Apps, Tech, AI, Services
I’m curious about how technology is adapting to — or perhaps changing — the way we help patients and families. What works? What do we need that’s yet to be developed? Are these solutions manageable and affordable?
A note on apps or games that advertise dementia prevention: The FDA recently slapped one with a $50 million fine for lack of substantiating evidence. So go ahead and exercise your brain however you wish, but beware of dubious claims.
The Wall Street Journal discusses new technology to help patients with dementia. It’s an interesting overview.
By Shirley S. Wang – May 28, 2018
Technology promises to make it easier for people with dementia to live independently for longer and stay connected with family and friends.
Home sensors, communications and personal navigational devices—some of which are already commercially available—provide ways to monitor patients and loved ones from afar. Robotics, smartphone apps and some intriguing experiments with tablet computers, meanwhile, show the potential to help sufferers of dementia sustain their social and family contacts.
Help can’t come soon enough. An estimated 50 million people world-wide suffer from dementia, according to the World Health Organization—a number that is expected to rise exponentially as the global population ages. And for families of patients who require nursing homes in later stages, the resulting costs can be crushing.
“Technology has the potential to help preserve independence, or at least maintain it, for many, many more years than is currently possible,” says Dr. P. Murali Doraiswamy, director of the neurocognitive disorders program at Duke University Health System. “Ultimately we want nursing homes to disappear. We want people to live peacefully in their own home.”
Still, experts caution that many products being marketed as helpful to those with dementia haven’t been systematically tested for that population, and that unintended consequences, such as invasion of patient privacy, need to be considered.
“The reality is the evidence that any of this helps or works is very thin,” says Jeffrey Kaye, director of the Oregon Center for Aging and Technology.
Among the products already available are remote-home-surveillance systems that enable basic monitoring of patients from a distance using a mobile phone—offering reassurance about patients’ well-being and capabilities.
Wrist-worn motion detectors and GPS devices, for instance, can help detect what a person is doing inside the home, such as if they are sleeping or agitated. Such devices could potentially help with detecting falls or finding a person who leaves the house and becomes lost. Pine Brook, N.J.-based AngelSense markets a service for dementia patients that requires an equipment purchase of $99 plus a monthly service fee of $33 and up.
Something as simple as an electronic-calendar reminder may help some remember appointments and medicines. A case study published last year in the Journal of Alzheimer’s disease found that Google calendar helped a woman with dementia remember scheduled events.
At the University of Montreal, a team led by Nathalie Bier, a professor in the School of Rehabilitation, is trying to design “smart homes” by fitting small, commercially available “Z-wave” wireless sensors around the house in nearly invisible locations, such as on a fridge door. The sensors can detect activity around a stove, for example. If the stove is on but activity there stops, the stove can turn itself off. Similarly, monitoring of water usage shows whether a shower or bath was left running. Another idea the group plans to incorporate: a smart pillbox that can reveal when someone is, or isn’t, taking their medicine. Of versions that already exist, some send a record of when they have been opened and whether the weight has changed, suggesting a pill was taken.
Such details provide information about a patient’s routine and what level of care that person needs, such as whether he or she needs help bathing or preparing their own meals, says Dr. Bier.
“It’s really trying to provide the right service for the right person at the right time,” she says.
Oregon’s Dr. Kaye also is experimenting with inexpensive infrared sensors to capture data continuously in the home in real time. He monitors everything from pulse rates and walking speeds to whether the patients open their pillboxes This kind of data, Dr. Kaye says, is much more telling than information obtained by interviewing patients or caregivers.
Induct, a British-based consortium of researchers who study technology for dementia care, is investigating the potential usefulness of a number of devices, including an experimental smartphone app that attempts to improve the emotional states of people with dementia. The app is designed to launch itself several times a day and assess the person’s general mood or well-being by asking how he or she is feeling at that moment, says Martin Orrell, the head of Induct and director of the Institute of Mental Health at the University of Nottingham. The goal is to examine not just what people are doing, but how they are coping. If a person is feeling down, Dr. Orell says, the device could suggest activities the person likes that could help distract them or make them feel better.
Home sensors can help in the management and treatment of Alzheimer’s, tracking changes in patients’ wandering, agitation and circadian rhythm, as well as monitoring for safety. How sensors could be deployed in one apartment and what they track:
- The patient’s movements
- Use of appliances, lights, etc.
- Opening and closing of doors
- Water usage
Source: Nathalie Bier, University of Montreal
Still other researchers see potential in tablet computers. Dr. Bier and her team in Montreal have run experiments which suggest that, with specialized training, dementia patients using tablets can keep to schedules and orient themselves to the correct date.
Even as memory deteriorates with disease, Dr. Bier says, good training can help people with dementia use tablets and smartphones to assist them in everyday living for years.
Pilot work by Franka Meiland, senior researcher in the department of psychiatry at VU University Medical Center in Amsterdam, has shown technology that reminds people about which day it is helps to better orient them in the present. Dr. Meiland says she has also conducted research that shows that tablet computers help people with dementia keep in touch with relatives and do activities that improve their quality of life, such as listening to music they like or playing games and activities that keep them entertained.
“We must be cautious” about the role of technology because often a caregiver still may be needed to help the patient use it, Dr. Meiland says, but “there’s a promise that assistive technology may make health care much more efficient, helping maintain good quality care.”