There’s an app for that…

Author details

Catherine James undertook the digital personal assistant study for the Youth Industrial Strategy Competition Finals. It was voted one of the top ten creative science projects by the British Science Association. 

Digital technology could be embraced more widely by people in the early stages of dementia, says Catherine James, explaining her award-winning project to design a personal assistant for dementia app. 

My study evaluated the feasibility of using a smartphone, iPad, or home screen personal assistant for dementia (PAD) with people in the early stages of the condition. It showed the potential positive effects of such a tool on wellbeing, orientation, and independence.   I undertook the project over one year, motivated by spending time with people living with dementia and by a desire to help them overcome symptoms and maintain independence for the longest time possible. I wanted to explore the potential advantages and disadvantages of a digital smartphone, iPad or computer home screen personal assistant application (“app”).    Specifically, I set out to examine use of orientation screens, daily reminders, medication prompts, healthy eating, active living, brain training, wellbeing activities, lost language aids, map functions, memory and home safety screens on positivity, sense of wellbeing, confidence, and independence for people with early-stage dementia.  

Methods  

Using information from literature reviews of dementia and digital health (eg, Nijhof et al 2013, Astell et al 2010, Black et al 2011) and dementia experts including people with dementia, I explored the principal symptoms and created digital solutions to each one on the personal assistant app.    Among these were orientation in time and place, memory aids, assistance with familiar tasks, healthy living, safeguarding against falls, “walking with purpose” alerts and sleep, and mood and relaxation functions.    I held informal focus group discussions with five people with early-stage dementia and their carers to explore the design, functionality, safety, and practicality of the personal assistant. I refined the design in the light of this feedback, using App Shed digital software. 

Approach 

The PAD was designed with sixteen screens, accessed via push button icons. A “Today” screen assists orientation with date, year, month, day, and time, “My Day” provides a diary page with daily reminders and event alarms, and a “My Contacts” function comprises key contacts with their photos, name, relationship, birthday and contact details. This screen also allows the person to record their own information including age, date of birth, address, email, phone number and NHS/NI numbers.   A digital medication aid is included with reminders and alarms for tablet taking, while healthy living screens provide video links to seated exercise, tai chi, pedometer, and gentle dance. Relaxation screens include breathing, mindfulness, and visualisation exercises. Maps and location services assist access to key destinations while the “Groceries” screens assist meal preparation.   Elsewhere on the PAD, a “Reverse Dictionary” helps with lost language and a “Find My” screen traces misplaced items, whereas “My Brain” provides dementia appropriate crosswords, sudoku, jigsaws and brain training games. “My Memories” comprises a digital memory box with access to special photos, treasured letters, keepsakes or personal memories. A “Help Me” screen offers push button access to professional help, home safety and emergency assistance.  

Results 

The feasibility of the dementia personal assistant was tested informally with focus group members and their families. It appeared to be a valuable tool which was positively received. Computer home screens were preferable to mobile phone app technology for those with concomitant disease, vision, or dexterity issues.   All involved valued orientation, diary, contacts, medication, and exercise screens, and made use of brain training, relaxation, music, healthy diet, and memory functions. One made use of the safety lanyards and three valued the waterproof, smash-proof casing. All five gave positive feedback and four reported a greater sense of wellbeing, confidence, and independence.  

Discussion 

While conclusions must be drawn cautiously, given the small sample, my study does suggest that a digital personal assistant for dementia may be a useful tool for individuals with early-stage dementia, promoting confidence, wellbeing, and independence. Early use prior to a diagnosis or in the early stages of the condition appears helpful in ensuring familiarity with functions.   All individuals who took part were familiar with mobile phone technology and could access the home button on their phone before accessing PAD. Family carers suggested difficulty learning or retaining new information could be a barrier to using PAD for those in the later stages of dementia.   Overall, home screens, websites, iPad and mobile phone apps were all considered positive delivery methods for a digital personal assistant. Digital watch technology was not favoured, and feedback suggested that screen size, visibility and familiarity with watch devices was currently problematic for older people.   Less mobile individuals favoured home screens. Voice-activated prompts, remote carer access, links to hearing aids and spoken instructions were potential improvements suggested by carers and families for optimal PAD function. Alarms on medication screens together with falls and “walking with purpose” functions on map services were other suggestions.  

Conclusion 

My small-scale study suggests that the PAD app may be a helpful tool to support people with early-stage dementia, enhancing wellbeing, confidence, and independence. While the progress of digital health in patient care accelerates rapidly as mobile health apps and wearable sensors are adopted more widely in managing diseases and conditions, it seems that such health solutions may be of value, too, in the field of dementia care.  To see Catherine James explain her PAD app click here.

References 

Astell A, Ellis M, Bernardi L, Alm N et al (2010) Using A Touch Screen Computer to Support Relationships Between People with Dementia and Caregivers. Interacting with Computers 22(4) 267-275. 
Black A, Car J, Pagliari C, Anandan C et al (2011) The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLoS Medicine 8(1) e1000387.  
Nijhof N, Van Gemert-Pijnen J, Burns C, Seydel, E (2013) A Personal Assistant for Dementia to Stay at Home Safe at Reduced Cost. Gerotechnology 11(3) 469-479.