Dementia and assistive technology

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we help to improve social care standards
Dementia and assisted living technologies
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Dementia and assisted living technology
This module is just one of a number of resources
supporting Skills for Cares assisted living
technologies learning and development framework.
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Dementia and assisted living technology

• Use of an image showing a specific product is
  illustrative only and does not constitute an
  endorsement of the product or the company who
  supplied the image.

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Welcome, introductions and house keeping
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The Audience

• This module will be relevant to members of the
  social care workforce, particularly those working
  with people with dementia and their carers.
• It is particularly relevant to those who wish to
  know more about dementia and how ALT can support
  people to live happier, safer and more
  independent lives.

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Task 1

• In groups spend 5 minutes discussing why you are
  here and your aims for the day.

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Aims of today

• By the end of the module you will
• understand what dementia is and its causes
• be able to state the early signs of dementia
• be aware of the impact of dementia on the NHS,
  social care, families and the individual
• understand the importance of correct assessment
  of individuals with dementia and their carers
• be able to identify some of the solutions
  including assisted living technologies, that may
  assist the individual, their families and carers
• understand the links between assisted living
  technologies and the common core principles for
  supporting people with dementia.

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Task 2

• In your groups discuss what dementia is and write
  down how you think it is defined.

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Definition of dementia

• The term dementia refers to a set of symptoms
  including memory loss, mood changes and problems
  with communication and reasoning
• Dementia is NOT a natural part of growing old.
  It is caused by diseases of the brain, the most
  common being Alzheimer's.

Alzheimers society, 2012
Alzheimers society, 2012
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Common core Principles

• Principle 1 Know the early signs of dementia.
• Principle 2 Early diagnosis of dementia helps
  people receive
• information, support and treatment at the
  earliest possible stage.
• Principle 3 Communicate sensitively to support
  meaningful interaction.
• Principle 4 Promote independence and encourage
  activity.
• Principle 5 Recognise the signs of distress
  resulting from confusion and respond by diffusing
  a persons anxiety and supporting their
  understanding of the events they experience.
• Principle 6 Family members and other carers are
  valued, respected and supported just like those
  they care for and are helped to gain access to
  dementia care advice.
• Principle 7 Managers need to take responsibility
  to ensure members of their team are trained and
  well supported to meet the needs of people with
  dementia.
• Principle 8 Work as part of a multi-agency team
  to support the person with dementia.

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Prevalence
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Prevalence
Alzheimers society
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Task 3

• Think about people you know or have cared for.
  What excuses do they give when they forget things
  and why do you think they do this?
• From your experience and knowledge what do you
  think causes dementia?

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Causes of dementia

• Alzheimers disease (62) This is the most
  common cause which involves changes within the
  structure of the brain and also a reduction of
  the chemicals that help transmit messages.
• Vascular dementia (17) This is considerably
  less than Alzheimers, this is due to reduced
  blood supply to parts of the brain. This is often
  caused by Transient Ischaemic Attacks (TIAs or
  mini strokes) or a Cerebrovascular accident
  (stoke).
• Mixed Dementia (10) This is due to combination
  of the two above.
• Dementia with Lewy bodies (4) This is much
  less common and is caused by brain cell
  irregularities often causing symptoms commonly
  seen in Alzheimer's disease and Parkinsons
  disease.
• Other causes of dementia (7) There are some
  diseases that have dementia like symptoms which
  include, Creutzfeldt-Jakob disease, multiple
  sclerosis, Huntingdon's disease and Alcohol
  related brain damage.

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Early signs of dementia

• One of the core principles for supporting people
  with dementia is recognising the early signs.
  These symptoms may include
• loss or lapses of recent memory
• poor concentration
• problems communicating
• getting lost in familiar places
• making mistakes in a previously learned skill
  (e.g. cookery)
• problems telling the time or using money
• changes in sleep patterns and appetite
• personality changes-the brain does not process
  images as normal
• mood changes or uncharacteristic behavior (in
  later stages this will become more pronounced).
• Adapted from Common core principles for
  supporting people with dementia (SFC)

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Treatment For Dementia

• No single treatment has yet been developed that
  slows, changes or reverses the progressive
  decline of brain functions.
• There are a number of potential drug and non-drug
  therapies, that focus on treating some of the
  symptoms of dementia.
• People with dementia are at an increased risk of
  physical health problems.
• For these reasons, high quality support to
  remain independent and have the best quality of
  life are crucial to people with dementia.

