Best Practice Guidance
Human Interaction with Technology in 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

To avoid excluding some people with dementia, service developers should provide alternative non-ICT options when they deliver services and interventions that rely on smartphones, tablets and computers.

Explanation and Examples

A standardized questionnaire mapped how many Everyday Information & Communication Technologies (EICTs) (maximum 31) were relevant to 35 people living with dementia and 34 people with no known cognitive impairment in Sweden. In the same questionnaire, each person also rated their perceived their ability to use (maximum 90) relevant ETs on a 5 step rating scale. A relevant EICT is one that is being used, or has been used in the past, or is planned for use in future. This data was analysed (in a Rasch model) to produce a score for each person’s ability to use ET, and a challenge measure for each of the 31 EICTs to show how difficult or easy they were to use compared to each other. EICTs on smartphones and tablets were not relevant for a high proportion of both groups. Combined with a lower ability to use ET, particularly for people in the group with dementia, and high challenge measures for computer and automated telephone service functions, this could mean some people cannot access EICT-based services and interventions on computerized devices. However, the landline telephone was easiest to use and relevant to the majority of both groups, so this, together with face-to-face options could provide viable alternatives.

The study is currently under review and will be available under open access.