Best Practice Guidance
Human Interaction with Technology in Dementia

Guidance

When selecting technologies for use in public spaces, procurers should involve occupational therapists and designers with expertise in dementia, and people living with dementia.  Public space technologies should:

1. have the most cognitively enabling and inclusive design features (i.e. minimal steps and memory demands),
2. be sited in the most supportive physical location (i.e. secure vestibule, busy thoroughfare) and
3. identify and account for wider sociocultural preferences (i.e. continued face-to-face services).

Explanation and Examples

Life outside home in most countries increasingly demands the use of everyday technologies (ETs i.e. transport ticket and parking machines, ATMs, airline self-check in machines, fuel pumps). However, ETs can present challenges, particularly for people with dementia, and differences in design and location may mean some ETs are easier to use than others.

To investigate variation in the challenge of ETs; the Everyday Technology Use Questionnaire was administered with 315 people with and without dementia (73 in Sweden, 114 in the USA, 128 in England) in a cross-sectional, quantitative study. Modern statistical analysis found 5/16 public space ETs differed in challenge level between countries (specifically: ATM, airline self-check-in, bag drop, automatic ticket gates, fuel pump).

These differences result from variation in design features or siting of technologies. However, they may also be due to differing habits between users in different countries (i.e. necessity and frequency of use, preference for particular modes of transport, concerns about security, embarrassment) or varying progress towards technologised rather than face-to-face services (i.e. towards cashlessness).

Taking account of inter-country differences could lead to selecting the most useable technologies and services. This could improve inclusiveness of public space internationally for older adults with and without dementia.

Guidance

Due to UK bank and post office closures, local shops have a more central role in ensuring that older adults have continued, secure access to cash via face-to-face services offering card payments and cashback. Staff, managers and proprietors need to be aware of legal obligations to accept customers’ chip and signature cards, which support some people with dementia to access their finances. Other countries may need to make legal provisions to ensure financial services and retailers do not discriminate against people with disabilities regarding payment methods and access to cash.

Explanation and Examples

Cash can be a preferred option among people of all ages – including some older adults with dementia – who prefer to retain visual control over their spend. Bank and post office closures have occurred across the UK, affecting particularly people in rural areas, who may now face increased travel distances to reach a branch.

Technologies (ATMs and chip and PIN devices) are therefore becoming less avoidable in the process of accessing cash, however, can present problems for people living with dementia. A case study of 13 rurally dwelling older adults in the UK with mild dementia gathered data from in home interviews involving two structured questionnaires, observations, maps, and subsequent relevant document collation (i.e. public transport timetables, local news reports).

The importance of local grocery shops and supermarkets in providing a trusted, face-to-face option for accessing cash was highlighted, particularly among cases who lived alone. Subsequent document analysis found some retailers were unaware of legal obligations to accept chip and signature cards leading to occasional refusals.

Raising retailer awareness of the importance of card payment options rurally, and obligations to accept signature cards, could support people living with dementia to continue independently accessing their finances locally.

Guidance

Private car parking companies that use vehicle number plate recognition and surveillance technologies must make accessible provisions that account for memory difficulties common among drivers with mild dementia. Parking facilities must allow users control and provide feedback about time of arrival. Contractors of these companies must ensure the systems they agree to are useable for their customers living with dementia.

Explanation and Examples

Driving remains essential for daily life in rural parts of the UK where public transport infrastructure is sparse. Driving also means handling continually evolving technologies: parking ticket machines (cash, cashless, SMS/app, number plate inputting), automated barriers, fuel pumps, parking surveillance systems.

These technologies may increase the complexity of parking and driving, particularly for people living with dementia’, and could impact some people’s ability to complete everyday activities. A case study of 13 rurally dwelling older adults with mild dementia gathered data from in-home interviews involving two structured questionnaires, observations, maps, and subsequent relevant document collation (i.e. public transport timetables, local news reports).

Driving was highlighted as centrally important to daily life, particularly for cases living alone. Carparks which used number plate surveillance on entry and exit were highlighted by one case as particularly problematic. These types of parking technologies offer drivers no feedback about time of arrival, nor any method by which drivers can control their own actions in relation to rules and restrictions leading to unfair discrimination.

Short term memory difficulties common among people with mild dementia increase their risk of being unfairly penalised by these systems, leading to curtailed or abandoned activities, or handling complex administration of fines.

Guidance

People with dementia reporting new difficulties using everyday technologies should be offered a comprehensive assessment by an occupational therapist. While everyday technology can be assistive to everyday activities, in some cases, a pattern of detechnologising indicates instability in the person’s wider pattern of participation and may indicate a need for support, or change in housing situation.

Explanation and Examples

Everyday life, including outside home, more and more involves the use of everyday technologies (mobiles, smartphones, ATMs, transport ticket machines etc), which could even influence the places that people go to. A cross-sectional, quantitative study with 128 older adults with and without dementia in England was conducted using the Everyday Technology Use Questionnaire and the Participation in Places and Activities Outside Home questionnaire.

Results of statistical analyses confirmed that for some people; going to a lower amount of places was related to perceiving a lower amount of technologies relevant in daily life and living in a relatively more deprived area. A subsequent case study was conducted with 13 rurally dwelling older adults from the same sample (using the same questionnaires with additional interview notes, observations, maps, subsequent relevant document collation i.e. mobile and internet network availability reports).

Findings highlighted a person could perceive detechnologising, particularly around the home and garden, as one of several signs of vulnerability when living alone rurally. Such vulnerability was then a sign of a need for support to make living at home more tenable, including to increase safety in the grounds surrounding home, or was a sign of a need to relocate.

Guidance

Consider using smartphone-based experience sampling apps to measure everyday fluctuations of variables such as mood, behaviors, or cognition in people with mild cognitive impairments or carers of people with dementia to better understand variations in daily experiences.

Explanation and examples

The ‘Partner in Sight’ intervention for carers of people with dementia, the ‘Monitor-Mi’ study (feasibility of the experience sampling method (ESM) in people with MCI), and the development of two cognitive tasks (mDSST; mVSWMT), all included the experience sampling method (ESM). These studies are first steps towards a better understanding of and support for people with cognitive impairments, such as MCI or dementia, and their carers in everyday life.

The results indicate positive effects on carers’ well-being, feasibility of using the ESM in people with MCI, and internal validity when assessing momentary cognition in healthy older individuals. The experience sampling method has a high ecological validity with a reduced memory bias, allows to see fluctuations, and uncovers a complex picture of affect, behaviour, and other variables in everyday life. It can be used to increase awareness of own daily patterns and motivate behavioural changes towards more meaningful activities.

Guidance

Consider involving occupational therapists in providing interventions that enable people with dementia to use the everyday information and communication technologies they have.

Explanation and Examples

A standardized questionnaire mapped how many Everyday Information & Communication Technologies (EICT) (maximum 31) were relevant to 35 people living with dementia and 34 people with no known cognitive impairment in Sweden. A relevant EICT is one that is being used, or has been used in the past, or is planned for use in future. The median amount of relevant EICTs was shown to be 11 in the group without dementia, and 7 (significantly less) in the group with dementia. Each person also rated their ability to use (maximum 90) relevant Everyday Technologies (ETs) on a 5 step rating scale. This data was analysed (in a Rasch model) to produce a score for each person’s ability to use ET. When we compared ability to use ET with amount of relevant ETs in each group, the more EICTs a person counts as relevant, the higher was their ability to use ET. This pattern was only found in the group of people with dementia, and not the group without. The amount of relevant EICTs is affected by a person’s ability to use them. So some people may need support to identify the usefulness and possibility to use an EICT function that they have access to.