Personalized Multimedia Videos As Reminiscence Therapy For Persons With Dementia

Reminiscence therapies are an effective intervention in increasing self-esteem, well-being, sense of personhood and even reducing distress and confusion in persons with dementia. There is even evidence that reminiscence therapies can slightly slow the progression of dementia, by enabling a cohesive narrative and sense of identity. This paper will consider relevant literature and explore the potential of using modern technological advances, such as a wealth of digital media and the ability to scan old photos, to create personalized and engaging life narratives. In addition to this paper, this special project will include a concrete example of this type of video that I will create of memorabilia, primarily photographs, from my grandfather’s life, from what exists from his early childhood up to present day. It will also include a qualitative questionnaire to be given to the participant and their care partner to assess the effectiveness of increasing well-being, personal identity and even to further understand reminiscence therapy’s relationship with dementia symptomology

Psychosocial interventions for people with dementia: a synthesis of systematic reviews

Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works. Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted. Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews. Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change

Scrapbooks: biographical digital scrapbooks for people with dementia

Tese de mestrado, Informática, Universidade de Lisboa, Faculdade de Ciências, 2017Demência é o termo utilizado para descrever uma ampla variedade de sintomas, que envolvem um declínio ao nível da memória, linguagem, raciocínio e outras funções cognitivas, e que afetam gravemente a capacidade da pessoa para realizar atividades cotidianas. Os números mais recentes [1] indicam que existem em todo o mundo 47 milhões de pessoas que vivem com demência. Com o envelhecimento natural da população, este número irá praticamente duplicar a cada 20 anos, atingindo mais de 131 milhões em 2050. A estimativa para o custo total mundial com a demência é superior a 733 biliões de euros. A forma mais comum de demência, 60% a 80% dos casos, é a doença de Alzheimer [2]. A doença de Alzheimer geralmente progride lentamente e pode ser dividida em três fases: fase inicial, fase intermédia e fase avançada. Uma vez que esta doença afeta as pessoas de diferentes maneiras, é importante realçar que nem todas as pessoas têm os mesmos sintomas ou passam por todas as fases. Na fase inicial, a pessoa torna-se mais esquecida de detalhes de eventos recentes, apresenta um mau julgamento e toma más decisões. Consciente disso, em geral, a pessoa encobre os seus lapsos de memória e os membros da família não os associam a uma doença. A próxima fase (fase intermédia) geralmente é a mais longa e pode durar anos. Naturalmente, com o progresso da doença, a pessoa exigirá um maior nível de cuidado. Nesta fase a pessoa começa a enfrentar sérios problemas, como esquecer-se de eventos da vida pessoal ou não conseguir lembrar-se da própria morada. Na fase mais avançada, a pessoa, eventualmente, torna-se incapaz de comunicar verbalmente ou cuidar de si mesma, e é necessário um acompanhamento pessoal 24 horas por dia a fim de garantir a maior qualidade de vida possível. Uma vez que não existe cura conhecida, o objetivo dos especialistas é retardar a sua evolução. As intervenções farmacológicas têm benefícios limitados, e os especialistas reconhecem que, na melhor prática, as opções não-farmacológicas devem ser testadas primeiro e os tratamentos farmacológicos devem ser utilizados como uma segunda abordagem [3]. Existem muitos tratamentos não-farmacológicos [4], mas, uma vez que existem várias áreas de sobreposição entre eles, estes tratamentos raramente são realizados isoladamente. A terapia comportamental (que visa encontrar a origem de comportamentos desafiadores das pessoas com demência e elimina-los), a terapia de orientação para a realidade (lembrando as pessoas com demência de factos sobre si e sobre o meio envolvente), a terapia de validação (onde os psicólogos tentam encontrar os sentimentos por detrás do discurso da pessoa com demência), a musicoterapia (onde a pessoa com demência dança, canta ou simplesmente ouve música), a aromaterapia (onde são utilizados óleos vegetais aromáticos para estimulação cognitiva), a terapia de estimulação cognitiva [5] (onde são realizadas atividades, como jogos, para estimular o pensamento, concentração ou memória da pessoa) e a terapia de reminiscência são apenas alguns exemplos. A terapia de reminiscência geralmente envolve a discussão de atividades, eventos e experiências passadas com outra pessoa, ou grupo de pessoas, com a ajuda de imagens, vídeos, lembranças, gravações de música ou de sons para motivar a discussão. O objetivo é elicitar memórias que a pessoa com demência possa ter acerca do seu passado, sendo este um processo em grande parte conversacional. O foco desta tese é a terapia de reminiscência, que tem a vantagem de poder ser adaptada a pessoas com diferentes níveis de demência (mesmo as que não consigam verbalizar podem ouvir música). Esta terapia pode ser executada de duas maneiras diferentes: em grupo, onde os participantes se reúnem para conversar sobre eventos passados; ou em sessões individuais, onde é feita uma revisão de vida na qual a pessoa é guiada cronologicamente através de experiências de vida e pode até produzir um livro de história da sua vida. Os cuidadores, geralmente os familiares