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Task 4
Below is a chart displaying four columns 1,2,3
and 4, this represents billions of pounds
spending per year on health and social care for
the following conditions Cancer, heart disease,
dementia and stroke. Put them in the correct
order of spending.
Alzheimers Research Trust 2010
23bn
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How did you do? surprised?

• Most of the cost of dementia 12.4 billion per
  year - is in unpaid carers. Social care costs are
  9 billion, health care 1.2 billion and
  productivity losses 29 million.

Alzheimers Research Trust 2010
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Prevalence of Dementia

• There are suggestions that 30 of beds on older
  persons wards are occupied by those with dementia

• Around 60 of people with dementia live at home,
  with spouses or family members acting as carers.

Housing LIN 2012
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Carers

• In the UK there are 670,000 people acting as main
  carers for people with dementia.(Alzheimer's
  society 2012).
• Unpaid caring can be for more than 50 hours per
  week (NHS Survey of carers 2009/10).
• Carers UK (2010) state that within the next 3 to
  4 years the numbers requiring care will exceed
  that able to provide unpaid care.

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Task 5

• Weve looked at lots of hard facts about
  dementia, but what about the human impact?
• Watch this clip and reflect on your thoughts
  about it
• http//www.youtube.com/watch?vb7ZcbHrJP6ofeature
  player_embedded

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Risks for people living with dementia in their
home.

• Falls leading to injury and hypothermia
• Fire, flood or harm due to inappropriate use
• of household appliances - leaving the cooker on,
• leaving taps on
• Admitting unwelcome visitors or harassment
• Failure to take medications or taking too many
• Leaving home at inappropriate times and/or
• getting lost.

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Risks for people living with dementia in their
home.

• Many of these problems may be seen as not
  coping or not being safe and may be used as
  reasons to move the individuals away from own
  homes to another place of care.
• ALT can assist in decreasing many of these risks
  and therefore
• potentially allow the individual to stay in their
  own home
• environment.

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Dementia policy - the role of Assistive technology

• The National Dementia Strategy was published in
  2009 and
• makes explicit reference to the potential
  benefits of telecare....
• Three key steps
• Ensure better knowledge of dementia and remove
  the stigma
• Early diagnosis, support and treatment
• Develop services to meet changing needs better

The needs of people with dementia and their
carers should be included in the development of
housing options, assistive technology and
telecare. As evidence emerges, commissioners
should consider the provision of options to
prolong independent living and delay reliance on
more intensive services.
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• The Prime Ministers challenge on dementia
  Delivering major improvements in dementia care
  and research by 2015 A report on progress

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What are Assisted Living Technologies (ALT)?

• Skills for Care define ALT as including
• telecare - the use of technology, including
  monitors and sensors, to promote independent
  living and support to people in need of care to
  live longer at home, in homely environments and
  in their communities
• digital participation services can help people
  stay connected to their communities and loved
  ones. They can enable social interaction and
  provide education, entertainment and access to
  information. Examples might be the use of social
  networking sites or video-links to keep in touch
  with geographically remote family or friends. By
  doing so, services can help to reduce the risks
  associated with social isolation.

Adapted from Lewin et al 2010 Lewin, D, Adshead
S, Glennon B et al (2010) Assisted Living
Technologies and Disabled People in 2030. London
Plum Consulting
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What are Assisted Living Technologies (ALT)?

• Wellness Services are technologies that support
  people to have healthier lifestyles. They can
  help people reduce their chances of becoming ill
  and can help those with chronic conditions to
  care for themselves. Examples might be a
  smartphone application to support someone to give
  up smoking. Another example might be a piece of
  wearable technology that monitors how much
  exercise someone does every day to promote
  greater physical activity.  

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Who can use Assisted Living Technologies (ALT)?

• ALT can be used to help people with many
  different requirements, needs and goals. For the
  rest of the workshop, we will focus on dementia
  as a condition where ALT can support the family
  and carers.
• However, for a broader view of the potential
  benefits of ALT, please look at the other
  resources supporting the Skills for Care learning
  and development framework.
• www.skillsforcare.org.uk/assistedlivingtechnologyr
  esourcehub

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Task 6

• Think about people you meet regularly. Have you
  come across any ALT, at work or in your home
  life? Write down the examples of ALT with reasons
  why you think they are used.
• If you havent had experience of ALT think about
  the definition of ALT, can you identify any
  individuals that may benefit from such
  technology?

