Lessons Learnt from the Evaluation of Reminding Aids

C Nugent, S O’Neill, M Donnelly, L Galway, M Beattie, S McClean, B Scotney

Dementia

• Dementia is a progressive, disabling, chronic disease.

• 28 million people suffer from dementia worldwide.• By 2030 the numbers are expected to double and

by 2050 they are expected to triple (Prince 2010). • The costs of care associated with those suffering

from dementia were estimated at £400bn in 2010.

• Typical symptoms include impairments of memory, thought, perception, speech and reasoning.

• It is also common to witness changes in personality and behaviour in addition to exhibit symptoms of depression, apathy and aggression.

Technology Aids

Activity Assistance

Location tracking

Item locators

Electronic Memory Aids

Robot assisted activity

Medication Management

Mobile Phone Video Reminding

Support persons with mild Dementiato improve independence and QoL.to reduce caregiver burden.

Focused on using a truly ‘everyday’ technology:Use a familiar face to offer the reminders Provide a ‘virtual Caregiver’ throughout the day.

# Participants Days of UsageRange (Days)

Initial 21 79 2-5

ABA 9 18 2

Longitudinal I 6 205 6-61

Longitudinal II 4 101 12-34

Total 40 403

EvaluationMethodology

Evolution of Reminder Interface

• Video reminder• Phone with merged button• Phone weight: 99g• Phone size: 1.8"x28x35mm• Resolution: 176x220

Sony EricssonK750i

• Video reminder• Phone with merged button• Warning that alert will come by

lighting up the background 30s before reminder delivery

• Phone weight: 71g• Phone size: 47x103x9mm• Resolution: 240x320

Sony EricssonW880i • Video reminder

• Phone with merged button• Warning that alert will come by

lighting up the background 30s before reminder delivery

• Repeat reminder for routine tasks (daily, weekly, monthly)

• same phone details as before

Current System

EVOLUTION

•Recording with webcam

•One screen interface for recording & scheduling

Laptop based interface

• Recording with webcam • Recording with

microphone to improve audio quality

• Wizard-led interface querying one piece of information at a time for recording & scheduling

Laptop based wizard-led interface

• Recording and scheduling on touch screen

• No extra microphone or camera required

• No cluttery cables, mouse, keyboard required

• User of wizard-led interface• Option to schedule repeat reminder

for routine tasks

Touch screen based wizard-led interface

EVOLUTION

Evolution of Carer’s interface

User Recruitment

• Participants were recruited by clinical research staff at the Memory Clinic, Belfast City Hospital.

• Inclusion criteria: – recorded as having mild dementia (MMSE >18), – who lived alone and/or with a wiling carer able to record video messages.

• Both patient and carer were involved in the informed consent procedure.

• Baseline measurements of cognition were made based on MMSE and the Disability Assessment for Dementia was used for functional ability.

• Pre and post evaluation questionnaires were administered by a research nurse via face-to-face interviews.

User Engagement

Patient ID

Age Gender Length of condition

MMSE DAD Carer Age

Carer Gender

Relationship

Living Arrangement

C11 75 Female 2 years 26 78 45 Female Daughter in law

Together

C12 73 Female 2 years 18 68 77 Male Spouse Together

C14 61 Male 4 years 27 60 58 Female Spouse Together

C15 71 Female 2 years 25 63 73 Male Spouse Together

Details of participants and carers engaged in evaluations

Identified Needs

Carer personally reminds

Carer calls to remind

Post-it or reminder

note

Diary or Calendar

entry

Mobile phone or

TV reminder

Other Technology

(please specify)

Don't need

it

Meals 4

Drink 4

Entertainment 2 1 1 1

Appointments 2 2 3

Medication 2 1 1

Housework 4

Make calls 2 2 2

Other

Summary of identified user needs based on pre-evaluation questionnaires.

In-situ measurements

10:57:2112:41:2014:25:2016:09:2017:53:2019:37:2021:21:2023:05:200:49:202:33:204:17:206:01:207:45:209:29:20

11:13:2012:57:20

0

1

12:01:0517:49:0423:37:045:25:04

11:13:0417:01:0422:49:044:37:04

10:25:0416:13:0422:01:043:49:049:37:04

15:25:0421:13:043:01:048:49:04

0

1

Results

Participant Duration No. of reminders recorded

and delivered

No. of reminders

missed

No. of reminders

ack. 1st attempt

No. of reminders

ack. 2nd attempt

No. of reminders

ack. 3rd attempt

No. of reminders

ack. 4th attempt

C11 34 days 145 8 108 17 7 5

C12 12 days / / / / / /

C14 27 days 22 0 19 2 1 0

C15 28 days 49 10 34 2 0 3

Analysis of Results following evaluations

Numbers of missed reminders were low.

The majority of reminders were acknowledged the first time it

was received

Analysis of post evaluation questionnaires

• Overall the feedback from the participants and carers (based on set of 30 questions post evaluation) was positive:

– It supported reminders for their necessary tasks.– The phone was easy to use.– The phone interface and button size was very usable.

• Only 1 participant wore the phone around their neck others felt it was too heavy.

• There was reported embarrassment about the reminder being delivered in public.

• When asked about WTP, all dyads agreed that they would pay for the service.

Analysis of post evaluation questionnaires

• Negative Comments

“It didn't do anything, I didn't hear the messages.”

“It was too much she couldn't manage it and got frustrated, she kept trying to listen like a phone to her ear” (Carer)

• Positive Comments

“Reminders very good especially re medication in middle of day.”

“useful prompt, took time to get used to it, only getting real hang of it now”

Challenges• Internet access (Broadband / Dongle)• Personalisation

– Level of detail shown on screen and on documentation– Mode of reminder delivery (text, video)

• Data Management – Heartbeat– Activity / Acknowledgments– Battery level

• Compliance– Compliance Assessment (Sensorised Environment)– Feedback Management

Conclusions

• Although data was limited with 4 participants, a useful insight has been gained into the overall utility of the system. (Long duration and recording of video messages.)

• Varying levels of personalisation should be offered.• Value the importance of technical framework to

support deployments.• Support by carer is correlated with success of using

the device.• Consider factors affecting technology adoption.

• Kyle Boyd• David Craig• Dorian Dixon• Mark P. Donnelly• Leo Galway• Sarah Mason• Sally McClean• Brian Meenan• Chris D. Nugent• Sonja A. O’Neill• Guido Parente• Bryan Scotney

Acknowledgements