Abstract:
For people living with dementia, technology is traditionally not at the forefront of possible interventions. But the times they are a-changing! Technology, in various flavors, can have a dramatic impact in an individual’s quality of life, as well as for family and professional caregivers, when accompanied by clinical intervention. This article will give a perspective spanning more than two decades of how these technologies have evolved and the benefits that now are possible. The world has dramatically changed with the adoption of technology—there is no reason that people living with dementia should be left out of the revolution.
Key Words:
technology, dementia, caregivers, long-term care, engagement, joy
The exponential growth of older adults embracing technology is unparalleled. According to a recent Pew Research Center survey (Faverio, 2022), 75% of those ages 65 and older report being internet users, and 61% of that same cohort have a smartphone. However, the data usually focuses on independent older adults, not individuals living with dementia. This article will provide a different perspective, i.e., that individuals living with dementia may have the most to gain through the use of various readily available technologies. There are multiple technologies available to be discussed, including technologies geared toward clinical outcomes, fall prevention, remote monitoring, engagement, etc., with more appearing seemingly every day.
My perspective, as one of the founders of an engagement technology company (iN2L), has dramatically shifted since 1999 when we opened our doors. I had worked in Silicon Valley for almost 20 years and understood technology from a traditional consumer context. But my partners and I had no experience in engagement technology, in senior living, or in the world of dementia. At that point, technology was just taking off as the internet was coming to life.
But technology was not at the forefront in the aging field, much less used as a way to engage people with dementia. However, as the years progressed our customers taught us the transformational power that technology held for people regardless of their physical or cognitive abilities. Granted, it was anecdotal and observational evidence, but the engagement levels (and the smiles) were tangible and powerful. Those observations altered my perspective of the power of technology for people living with dementia, and fundamentally shifted the direction of our company.
Today, two decades later, evidence-based research and multiple technology options (to be articulated later in this article) abound. In 2020, we at iN2L realized the need to add a research component to our work. We hired Dr. Lydia Nguyen, a neuroscientist with expertise in neurocognitive aging, neurodegenerative diseases, and technology-based interventions, to lead our research efforts.
As Dr. Nguyen explains, “research has shown that technology can be incredibly valuable for both the person living with dementia, as well as their caregivers in a multitude of ways. Technology can help fight social isolation and loneliness by enabling easy connections and enhancing interactions. It can provide person-centered engagement by taking into account individual’s interests, preferences, and needs. This engagement can inspire joy and relaxation, stimulate reminiscing, fight boredom, redirect behavioral expressions like agitation or aggression, and alleviate stress and feelings of sadness. Technology can also provide caregivers with a vital lifeline to information, resources, advice, and supports (e.g., support groups). The possibilities are seemingly endless.”
‘Technology can also provide caregivers with a vital lifeline to information, resources, advice, and supports.’
Later the article will delve into examples of technology shown to be beneficial for individuals living with dementia. But it’s also wise to look at free, readily available tools that can have dramatic impact for older adults living with dementia and their caregivers. We have seen pronounced benefits from simple applications available on the internet or as part of off-the-shelf computer technology. Examples include: using Google Earth to zoom in on a person’s childhood home, setting up customized playlists on Spotify, running off-the-shelf flight simulators, and more. Often, it’s not necessary to look for new technologies, as it’s relatively easy to repurpose what is already in use.
There is no one-size-fits-all technology solution for dementia. What’s appropriate in the early stage of the disease may not be as appropriate for someone in the later stages. But solutions exist for all, though in many cases caregivers need to be actively involved in the implementation.
Majd Alwan, former executive director of LeadingAge’s Center for Aging Services Technologies (CAST), directed me to the work he was involved in when helping construct the Aging Services Technology Study Report to Congress (LeadingAge, 2012). An excerpt from that publication speaks to technology and cognitive decline issues in general:
“Technologies addressing cognitive impairments target a variety of problems. Most of these are directed at residents and caregivers in the community. In general, technologies aimed at prevention target healthy, aging adults who want to stay mentally fit. Typically, these technologies seek to maintain or improve existing cognitive function through training exercises. Technologies focused on detection of cognitive impairments and/or decline target adults with normal cognitive aging as well as persons with dementia. These technologies focus on identification of behavioral, cognitive, or physical symptoms of cognitive impairment and decline, and are intended to help users maintain independence, assist caregivers, and inform care. Intervention-oriented technologies assist adults with existing MCI [Mild Cognitive Impairment], dementia, or AD [Alzheimer’s disease]. These technologies attempt to slow the progression of cognitive decline (e.g., from MCI to dementia, or from mild to moderate dementia), track the progression of symptoms, and support adults with diminished cognitive abilities.”