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ALT and dementia

• ALT generally falls into two categories
• Active Devices-
• This requires the user to actively make the
  device work (e.g. a personal alarm)
• Passive devices
• This device is one that operates without the user
  activating it themselves (e.g. a smoke alarm)
• It is more likely that an individual with
  dementia will use the passive devices.

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Benefits that ALT can bring

• It can
• promote independence and autonomy, and control
  both for the person with dementia and those
  around them
• help manage potential risks in and around the
  home
• support the individual and carers reducing early
  entry into care homes and hospitals
• facilitate memory and recall
• reduce the stress on carers, improving their
  quality of life, and that of the person with
  dementia.
• The Alzheimers Society, 2012

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Using ALT to support memory

• ALT can help orientate people to time and place
  if they are having memory problems. Examples
  might be large display clocks or talking watches.
  
• ALT can also help people from the early stages of
  dementia when their memory becomes less reliable.
  Examples might include electronic prompts which
  remind people if they are expecting visitors or
  have other appointments.

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Using ALT to support taking medication regularly

• Memory problems might affect someones ability to
  remember to take their medication correctly.
  There are a range of different ALTs that can help
  here, from simple clocks through to more
  sophisticated medication dispensers.

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Technology used to assess behaviour

• Motion sensors can be placed in the home of
  someone with dementia. These sensors can provide
  a record of movement that provide data for
• Assessment e.g. Is someone up and about at
  appropriate times? What time and how long for?
• Monitoring Family members or carers can monitor
  someones behaviour and look for patterns.
• One system (others are available) is Just
  Checking http//www.justchecking.co.uk/the-system
  /index.php

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Technology to enhance safety in the home

• The changes in individuals with dementia may lead
  to an increased risk of
• fire
• flood
• natural gas leak due to cookers being left on.
• Simple telecare devices can therefore help
  provide early warning of hazards
• smoke/heat alarms
• flood detectors
• natural gas alarms.
• These devices link to a call response centre who
  will alert emergency services, the individuals
  carers or relatives.

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Falls and people with dementia

• People with dementia are at particular risk of
  falls and their after-effects
• 2-3 times the risk of falling compared with
  someone without dementia
• 60-80 of people with dementia will fall at least
  once every year
• risk of sustaining a fracture is 3-4 times
  greater than a cognitively healthy person
• worse outcomes following treatment for
  fall-related fracture.
• Harlein et al (2009)
• Falls prevention and detection is extremely
  valuable for people with dementia this may
  include bed sensors or lights sensors.

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Falls prevention and detection
Automatic lights
Chair/bed sensors
Fall detectors
Darkness can increase the risk of falls.
Automatic lights can be installed which will come
on whenever the person gets out of bed.
Used to detect falls quickly, these alert a
monitoring centre (or, if appropriate, a live-in
carer) if an individual gets up and does not
return within a defined period.
Often worn on a belt, if an individual does fall,
help is summoned quickly by a monitoring centre.
This can provide reassurance and reduce the
health risks associated with falls.
Image provided by Tunstall
Image provided by Tynetec
Image provided by Tynetec
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ALT to promote safer walking

• People with dementia are at risk of getting lost,
  falling, or being involved in an accident when
  walking outside their place of residence.
• ALT interventions which may be useful
• Automatic voice reminders (triggered by movement)
  not to leave the house at odd times.
• Door sensors that alert a call centre if the door
  is opened at certain times (e.g. during the
  night).
• Safe walking systems can be carried or worn by
  users. These devices which can be within mobile
  phones or watches include GPS that allows a
  persons position to be located.

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ALT and Reminiscence

• Aids for reminiscence - There are different
  multimedia software available to facilitate
  conversation and encourage memories this can be
  achieved by looking at photographs or films about
  how life used to be, and playing familiar music
  or favourite songs to the person.
• Talking photo albums can also be useful
  reminiscence aids, this where a message can be
  recorded for each photograph.
• http//www.youtube.com/watch?vr0nx1g4Dtr4

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ICT and dementia

• SCIE have put together a website looking at
  information and communication technology (ICT) in
  activities for people with dementia.
• Aimed at managers and staff in the care sector,
  and those who organise activities for people with
  dementia.
• The technology can be used to find pictures,
  information, entertainment, keeping in touch and
  reminiscence activity.