mais próximos, também podem estar envolvidos no processo. Vários estudos comprovam alguns dos benefícios importantes da terapia de reminiscência [6] [7], como melhorias ao nível do humor, do bem-estar e do sentido de identidade pessoal; o aumento da socialização e comunicação; e a redução do stress existente nos cuidadores. Os cuidadores, já sobrecarregados com outras atividades diárias das suas vidas, acabam por sacrificar o seu próprio bem-estar em favor da pessoa com demência, ficando eles próprios reféns da doença. Além disso, quando estas atividades de estimulação de memória são realizadas por um psicólogo, estes acabam por não ter o conhecimento necessário sobre a pessoa, levando a uma falta de tópicos de discussão e a que não seja retirado o máximo proveito possível da terapia. Ao longo dos anos têm sido criadas diversas tecnologias para auxiliar psicólogos, cuidadores e pessoas com demência no combate a esta doença, no entanto a maioria dos psicólogos continua a trabalhar com os métodos tradicionais, maioritariamente com papel e caneta, e com escassez de elementos autobiográficos da pessoa com demência. Após uma análise detalhada do trabalho relacionado, é possível chegar a algumas conclusões. As soluções como os DVDs têm um custo demasiado elevado, demoram demasiado tempo a criar e a sua produção resultará em um filme que exibirá sempre os mesmos conteúdos para a pessoa com demência, levando à existência de memórias que nunca serão exploradas. Alternativamente, as ferramentas de imersão, como ferramentas de realidade virtual, geralmente não utilizam conteúdos autobiográficos, e as que o fazem requerem um grande esforço para criar ambientes virtuais. O uso de ferramentas interativas parece ser o mais aconselhável, no entanto, atualmente, estas ferramentas não exploram todo o seu potencial. A capacidade de recolher e utilizar conteúdos de qualquer tipo de media, aliada à facilidade de recuperar grandes quantidades de dados acerca do passado da pessoa com demência não tem sido explorada. Tendo em conta estes aspetos, o trabalho existente no grupo de investigação onde me inseri, e duas entrevistas preliminares realizadas com dois psicólogos diferentes, foi criado o Scrapbook. O Scrapbook é uma aplicação web destinada a ser utilizada por psicólogos durante sessões de terapia de reminiscência, e que tem como objetivo mitigar alguns dos problemas associados à terapia de reminiscência, nomeadamente a falta de informação biográfica acerca das pessoas com demência. A plataforma faz uso do crescimento constante das redes sociais, mais precisamente do Facebook, para extrair informações e conteúdos pessoais sobre as pessoas com demência, como gostos, locais visitados, fotografias, vídeos, eventos ou familiares, e interagir com os amigos para recolher novos conteúdos. Claro que nem todas as pessoas com demência têm uma conta no Facebook, e como tal o psicólogo tem também a opção de inserir estes dados manualmente. Para além das fotografias e vídeos recolhidos através do Facebook, o sistema é capaz de recolher outros conteúdos, vindos de outras Web APIs, baseados nos interesses das pessoas com demência e que podem também ser utilizados em jogos de estimulação cognitiva. Um estudo de duas semanas realizado em ambiente real de consulta, com uma psicóloga e três pessoas com demência, deixou indicadores que o Scrapbook pode ser útil para os psicólogos e que pode trazer benefícios ao nível da apatia e da deambulação.Dementia is a general term that describes a wide range of symptoms. These symptoms involve decline of memory, language, reasoning and other cognitive skills that affects a person’s ability to perform everyday activities. The most common form of dementia is Alzheimer's disease. There are worldwide nearby 47 million people living with dementia and this number will almost double every 20 years reaching more than 131 million in 2050.The total estimated worldwide cost with dementia is more than 733 billion euros. Once there is no known cure, the goal of experts is to slow down its evolution by pharmacological (has limited benefits) or by non-pharmacological (best practice) interventions. One of these non-pharmacological treatments is reminiscence therapy. The main goal of this therapy is to elicit memories that people with dementia have from their past, which can bring improvements in the level of well-being and mood, or delay the evolution of the disease. It involves a caregiver sitting next to the person with dementia showing pictures, keepsakes or music to motivate the discussion. Caregivers, usually already overburdened with other daily activities of their lives, end up sacrificing their own well-being in favour of the person with dementia, being themselves hostages of the disease. Furthermore, when the memory stimulation activities are carried out by a psychologist, they end up not having the necessary knowledge about the person, provoking a lack of discussion topics and, ultimately, ending up not taking full advantage of the therapy. Thus, the goal of this project was to create a web platform that supports the work of psychologists, streamlining the collection of relevant information about people with dementia and using this information as a starting point to perform reminiscence therapy, which involves watching slideshows with images, videos or music. A study, carried out in a real clinical environment, showed that the system was well accepted by psychologists, people with dementia and caregivers, and left indicators that Scrapbook can be truly useful for psychologists and can bring benefits in the level of apathy and ambulation

