Best Practice Guidance
Human Interaction with Technology in Dementia

Guidance

Nursing homes providing care for people with dementia should consider introducing portable devices in addition to desktop devices for electronic patient records (EPR). Devices should not disrupt or invade residents’ privacy.

Explanation and Examples

Portable devices have been shown to increase efficiency in some instances as they allow staff to record data into the EPR at the point of care instead of at the end of the shift. This enables staff to spend more time providing care to residents, particularly for residents with dementia and complex needs. Portable devices can support person-centred care by allowing immediate access to care plans with vital information about residents, such as dementia diagnosis. Rapid access to care plans is important for staff retrieving information about individuals who are at the nursing home temporarily on respite; for those residents who may be unable to recall personal information; and for those staff who work infrequently in the home and are unfamiliar with residents. However, it should be taken into consideration that some staff may prefer desktop devices based on ease of use when completing substantial documents. During the development of portable devices for nursing homes, the impact that such devices could have on residents should be taken into account and staff should explain the purpose of EPR devices to residents and family members who may be unfamiliar with the technology.

Guidance

Applications that should be incorporated into EPR systems used in nursing homes providing care for people with dementia include a spell-check, a copy and paste function and a keyword search function. Log-in processes should be rapid and secure.

Explanation and Examples

The presence of a spell-check has been described as saving time on proofreading, as well as increasing legibility and comprehension of documentation. This allows for more time to be spent with residents with dementia in direct care, and for correct care to be provided. A copy and paste function also saves time by allowing staff to easily transfer information across sections of the EPR where information is often required to be replicated. A keyword function allows staff to enter a keyword and jump to the relevant section in a resident’s notes, allowing for more efficient retrieval of information, important in situations when a resident is unable to recall personal information. Rapid log-in processes should reduce barriers to using the EPR, as slow log-in processes have been found to prevent staff from accessing information about residents before delivering care, and have meant staff have been forced to pass on information about residents verbally instead of entering it into the EPR. This may mean important information regarding any sudden changes in an individual’s condition might be missed.

Guidance

Developers of EPR systems for dementia care should consider including a function allowing for the automated generation of graphs to show trends in data, and an accompanying function to prompt staff about changes in a resident’s condition.   In addition, functions allowing for the automated generation of care plans from assessment data, and alerts to prompt staff to create or update a new document in the EPR may be of value to nursing homes. Interoperability should be a goal for the future.

Explanation and Examples

Automatic generation of graphs displaying trends in a resident’s condition increases visibility of changes, allowing staff to more rapidly identify and respond to changing care needs. For example, graphs showing changes in weight, which can commonly affect individuals with dementia. Furthermore, through the incorporation of artificial intelligence (AI), some EPR systems are able to analyse resident data and provide alerts to staff about potential risk factors. For instance, alerts to warn staff about potential skin breakdown, important for those residents with dementia receiving end-of-life care, who may be spending considerable amounts of time in bed and have reduced fluid intake. Automatic generation of care plans from assessment data could save staff time in administration, as well as automatic alerts incorporated into the EPR that prompt staff to update care plans, meaning optimal care can be planned and provided to individuals with dementia. Finally, EPR systems should be interoperable, so that staff can access and communicate relevant information securely over the internet with external healthcare providers, instead of using paper records.

Guidance

EPR systems should include the necessary assessment templates for use in the care of people with dementia, as well as space for entry of free text and to upload photos of residents. Electronic assessment forms and care plans for dementia care should use formalised nursing language to prompt the entry of correct information, and structured templates that guide staff through body systems, leading to comprehensive care plans.

Explanation and Examples

EPR systems in nursing homes have been found to omit the appropriate scales and assessments required by nursing staff caring for people with dementia. For instance, staff stated that they require the MMSE assessment, the QUALID scale, and the Barthel Index of Activities of Daily Living incorporated into the EPR. Furthermore, staff have identified incorrect nursing language in electronic forms, meaning important information is not recorded. For example, the omission of the term ‘dementia diagnosis’ from assessment forms meant that nurses were not entering this information about residents. By including the appropriate structured forms for data entry with formalised nursing language, Artificial Intelligence (AI) tools can be more successfully integrated into the EPR. Space for photos of residents is important for new staff when learning residents names and for confirming identities of residents when required, and structured body templates included into the EPR have been identified as a useful visual prompt for completing assessments. Staff also require space to enter life stories, and space for free data entry for additional notes and observations. For example, changes in the behaviour of a resident with dementia.

Guidance

Electronic assessment forms and care plans used for planning dementia care in nursing homes should prompt staff to consider the following needs of residents: activities, maintaining previous roles, reminiscence, freedom and choice, appropriate environment, meaningful relationships, support with grief and loss, and end-of-life care.

Explanation and Examples

The themes above have been described by people with dementia in various studies exploring their self-reported needs and experiences in nursing homes. Developers should therefore consider including these themes into electronic assessment and care plan templates as prompts for nursing home staff to explore with residents.

Guidance

To improve usability design of the technology should be developed specifically on the characteristics of the person with dementia, with respect to vision, auditory and cognitive capacities.

Explanation and Examples

Dementia is mainly suffered by elderly people. It´s well known the visual and auditorily perception changes. Shapes, colours, glares, temporal frequency of stimuli, visual acuity, and relevant visual stimuli can be bad perceived. Therefore, the design of any technology should be focused and fitted to these perceptual changes. Consequently, it is important to increase the lighting of the context of the task, the level of contrast and font size.

Equally elderly people might suffer impaired hearing, especially in sensitivity to high frequencies, discrimination of tones and differentiation of the speech of the background noise. Therefore, it is necessary for any technology to increase the intensity of the stimuli, control the background noise, avoid stimuli with high frequencies and adapt the speed of the words.

The design of the technology should take into account the cognitive impairment of a person with dementia (type, level, and deficits associated with impairment). Technology for rehabilitation must comprise different difficulty levels, take slow processing speed into account by extending response intervals of exercises, and an increase the variety in types of exercises.

The degree of usability of a technology will influence the user´s experience, generating a degree of satisfaction in the person with dementia that will affect their level of motivation to continue using a rehabilitation program such as Gradior.

Guidance

User-centered design should be considered in the development of any technology or computer-based program for cognitive rehabilitation in people with dementia.

Explanation and Examples

User-centered design is a methodology applied in the development of programs or new technologies for cognitive rehabilitation in people with dementia. This design takes into account the target population from the beginning to the end of the development process, with the aim of investigating their needs and expectations, developing a prototype that meets these needs and evaluating the final prototype based on usability and user experience criteria.

Guidance

Researchers and developers of digital psychosocial interventions for people with dementia and family carers should consult end users on the mode of delivery of their interventions to ensure its usability.

Explanation and Examples

Consensus exists that consultations with people with dementia and family carers should be carried out when developing digital complex interventions for these populations. However, with different platforms that are available to researchers and developers, it is especially important to ensure that the mode of delivery of these technologies (e.g., smartphone application, website, text messages etc.) is appropriate and useful for people who are going to use the intervention. Qualitative consultations in the form of interviews and focus groups with end users can be especially useful for this. We conducted focus groups with 17 people with dementia and family carers to establish their needs and wishes regarding the digital adaptation of an existing face-to-face intervention. Contrary to our expectations, we discovered that participants preferred a website intervention if they were going to use the intervention for a limited amount of time, for example less than four weeks. Smartphone applications were preferred if they were going to be used for a longer period. Consultations with end users are recommended to establish not just the intervention content but also its mode of delivery.