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Technology to promote health in people with
dementia

• The presence of more than one disease is common
  in people with dementia.

• Some people may benefit from the remote
  monitoring of vital signs (telemonitoring) but
  this has not really been evaluated in people with
  dementia.

Other diseases will include many of the long-term
conditions, for example heart failure, chronic
obstructive pulmonary disease (COPD).
In addition, medication reminders and dispensers
may help with physical disease management.
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Case study

• Doris is 83 years old, a widow who lives with her
  daughter. Doris came to live with her daughter
  when Fred her husband died 3 years ago, as she
  just wasnt coping on her own.

• Joan, Doriss daughter noticed 8 months ago that
  Doris had become more forgetful than usual and
  often forgot how to make a cup of tea, but she
  put it down to old age and what do you expect
  when you are 83?. Whilst Doris was at a routine
  visit to the GPs Joan mentioned the
  forgetfulness to him and he decided to
  investigate this. Doris was eventually diagnosed
  with Dementia.

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• Joan is worried about how she will cope as Doris
  has fallen twice in the last month at night when
  getting up. Joan has also noticed that her mum is
  getting up more frequently during the night and
  not always knowing why. Joan isnt sleeping well
  as she feels shes always listening out for her
  mum.
• Joan works in a charity shop 2 days a week and a
  busy social life. She is finding it more
  difficult to go there as she is tired and is
  constantly worrying if her mum is ok? She has no
  one else to help as they are at work and have
  their own lives. She has stopped going out and
  contacting her friends as she feels she is always
  moaning and has nothing to talk about.

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• On one of the few days that Joan has
• managed to go to the charity shop, she
• started talking to one of the regular
  customers to the shop about her
  worry that she would have to give up her work due
  to concerns regarding her mum.
• As luck would have it she had a friend who had a
  similar situation and told her that there were
  things available to help.
• With a new determination Joan decided to make
  some enquiries.

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• After a few phone calls Joan found that there was
  quite a lot that would potentially help her mum
  and give her piece of mind at night and when
  Doris was on her own at home.
• Joan and Doris were visited and were assessed by
  a nice lady who seemed to understand what was
  happening and has told her about some of the
  equipment available. Joan began to feel
  optimistic about the future.

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Task 7

• Having thought about Doriss needs, what ALT may
  be of benefit to her?

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Collaborative care

• For an individual to feel safe, secure and as
  independent as long as possible collaborative
  care is a priority.
• Collaboration is a relationship between two or
  more people, groups or organisations working
  together to define and achieve a common purpose
  Hornby and Atkins (2000)
• Collaborative care is a key component in the
  National Dementia Strategy 2009.

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Initial assessment

• During the initial assessment, Doris would have
  been asked these questions.
• What are your goals and aspirations?
• What is important to you?
• Do you need help with any aspect of your life?
• What help you get now?
• What extra help you think you may need?

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Initial assessment

• Things that have to be considered when assessing
  the individual is their ability to consent
  regarding ALT.
• The next section will look at decision making of
  an individual with dementia and ALT.

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Active decision making

• What is active decision making?
• It is the process of decision making that keeps
  the individual and their family at the centre,
  whether it is about the use of ALT or the
  introduction of home care, or going into
  alternative accommodation either temporarily or
  permanently.

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Active decision making

• The person with dementia should still be involved
  in making the decision we need to find out
  their views and wishes.
• People who know the person well family, friends
  and care staff should be consulted.
• The decisions should where possible limit
  restrictions placed on the person.
• Active decision making should be underpinned by
  an understanding of ethical principles

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What do we mean by ethics?

• At the broadest level, ethics is the study of
  peoples moral behaviour (e.g. Good/evil
  right/wrong).
• That may sound rather abstract, but the
  aspiration to act ethically should underpin
  everything we do.
• To start, well discuss some broad ethical
  principles and healthcare issues, before looking
  in more detail at ALT.

