementia.

RECENT FINDINGS

Technology use varied in type and extent of use across the different areas that have been reviewed. Telepsychiatry, internet-delivered therapy programs and bright-light therapy were used in managing symptoms associated with depression. In psychosis, multisensory therapy, reminiscence and virtual cognitive stimulation showed some benefits. Navigation aids and computerized diaries assisted in maintaining independence in the normally ageing and mildly cognitively impaired, although the benefits of cognitive stimulation are yet to be consistently established. By far, dementia technology received the most research attention. Benefits in this population included reductions in behavioural and psychological symptoms and carer burden and increased independence, task engagement and safety.

SUMMARY

Research in the use of low and high technology in late-life mental disorders continues to evolve in its scope and innovation. To progress the accessibility and acceptability of technology, involvement of stakeholders and users in the design and application, as well as examination of cost-effectiveness and robust methodologically designed studies are necessary.

Environmental interventions and the design of homes for older adults with dementia: an overview

In Western societies, the vast majority of people with dementia live at home and wish to remain doing so for as long as possible. Aging in place can be facilitated through a variety of environmental interventions, including home modifications. This article provides an overview of existing design principles and design goals, and environmental interventions implemented at home, based on literature study and additional focus group sessions. There is a multitude of design principles, design goals, and environmental interventions available to assist with activities of daily living and functions, although few systematic studies have been conducted on the efficacy of these goals and interventions. The own home seems to be a largely ignored territory in research and government policies, which implies that many problems concerning aging in place and environmental interventions for dementia are not adequately dealt with.