Technologies to support community-dwelling persons with dementia: a position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics

Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them

Technology-based tools and services for people with dementia and carers: mapping technology onto the dementia care pathway

The extent to which technology may be able to support people with dementia and their carers along the care pathway and in different care settings is of interest to policy makers and governments. In this paper we provide an overview of the role of technology in dementia care, treatment and support by mapping existing technologies – by function, target user and disease progression. Technologies identified are classified into seven functions: memory support, treatment, safety and security, training, care delivery, social interaction and other. Different groups of potential users are distinguished: people with mild cognitive impairment and early stages of dementia, people with moderate to severe dementia and unpaid carers and health- and social care professionals. We also identified the care settings, in which the technologies are used (or for which the technologies are developed): at home in the community and in institutional care settings. The evidence has been drawn from a rapid review of the literature, expert interviews and web and social media searches. The largest number of technologies identified aim to enhance the safety and security of people with dementia living in the community. These devices are often passive monitors, such as smoke detectors. Other safety interventions, such as panic buttons, require active intervention. The second largest number of interventions aims to enhance people’s memory and includes global positioning systems devices and voice prompts. These technologies mostly target people in the early stages of dementia. A third group focusing on treatment and care delivery emerged from the literature. These interventions focus on technology-aided reminiscence or therapeutic aspects of care for people with dementia and their carers. While the review found a range of technologies available for people with dementia and carers there is very little evidence of widespread practical application. Instead, it appears that stakeholders frequently rely on everyday technologies re-purposed to meet their needs

Evaluating a technology-based reminiscence program on engagement and affect in respite aged care : time travelling with technology

