Approach Matters: Linking Practitioner Approaches to Technology Design for People with Dementia

Enriching Social Sharing for the Dementia Community: Insights from In-person and Online Social Programs

The dementia community faces major challenges in social engagements, which have been further complicated by the prolonged physical distancing measures due to the COVID-19 pandemic. Designing digital tools for in-person social sharing in family and care facility settings has been well explored, but comparatively little HCI work has focused on the design of community-based social technologies for virtual settings. We present our virtual fieldwork on remote social activities explored by one dementia community in response to the impacts of the pandemic. Building upon our previously published on-site fieldwork in this community, we expand on our initial publication by follow-up interviewing caregivers and facilitators and reflecting on a virtual social program. Through thematic analysis and contrasting in-person and online formats of the program, we deepened the understanding of virtual social engagements of the dementia community, examining their efforts to leverage physical objects and environments, enhance open and flexible experiences, and expand collaborative space. We propose to open new design opportunities through holistic approaches, including reimagining community social spaces, rethinking agency in people with dementia and caregivers, and diversifying HCI support across communities and stakeholders.

Voice Over Body? Older Adults' Reactions to Robot and Voice Assistant Facilitators of Group Conversation

Intelligent agents have great potential as facilitators of group conversation among older adults. However, little is known about how to design agents for this purpose and user group, especially in terms of agent embodiment. To this end, we conducted a mixed methods study of older adults' reactions to voice and body in a group conversation facilitation agent. Two agent forms with the same underlying artificial intelligence (AI) and voice system were compared: a humanoid robot and a voice assistant. One preliminary study (total n = 24) and one experimental study comparing voice and body morphologies (n = 36) were conducted with older adults and an experienced human facilitator. Findings revealed that the artificiality of the agent, regardless of its form, was beneficial for the socially uncomfortable task of conversation facilitation. Even so, talkative personality types had a poorer experience with the "bodied" robot version. Design implications and supplementary reactions, especially to agent voice, are also discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12369-022-00925-7.

The use of technology for arts-based activities in older adults living with mild cognitive impairment or dementia: A scoping review

For older adults living with mild cognitive impairment or dementia, creative arts-based activities can offer many benefits from enjoyment as leisure/recreation to an avenue to maintain cognitive, social and emotional wellbeing. With growing interest and recognition that technology could have potential to assist in delivering these activities in more accessible and personalised ways, a scoping review was undertaken to systematically examine the scientific literature for technology-assisted creative arts activities for older adults living with dementia. We searched PubMed, PsychINFO, Web of Science, Scopus and ACM Digital Library databases using keywords centering on population with dementia, an intervention using technology, and a context of creative arts, with no restrictions on the type of outcome measured. We retrieved 3739 records, with an additional 22 from hand-searching. 51 full-text articles met the inclusion and exclusion criteria. Findings of the review indicate technologies principally being designed for music activities (listening, and music-making), as well as storytelling and visual arts. The majority of devices were custom-made, with studies mainly reporting on validating the success of the device/intervention. This suggests most work in the field is currently at prototyping stage, although a few devices are now commercially available. Recommendations for future research includes involvement of participants reporting on their previous experiences in the arts and how this influences co-design choices, and inclusion of different severities of dementia in the participant/co-design group. Furthering device development past prototyping stage as well as collaboration between teams would enable comparisons to be made across different types of devices used for the same activity, and comparisons across arts-based activities that could lead to cross-disciplinary outcomes for the design of creative arts-based assistive technologies.

Key Stakeholders' Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis

BACKGROUND

Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area.

OBJECTIVE

The aim of this QES was to explore key stakeholders' experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation.

METHODS

QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders' experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research).

RESULTS

A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use.

CONCLUSIONS

This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology.