The benefits of the technologies from a prevention standpoint also are addressed in the same piece:
“Technologies aimed at preventing cognitive impairment and decline focus heavily on cognitive training exercises that target specific aspects of cognitive functioning such as memory, attention, and language. Computer-based cognitive training aims to maintain cognitive function, thereby reducing risk of decline. In this general approach, well-studied paper-and-pencil tasks that target abilities such as memory, reasoning, and processing speed are adapted for computer-based use and implemented in computer memory games, puzzles, cognitive exercise, and brain fitness software applications. This type of training is available as software that can be installed on a personal computer, on websites that can be accessed with an internet browser or, in some cases, on dedicated touch-screen computers with easy-to-operate user interfaces. One study explored the efficacy of cognitive training software in a cohort of adults age 65 to 94 and showed that, although computer-based training raised cognitive performance scores, it did not improve ADL [Activities of Daily Living] performance (Ball et al., 2002). However, certain elements of this training did favorably impact quality of life (Wolinsky et al., 2006).”
There are multiple products on the market that address the needs of individuals living with dementia. Laurie Orlov, Principal Analyst at Aging and Health Technology Watch, has written extensively on the subject. Citing her piece on the subject of technology for individuals with dementia, several technologies are highlighted. The report breaks available technologies into early-, mid-, and late-stage dementia. Here are some excerpts from her report:
From an early-stage standpoint, technologies that provide motion sensors, medication reminders, smart doorbells/thermostats/speakers are readily available from Lively, MedMinder, Ring, Google Nest, Amazon Echo Dot, Siri, and Amazon Alexa. Wandering issues can be addressed through GPS tracking and fall detection from companies such as Lifeline, MobileHelp, and FallCall (Apple Watch).
Moving onto mid-stage issues, Orlov’s report continues:
“a wearable with location tracking may help keep their loved one safe and reduce worry about getting lost near their home. Home safety needs to be addressed as well. Tools such as an automatic stove shutoff and a home alarm system with water detection for faucets that may be left running can help reduce risks. From a health standpoint, it may make sense to have a medication reminder/dispensing system that both alerts about a dosage and only alerts/releases the appropriate medication at the right time.”
From a care coordination standpoint, CaringBridge and CareZone provide support. iTraq and GPS SmartSole can help with wandering issues. Philips Medication Dispenser and MedMinder have tools available for medication management, and ADT Water Alarm and Cookstop can help with home safety.
From a later-stage perspective,
“a loved one might need an in-home care worker while you are out or at work. Or a family member may need to hire a round-the-clock caregiver to help their loved one with meals, showers, dressing and other routines. Installing a remote camera may help provide peace of mind. Families can also consider other tools that help comfort and relax their loved one. An adult day center that can provide a full day of activities and interactions for those with dementia is also a resource.”
When iN2L was founded 23 years ago, there were few, if any, technologies designed to engage residents in senior living, much less residents living with dementia. Thankfully that landscape has changed dramatically in the past two decades. Providers have learned that technologies used to benefit residents’ quality of life are dependent upon the staff embracing the experience. To be successful, staff must perceive any technological tool as an enhancement to their work, not an additional burden. iN2L+LifeLoop, Touchtown, Linked Senior, and TSO Life are examples of engagement technologies that can be used throughout the continuum of the illness.
In recent years, virtual reality (VR) has entered the scene, with Rendever and Mynd VR leading the pack (Embodied Labs has created a successful niche using VR as a staff training tool, with a focused set of content on caregivers dealing with dementia—I’ve experienced it firsthand, and it is remarkable!), and applications and creative concepts are coming from all directions—Utopia Experience, Composure, Joy For All, and more. During the first decade of iN2L’s existence, our business was driven by nonprofit communities with access to foundations and other external funding sources. Today, our customer base is more for-profit communities than not-for-profit, as the business case for these technologies has been made.