With an aging population, there is greater focus in ensuring that aged care facilities are delivering high quality care. This is particularly important with the increase in aged related diseases, such as those that result in dementia. Previous research makes clear the value of meaningful activity, socialisation and engagement for wellbeing and quality of life for older adults. Reminiscence therapy (RT), is as well-established a non-pharmacological intervention, used to increase engagement in older adults. It actively involves stimulating conversation through discussion of past events and experiences. The theory behind RT is founded in person-centered care and meaningful activity. Person-centered care focuses on the needs of an individual and has an emphasis on interpersonal relationships. Through personal life events, autobiographical memories are recalled, which assist in creating a meaningful experience and connecting a person to their identity. Additionally, technological developments (such as sharing video/images) offer possible new methods for increased engagement in the RT approach. However, there is controversy in existing research as to the benefits of RT and there is limited understanding of the effect of RT when driven by digital technology. The aim of this thesis is to build on and refine previous research by conceptualizing and quantifying older adult engagement. It explores this through investigating the impact of an experimental framework Time Travelling with Technology (TTT) on the engagement of older adults in respite aged care. TTT is a dynamic, interactive and immersive, technology driven RT program, that enables older adults to travel to locations of their past and novel places of interest. The research objective of this thesis is to investigate the effect of technology driven group RT on older adult engagement. More specifically, the focus is primarily on characterising engagement of older adults in residential care. This will be achieved through a multi-dimensional approach to measuring behavioural markers as proxies of the concept of engagement. The dependent variables include facial movement, lexical use and prosodic patterns of speech. Potential covarying factors, such as cognitive capacity, will additionally be considered to further explain such relationships. The central research question addressed in this thesis is: To what extent does technology delivered through TTT impact the engagement of older adults in respite aged care

The use of everyday technologies to enhance wellbeing and enjoyment for people living with dementia: A systematic literature review and narrative synthesis grounded in qualitative data

BackgroundEveryday technologies, such as laptops and tablets, are often used for enjoyment, pleasure, leisure and social participation. Despite this, whilst considerable research has investigated exploring people’s experiences of using assistive technologies, it is not clear how everyday technologies are experienced by individuals living with dementia. The aims of this review were to explore the experiences and views of people living with dementia and carers about using everyday technology to enhance their well-being and enjoyment, social engagement, participation and leisure as well as understand their views about the usability of everyday technology in dementia.MethodsA systematic search of the literature was conducted using the electronic databases: PsycINFO, PsycARTICLES, CINAHL Complete and EThOS. Five qualitative studies and five mixed-method studies were included and synthesised using a narrative approach. The methodological quality of the studies was assessed using the National Institute for Health and Care Excellence Qualitative Quality Appraisal, which uncovered key variation in the quality of the included, synthesised studies.FindingsThe review suggests that everyday technologies can help support well-being, particularly when technology is used in a group setting and when individuals received the right amount of support to help engage in the technology. Four major themes relating to experiences and views were derived from the findings of the 10 included studies: ‘Technology use maintaining a sense of identity’, ‘Assumptions held by the self and others’, ‘The importance of others’ and ‘The usability of technology influencing effective engagement’.ConclusionsOverall, everyday technologies appear to have a positive impact on different aspects of the well-being of people living with dementia. Clinical implications of these findings include supporting opportunities for people living with dementia to use everyday technology for enjoyment and making these technologies more widely available and accessible

Touchscreen interventions for people with dementia

This project builds on the existing evidence that suggests that art-based interventions can be beneficial for the wellbeing of people with dementia and their carers, and explores whether such interventions can be delivered via a touchscreen tablet device using an application that allows them to view art images. Twelve pairs of volunteers with dementia and their informal carers were recruited through Alzheimer’s Society Dementia Cafés. A quasi-experimental mixed-methods within-subjects study evaluated the impact of art-viewing on wellbeing using visual analogue scales as well as exploring the experiences of participants qualitatively with thematic analysis. Quantitative results showed a significant effect for change in composite wellbeing from viewing session one to session five. Wellbeing subdomain scores showed an impact on wellbeing which tended to increase with the number of sessions. Qualitative findings were reported in relation to shifts in cognition, changes in behaviour, mood and relationships between people with dementia and their carers. These changes tended to be viewed as positive by interviewees. The results suggest that touchscreen based art interventions have the potential to provide an activity people with dementia can engage in with their carers which can benefit their wellbeing. A larger-scale controlled study would help to further determine whether wider dementia care practice implications can be drawn for clinical psychologists and other healthcare providers