Exploring the requirements for technology to support people with dementia in the home

This thesis explores the requirements of technology to support people with dementia in the home. More specifically, it aims to establish design requirements for systems that prompt people with mild to moderate dementia through multi-step tasks. Chapter 1 presents existing literature that is relevant to the development of cognitive prostheses for people with dementia. The review describes patterns of cognitive decline in dementia, the impact of these deficits on everyday tasks, and technological and non-technological methods of support. Chapter 2 presents the problems of dementia in the home from a professional carer perspective. Nine interviews and one focus group were conducted with 22 occupational therapists and professional carers. The transcripts were analysed using Grounded Theory Analysis (GTA), in accordance with Strauss and Corbin (1990). The analysis revealed three main themes: 'Problems in the home' (daily activities, risks, and interpersonal interaction), 'underlying deficits' (sequencing, memory/orientations, and learning), and 'consequences' for the person with dementia (physical wellbeing and control) and the informal caregiver (relationship and care demands). The implications of these themes for the design of assistive technology are discussed. Chapter 3 presents the problems of dementia from a patient-caregiver perspective. Eight home visits and two individual interviews were conducted with people with mild to moderate dementia and informal caregivers. GT A revealed four main themes: 'Problems in the home' (daily activities, domestic tasks, leisure, and interpersonal interaction), 'underlying deficits' (sequencing and memory/orientation), 'consequences' for the person with dementia (Physical wellbeing and control), and the informal caregiver (relationship and care demands), and 'situated factors' (verbal cues, visual cues, and familiarity). The perspective is compared to the professional carer perspective, and the design implications are discussed. Chapter 4 describes the types of problems people with dementia experience when performing kitchen tasks. Six people with mild to moderate dementia were video recorded performing activities in their own kitchen. These included making a cup of tea/coffee, a bowl of soup, beans on toast, and tea/coffee with toast. Twenty-two video recordings were transcribed and analysed. Errors that prevented task accomplishment were recorded and grouped to form error classifications. Eight error types were identified with four main themes: 'Sequencing' (intrusion, omission, and repetition), 'orientation' (locating and identifying), 'operation' of appliances, and 'incoherence' (toying and inactivity). The error types are discussed in relation to cognitive theory and the implications for designing prompting systems. Chapter 5 describes an experiment embedded in a real activity, designed to evaluate the effect of a novel cueing method. Eight participants with moderate dementia carried out real cooking activities (making porridge with syrup and chocolate comflake cakes) with a care worker. At certain points, the participants were required to tum on/off the cooker. Correct control selection was scored under three different cueing conditions that represented the association between hotplates and controls. Condition 1 used the original design (symbols), condition 2 used verbal (written) cues, and condition 3 used a lighting effect (hotplate and corresponding control would light up). The implications of the experiment for the design and evaluation of technological prompts are discussed. Chapter 6 describes future steps that should be taken to develop prompting systems for people with dementia. This includes a review of recent developments in pervasive computing that match the design requirements for prompting systems, and an interactive design framework that should be used to guide the design of prompting systems for domestic settings. Chapter 7 provides a summary of the thesis. This includes an overview of requirements for technology to support people with dementia at home. The methodological contributions of the thesis are also discussed.