But it still comes down to team members within the walls of senior living. Presbyterian SeniorCare Network has been a 15-year iN2L partner. Their organization, under the direction of Carrie Chiusano, has established a leadership position in dementia care, with technology being one of its key drivers. Traditionally, iN2L is used as an activity tool and Presbyterian SeniorCare Network had successfully used the technology in that context for many years. The Oakmont, a Pennsylvania-based operator, decided to study its use in post-acute rehabilitation for residents living with dementia, in collaboration with Pennsylvania State University.
According to Steven Zarit, PhD, a researcher at Pennsylvania State and a clinical gerontologist, cognitive limitations can interfere with rehabilitation engagement. The 2021 study (Zarit et al., 2019) sought to find out if interactive technology could enable residents to participate more fully and thereby improve functional outcomes, Zarit said.
‘Technologies used to benefit residents’ quality of life are dependent upon the staff embracing the experience.’
The researchers followed about 100 individuals in two eldercare communities. All received occupational and physical therapy for about 10 to 14 days, typically after a hospital stay. In one community, residents had therapy as usual. In the other, therapists used the touchscreen system to incorporate music, visuals, and games personalized to the residents’ interests and tastes.
Participants who used the technology had significantly higher goal attainment than their peers who did not, investigators found. These residents also had higher levels of engagement at the study’s start, and greater increases in engagement as therapy continued, noted Zarit.
The results suggest that engagement in technologies drove better outcomes, Zarit and colleagues said. When a resident colored an onscreen picture, for example, the therapist might raise the artwork higher to encourage higher arm positioning.
“Before you knew it, they were painting with their arm above their original goal height,” said Chiusano, executive director of the operator’s Dementia Care Center of Excellence. In another case, a resident who loved airplanes moved from frustration to full participation when he played a flight simulation game.
The technology “adds to therapists’ clinical toolbox, helping them gain the attention of persons with dementia and engage them in activities more effectively,” concluded Zarit.
My (admittedly non-scientific) perspective, after 24 years of working with technology and older adults, is that the benefits and joys of engagement technology have nothing to do with aging, or with cognitive decline. As human beings, we all have a desire to stay connected, to stay relevant, to stay in the game. It’s part of our genetic makeup. And we all have different ways to trigger those experiences.
I get immense joy out of watching my children’s musical talent, out of listening to Bruce Springsteen belt out “Born to Run,” watching old video clips of the Nebraska Cornhuskers and Los Angeles Dodgers. I could watch Seinfeld re-runs all day long. Those moments of joy are not going to disappear as I age and decline cognitively—they’re a part of me.
A need for that personalized content will increase, not decrease, as the years go by. And all of you readers will have your own set of digital experiences that will give you joy and contentment. Technology is the vehicle to capture and keep those moments of joy alive. There’s no reason not to keep smiling!
Jack York is the co-founder of iN2L (it’s Never 2 Late), which offers computer-based experiences aimed at improving quality of life, reducing psychotropic drug use, providing stress relief and more, based in Greenwood Village, Colorado.
Photo credit: Prostock-studio/Shutterstock
References
Faverio, M. (2022, January 13). Share of those 65 and older who are tech users has grown in the past decade. www.pewresearch.org/fact-tank/2022/01/13/share-of-those-65-and-older-who-are-tech-users-has-grown-in-the-past-decade/
LeadingAge CAST. (2012). Report to Congress: Aging services technology study. https://aspe.hhs.gov/reports/report-congress-aging-services-technology-study-1
Orlov, L. (2020, February 26). Technology to help care for individuals with dementia. Aging and Health Technology Watch. www.ageinplacetech.com/blog/technology-help-care-individuals-dementia
Zarit, S. H., Chiusano, C., Harrison, A. S., Sewell, L., Krause, C., & Liu, Y. (2021). Rehabilitation of persons with dementia: Using technology to improve participation. Aging & Mental Health, 25(3), 543–50. https://doi.org/10.1080/13607863.2020.1711864