Introducing and Familiarising Older Adults Living with Dementia and Their Caregivers to Virtual Reality

Virtual Reality (VR) is increasingly being applied in dementia care across a range of applications and domains including health and wellbeing. Despite the commercial availability of VR, informants of design are not always aware of its functionality and capabilities, to meaningfully contribute to VR design. In designing VR applications for people living with dementia, it is recommended that older adults living with dementia and their support persons be involved in the design process using participatory approaches, thereby giving them a voice on the design of technology from the outset. A VR technology probe is a useful means of familiarising older adults living with dementia and their informal caregivers with the knowledge and understanding of interactive VR to employ technology that supports them to maintain their social health. This paper charts the implementation and evaluation of a VR technology probe, VR FOUNDations. To explore their experiences, nine older adults living with dementia and their nine informal caregivers trialled VR FOUNDations and completed semi-structured interviews after its use. Overall, older adults living with dementia and their informal caregivers perceived VR FOUNDations to achieve its aim of increasing understanding and inspiring future design decisions. The findings also identified promising positive experiences using a VR technology probe which may be indicative of its applicability to social health and wellbeing domains. This paper advocates for the structured design and implementation of VR technology probes as a prerequisite to the participatory design of VR applications for the health and wellbeing of people living with dementia. The use of such technology probes may afford older adults living with dementia and their informal caregivers the best opportunity to contribute to design decisions and participate in technology design to support their health and wellbeing.

A Support Worker Perspective on Use of New Technologies by People with Intellectual Disabilities

People with intellectual disability access innovative technologies in disability community centres in Australia, under the guidance of support workers. This paper investigates the perspectives of 15 support workers and 5 managers across four community centres on the introduction and use of technology like tablets, video games, 3D printing, virtual reality and social robots. They had diverse views on who is responsible for facilitating, embedding and shaping technology for learning life skills and socializing. We found technology use to be driven by facilitator's knowledge (pre-existing, observed or trained), interests, the value they place on the interactions afforded by the technology and organization values. We discuss how future designs can emphasise communities of users while empowering individuals to achieve their goals. We suggest co-design strategies for assistive technology that involve support workers in the dual roles of proxy and co-user. We finally discuss how broader organisational factors can influence appropriation and use.

The use of digital technologies by people with mild-to-moderate dementia during the COVID-19 pandemic: A positive technology perspective

A growing body of research has shown that people with dementia are using digital technologies to enhance lived experience. The COVID-19 pandemic has brought new digital opportunities and challenges and so provides a unique opportunity to understand how people with dementia have adapted to this new digital landscape. Semi-structured interviews were conducted with 19 people with dementia and analysed thematically. We generated five themes, showing how participants used digital means to combat the stresses of the pandemic by facilitating social connection, self-actualisation, enhanced well-being and by assisting with activities of daily life. These technologies helped to reduce isolation, provide access to support groups, create opportunities for cognitive stimulation and self-development, and engendered a sense of identity at a time of perceived loss. Despite these benefits, participants also reported challenges regarding cognitive fatigue and usability issues. We recommend that training on how to use digital technologies is co-produced with people with dementia and designers engage with the voices of people with dementia throughout the design process. In turn, this could promote the social connectedness, well-being and self-worth of people with dementia.

Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic

BACKGROUND

Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible.

OBJECTIVE

This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI.

METHODS

Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts.

RESULTS

An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users.

CONCLUSIONS

This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic.

Understanding How Sensory Changes Experienced by Individuals with a Range of Age-Related Cognitive Changes Can Effect Technology Use

Clinical researchers have identified sensory changes people with age-related cognitive changes, such as dementia and mild cognitive impairment, experience that are different from typical age-related sensory changes. Technology designers and researchers do not yet have an understanding of how these unique sensory changes affect technology use. This work begins to bridge the gap between the clinical knowledge of sensory changes and technology research and design through interviews with people with mild to moderate dementia, mild cognitive impairment, subjective cognitive decline, and healthcare professionals. This extended version of our ASSETS conference paper includes people with a range of age-related cognitive changes describing changes in vision, hearing, speech, dexterity, proprioception, and smell. We discuss each of these sensory changes and ways to leverage optimal modes of sensory interaction for accessible technology use with existing and emerging technologies. Finally, we discuss how accessible sensory stimulation may change across the spectrum of age-related cognitive changes.

