Apathy is an early and common dementia symptom. Yet it is often overlooked and frequently misdiagnosed as depression by healthcare providers. There are not many interventions specifically designed to address apathy, nor is it regularly included in dementia education for individuals and family members. Apathy can be distressing to family members when they see the person is no longer interested in visiting family or friends or doing activities they used to enjoy.
A person with apathy:
Innovative Design Combats Apathy
When Hester Le Riche was working on her doctorate in Industrial Design Engineering at the Delft University of Technology in the Netherlands, her professor encouraged her to design a playful product to combat apathy and engage nursing home residents living with dementia in meaningful daily activities. Le Riche began by looking at the physical and social environment as well as activity level of nursing home residents in the Netherlands. She decided to design a game that simulates a daily activity by using interactive light projections and sound, and spent more than three years on the design, rather than the typical four months spent on a doctoral project.
Le Riche’s professor encouraged her to design a playful product to combat apathy.
Le Riche tested prototypes with the primary users of the product, residents living with dementia, and sought input from family members and professional staff. This participatory design approach is known as Co-Design, in which community members are treated as equal collaborators in the design process to ensure the results meet their needs. Le Riche and her design team continue to use co-design with more than 6,000 care settings (e.g. nursing homes, adult day centers) worldwide.
Tovertafel Means Magic Table
The product is named Tovertafel, the Dutch word for magic table. The Tovertafel device is mounted to the ceiling and the projections are displayed on a large table, where up to eight participants are seated with a facilitator. Sound is supplied by its speaker, and the device uses artificial intelligence to detect a person’s hands even when at rest. For example, one game features different colored butterflies and each participant is invited to hold out their hands to see which butterfly lands on them.
Inclusive, Layered Design for All Abilities
The Tovertafel uses a no fail, layered design that means participants can play according to their ability, which instills confidence and makes it easy to enjoy at any level. Twenty-nine games are available, each promoting cognitive stimulation, physical movement, sensory abilities or social interaction.
The projections are beautiful and light, allowing some participants to simply appreciate the beauty. Games come in a variety of types, depending upon participant interest. Players can cast marbles, paint watercolors, pass a beach ball, bird-watch, finish common sayings and nursery rhymes, play a game of rummy or polish silverware. One of most popular games is Autumn Leaves, which encourages participants to make big hand and arm movements. Using their hands, they rake leaves together in a heap and can even look for ladybugs under the leaves. Accompanying sounds of leaves rustling gives players the feeling of being outside.
Impact on the Individual, Family Members and Care Professionals
Researchers, including student researchers, studied the impact of the Tovertafel on individuals living with dementia, family members and care professionals. Even though most studies are small, they demonstrate an overall positive impact. Observational studies indicate numerous benefits for individuals living with dementia including not only decreased apathy but also decreased sadness, reduced restlessness and a more positive self-image.
Family members find that the device increases opportunities for interaction with the person.
Care professionals report that the Tovertafel has helped them strengthen relationships with individuals living with dementia, to provide personalized care and has ultimately contributed to their job satisfaction. Care professionals also report that the device is easy to use and can be moved to different rooms or departments where a device is mounted. Family members find that it increases opportunities for interaction with the person and makes visits more meaningful and enjoyable. An NIH-funded study is examining the impact of the Tovertafel on common dementia behavioral symptoms and participant quality of life.
Defeating Apathy, Reconnecting With the World
Dementia is a complex syndrome that encompasses an array of cognitive, behavioral, motor and memory changes, making it difficult for a person to interact with others and manage daily activities. These symptoms are stressful for the individual as well as for family caregivers. Non-pharmacological interventions are often the most effective for addressing dementia symptoms and generally recommended as the first-line treatment. The Tovertafel offers opportunities for interaction with others and creates moments of joy by engaging participants in fun and familiar activities. It is currently being used in nursing homes, adult day centers and other care settings in 14 countries including Europe, Canada, Australia and most recently the United States.
Elizabeth Gould, MSW, is senior research public health analyst at RTI International and co-director at the National Alzheimer’s and Dementia Resource Center, funded by the Administration on Aging.