Abstract
BackgroundMany older adults with dementia require constant assistance from a caregiver when completing activities of daily living (ADL). This study examines the efficacy of a computerized device intended to assist people with dementia through ADL, while reducing caregiver burden. The device, called COACH, uses artificial intelligence to autonomously guide an older adult with dementia through the ADL using audio and/or audio-video prompts.MethodsSix older adults with moderate-to-severe dementia participated in this study. Handwashing was chosen as the target ADL. A single subject research design was used with two alternating baseline (COACH not used) and intervention (COACH used) phases. The data were analyzed to investigate the impact of COACH on the participants' independence and caregiver burden as well as COACH's overall performance for the activity of handwashing.ResultsParticipants with moderate-level dementia were able to complete an average of 11% more handwashing steps independently and required 60% fewer interactions with a human caregiver when COACH was in use. Four of the participants achieved complete or very close to complete independence. Interestingly, participants' MMSE scores did not appear to robustly coincide with handwashing performance and/or responsiveness to COACH; other idiosyncrasies of each individual seem to play a stronger role. While the majority (78%) of COACH's actions were considered clinically correct, areas for improvement were identified.ConclusionThe COACH system shows promise as a tool to help support older adults with moderate-levels of dementia and their caregivers. These findings reinforce the need for flexibility and dynamic personalization in devices designed to assist older adults with dementia. After addressing identified improvements, the authors plan to run clinical trials with a sample of community-dwelling older adults and caregivers.
Highlights
Many older adults with dementia require constant assistance from a caregiver when completing activities of daily living (ADL)
From a caregiver's perspective, decreasing the number of interactions required to complete an activity of daily living (ADL) has a direct positive impact on caregiver burden
It is interesting to note that these ratings coincide with the participant's Mini-Mental State Examination (MMSE) scores rather than participant performance during the handwashing activity. These results suggest an interesting possible additional application of COACH as a diagnostic tool; by watching older adults perform ADL over a series of weeks or months, a future version COACH may be used to detect changes in the users' abilities, and level of dementia
Summary
Many older adults with dementia require constant assistance from a caregiver when completing activities of daily living (ADL). Various studies have implied that older adults ( those who have AD) benefit from aging in environments to which they are accustomed as familiar environments can provide memory and task cues [4,5,6] This shift from the hospital to home-based care means that family members and other informal caregivers are being increasingly depended upon to attend to the long-term health-care needs of older adults with AD. Even small decreases in caregiver burden have been found to alleviate the prevalence of depressive symptoms in caregivers of individuals with AD [8] This can lead to more successful informal care, resulting in lower medical costs and delayed long-term care placements
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