Top 3 Considerations when initiating iPADs for Persons with Dementia ( PWD ) in Long Term Institutions in Singapore

A recent article discusses the lack of activity and boredom reported by persons with dementia ( PWD ) in long term care facility (Harmer et al, 2008). Therefore, it is crucial to engage them in meaningful activities as they can increase positive emotions (Leng, 2014) and thereby increasing one’s quality of life, even after the diagnosis of dementia.

With rapidly aging society and  shortage of healthcare staffing in Singapore, there has been a growing demand to explore the use of touchscreen technology (  as one of the therapeutic intervention to improve meaningful engagement, reduce BPSD behaviors, improve cognitive skills sets as well as improving social skills among PWD in care homes.  Since 2012, the long term care home I am rendering OT consultation services have piloted iPAD projects of various design constructs in hope to improve quality of life of persons with dementia ( PWD ) living in the care home. We have conducted a literature review on the use of touchscreen technology for persons with dementia ( PWD ) and we noted there are only a handful of studies available at the moment. On a overview, these studies suggested the potential of iPADs in expanding conversations, increasing depth of memories, improved subjective well-being and the well-being of formal caregiver.

Upon implementing the programme for 4 years,  below are the 3 Key Considerations when

implementing iPAD to Persons with Dementia ( PWD ).

1. Subtypes of Dementia

As different subtypes of dementia present different set of clinical symptoms, for a start, it is recommended to consider trialling the intervention for clients diagnosed with Vascular Dementia and Alzheimer’s Disease. This is because majority of the Vascular Dementia ( VD)  clients and Alzheimer’s Disease clients  ( AD ) will have their visual perceptual skillsets, an important prerequisite skillset for iPAD interventions, relatively preserved until later stages of the disease ( McGuiness et al, 2010).

In addition to intact visual perceptual skill, as long as one is relatively oriented to his/ her sense of space and time, in the absence of active mode of BPSD, with a reasonable amount of sustained attention span, clients of these dementia subtypes will be able to meaningfully engage in a simple, highly intuitive, carefully selected game applications upon weeks of graded, consistent exposure to touchscreen interventions. 

Know your patients, well

A thorough understanding towards persons with dementia ( PWD ) is half the battle won. Occupational Therapists can explore using Pool’s Activity Checklist for categorization purposes. It is recommended to use Life History Profile to complement a holistic understanding of the PWD under your care. It would be helpful to gather inputs from family members of Person With Dementia’s ( PWD )  favourite past times prior to enrolment in your centre. With these information at hand, it will be useful to filter the irrelevant apps to the clients and is helpful in facilitating the right selection of applications. We have had a client, formerly an IT -savvy retiree, who used to spent his lifetime in the casino ( prior to admission to care home )  and now has his favorite pastimes to be extended in the care home when we introduced to him the use iPAD where he has requested to access to Slot Machines-themed  games applications. He is now able to continue reminsicing his “good old days” and the team observed an elevation of his mood and well-being in his stay in the care home. Upon encouragement from care staff, he has since then took on the role of a iPAD facilitator in the care home.

2. Implementation

Physical Environment :

Keep the noise level low during touchscreen sessions as environments with high noise level are highly distracting. Quiet environment and sufficient, even lighting are highly recommended.

Social Environment:

Having the right social dynamic is half the battle won too. From our experiences, both individual sessions and group settings are highly therapeutic. If the client demonstrates a certain preferences to games applications not to the generic liking to other clients, individual setting is recommended.  If the OT wishes to address and facilitate turn-taking and reinforcing approprate social skills, group therapy might be worth considering. It is worthy to note that having the right social dynamic of clients will be a synergy to engagement rating while a poor match might lead to unfavourable outcomes.

3. Interface Design and the Best-suited Applications 

While there are various screen dimensions, we have trialled 2 dimensions of touchscreen devices, 8 inch and 10.1 inch. Generally, bigger screens are better and promotes better engagement. In regards to the best-suited apps for persons with dementia, with millions of applications availabe in App store, careful selection of applications are essential to facilitate meaningful engagement among persons with dementia.

Most interfaces of the applications made available in app store are not senior- friendly. Amongs all, its fast- moving graphics, the use of avatars and voice-overs might not promote engagement.  Therefore, from our experiences, general guidelines to facilitate our selection of application includes: clean interfaces, optional features ( flashing/ sound feature etc ) , contrasting colors and lastly but not the least, applications which are relevant to the value system and culture of the users.

For instance, we observed high level of  activity engagement when the team introduced a culturally-relevant game of manning an ice-cream booth in Singapore. User is required to take ice-cream orders by making ice-cream cones and bread of various local flavours ( durian, chendol, red bean ) as requested by the customers of various ethnic groups, with a physical Mass Rapid Transit ( MRT ) as the backdrop of the game. On the contrary, there is a stark drop in engagement rating when the same users were introduced the game of manning a French dessert ( Sorbet ) counter with the backdrop of a European café ( with every other aspects of the game remain a constant ). Culture matters. 

Conclusion:

In view of its relatively low-start up costs, highly customizeable, highly versatile, intuitive design and the vast  availability of appss, touchscreen interventions have enormous potential in improving quality of lives of persons with dementia in the care homes. As healthcare workers, particularly Occupational Therapists working  in care homes, it is about time to explore the use of this intervention in greater depth as we continue to make a difference in the lives of others in our community.

About the Blogger:

Blog1

Prudence Chan, Clinical Director and Principal Occupational Therapist of Pacific Rehab & Therapy in Singapore. She is a Dementia Care Specialist and Researcher with special interest towards redefining the Role of Occupational Therapists in Long Term Facilities in Singapore.

She has actively involved in various Dementia- specific Research Projects with close collaboration with local App Developers and Researchers of a Local University in re-purposing Games Applications for persons with Dementia ( PWD ).

She has also involved in the administration and coding of various Activity Engagement Scales since 2016 till present.

Prudence is due to complete her Msc in Dementia Studies in 2020.

References:

Harmer BJ, Orrell M. What is meaningful activity for people with dementia living in care homes: A comparison of the views of older people with dementia, staff and family carers. Aging Ment Health. 2008 Sep;12(5):548–58.

McGuinness B, Barrett SL, Craig D, Lawson J, Passmore AP. Attention deficits in Alzheimer’s disease and vascular dementia. J Neurol Neurosurg Psychiatry. 2010;81(2):157–159.

 

Leng FY, Yeo D, George S, Barr C. Comparison of iPad applications with traditional activities using person-centred care approach: impact on well-being for persons with dementia. Dementia (London) 2014 Mar 1;13(2):265–73.

Weir AJ, Paterson CA, Tieges Z, MacLullich AM, Parra-Rodriguez M, Della SS, Logie RH. Development of Android apps for cognitive assessment of dementia and delirium.

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