How Content Authored by People with Dementia Affects Attitudes towards Dementia

Negative attitudes shape experiences with stigmatized conditions such as dementia, from affecting social relationships to influencing willingness to adopt technology. Consequently, attitudinal change has been identified as one lever to improve life for people with stigmatized conditions. Though recognized as a scaleable approach, social media has not been studied in terms of how it should best be designed or deployed to target attitudes and understanding of dementia. Through a mixed methods design with 123 undergraduate college students, we study the effect of being exposed to dementia-related media, including content produced by people with dementia. We selected undergraduate college students as the target of our intervention, as they represent the next generation that will work and interact with individuals with dementia. Our analysis describes changes over the period of two weeks in attitudes and understanding of the condition. The shifts in understanding of dementia that we found in our qualitative analysis were not captured by the instrument we selected to assess understanding of dementia. While small improvements in positive and overall attitudes were seen across all interventions and the control, we observe a different pattern with negative attitudes, where transcriptions of content produced by people with dementia significantly reduced negative attitudes. The discussion presents implications for supporting people with dementia as content producers, doing so in ways that best affect attitudes and understanding by drawing on research on cues and interactive media, and supporting students in changing their perspectives towards people with dementia.

Designing for and with People with Dementia using a Human Rights-Based Approach

User-centered design is typically framed around meeting the preferences and needs of populations involved in the design process. However, when designing technology for people with disabilities, in particular dementia, there is also a moral imperative to ensure that human rights of this segment of the population are consciously integrated into the process and respectfully included in the product. We introduce a human rights-based user-centered design process which is informed by the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We conducted two editions of a three-day-long design workshop during which undergraduate students and dementia advocates came together to design technology for people with dementia. This case study demonstrates our novel approach to user-centered design that centers human rights through different stages of the workshop and actively involves people with dementia in the design process.

The Role of Sensory Changes in Everyday Technology use by People with Mild to Moderate Dementia

Technology design for dementia primarily focuses on cognitive needs. This includes providing task support, accommodating memory changes, and simplifying interfaces by reducing complexity. However, research has demonstrated that dementia affects not only the cognitive abilities of people with dementia, but also their sensory and motor abilities. This work provides a first step towards understanding the interaction between sensory changes and technology use by people with dementia through interviews with people with mild to moderate dementia and practitioners. Our analysis yields an understanding of strategies to use technology to overcome sensory changes associated with dementia as well as barriers to using certain technologies. We present new directions for the design of technologies for people with mild to moderate dementia, including intentional sensory stimulation to facilitate comprehension, as well as opportunities to leverage advances in technology design from other disabilities for dementia.

The Perspectives of Professional Caregivers on Implementing Audio-Based Technology in Residential Dementia Care

Music and familiar everyday sounds can be meaningful for people with dementia by providing benefits such as evoking memories and emotions or prompting social interactions with caregivers or relatives. Motivated by this potential, researchers and designers are investigating how to leverage these beneficial effects of sound in care environments through audio-based technology. However, there is a gap in the knowledge of how audio-based technology can be successfully implemented within everyday care practice. In this paper, we present the outcome of three participatory workshops with 18 professional caregivers to explore how audio-based technology can add value to existing care processes and activities in residential dementia care. During the participatory workshops, professional caregivers (1) mapped existing care activities; (2) linked findings in research with practice, and (3) designed scenarios for the Vita sound cushion. Care professionals indicate how audio-based technology can support existing care practice by influencing the mood of residents and by supporting social interaction during moments of care, daytime activities, or situational sessions. This study bridges research findings with insights from practice, contributing to a shared understanding of opportunities for embedding audio-based technology in dementia care. These opportunities motivate future research to implement and evaluate audio-based technology in residential dementia care.