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.