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Ethics for social care

• The most commonly used approach is that of
  Beauchamp and Childress (2008) which has four
  principles
• Respect for autonomy Allowing people to make
  independent choices.
• Beneficence Acting in a way that benefits
  others.
• Non-maleficence The principle of doing no harm.
• Justice Ensuring fairness in care e.g. Making
  sure that everyone have the same access to care.
• Another Key issue that relates to ethics is
  mental capacity.
• Using active decision making keeps all these
  principles at the forefront of any intervention.

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Task 8Ethical principles and ALT

• For the ethical principle that your group has
  been allocated, think about a possible
  circumstance where ALT
• supports that principle
• challenges that principle.
• Where there are ethical challenges, how can you
  work along side the individual and their families
  to reach a decision? What might you need to take
  into account?

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Real world ethical concerns
Doubts raised over safety of doctor by
broadband Patients could be put at risk by using
internet-based equipment to manage their
conditions from home, the lead investigator of a
nationwide trial into the technology has warned.
Reduced human contact
Dependence on technology
Big Brother
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Ethical benefits
Fairer distribution of resource
Quality of life benefit
Enhanced self-care and independence
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Supporting ethical practice
Holistic assessment
Privacy and dignity
Robust governance
Informed consent
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Guidance on ethics in ALT
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The Mental Capacity Act (2005)

• The Act states that ...a person
• lacks capacity in relation to a matter
• if at the material time he is unable to
• make a decision for himself in relation
• to the matter because of an
• impairment of, or a disturbance in the
• functioning of, the mind or brain

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The Mental Capacity Act (2005)

• The definition means that individuals receiving
  AT with dementia may be deemed to lack capacity.
  The brief key principles are
• someone should be considered to have capacity
  unless it can be shown that they dont
• everything practicable should be done to help
  someone make a decision for themselves before
  deciding that they lack capacity
• nobody should be considered to lack capacity
  simply because they make an unwise decision
• anything done for someone lacking in capacity
  must be done in their best interests
• when acting on behalf of someone who lacks
  capacity, we must consider other ways of
  achieving goals that are less restrictive of the
  person's rights and freedom of action.

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Remember

• People with dementia should feel safe and secure
  and are able to be as independent as possible
• Promoting Excellence (2011) NHS education
  Scotland

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In summary

• Many people with dementia are happier if they can
  live in their own home for as long as possible.
  Living in familiar surroundings and maintaining
  regular routines can be reassuring and with the
  right support can often help the person maintain
  their independence for a longer period of time.
• Much can be done to enable someone with dementia
  to remain in their own home, even when their
  dementia is quite advanced. However, a person
  with dementia who is living alone will need
  increasing support.

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Aims of today

• By the end of the module you will
• understand what dementia is and its causes
• be able to state the early signs of dementia
• be aware of the impact of dementia on the NHS,
  social care, families and the individual
• understand the importance of correct assessment
  of individuals with dementia and their carers
• be able to identify some of the solutions
  including assisted living technologies, that may
  assist the individual, their families and carers
• understand the links between assisted living
  technologies and the common core principles for
  supporting people with dementia.

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Common core Principles

• Principle 1 Know the early signs of dementia.
• Principle 2 Early diagnosis of dementia helps
  people receive
• information, support and treatment at the
  earliest possible stage.
• Principle 3 Communicate sensitively to support
  meaningful interaction.
• Principle 4 Promote independence and encourage
  activity.
• Principle 5 Recognise the signs of distress
  resulting from confusion and respond by diffusing
  a persons anxiety and supporting their
  understanding of the events they experience.
• Principle 6 Family members and other carers are
  valued, respected and supported just like those
  they care for and are helped to gain access to
  dementia care advice.
• Principle 7 Managers need to take responsibility
  to ensure members of their team are trained and
  well supported to meet the needs of people with
  dementia.
• Principle 8 Work as part of a multi-agency team
  to support the person with dementia.

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Any questions?
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If you wish to find out more regarding dementia

• Skills for Care provide a range of modules within
  their Qualifications and Credit Framework
• DEM 201 Dementia awareness
• DEM 202 The person centred approach to the care
  and support of individuals with dementia
• DEM 205 Understand the factors that can influence
  communication and interaction with individuals
  who have dementia
• DEM 207 Understand equality, diversity and
  inclusion in dementia care
• DEM 305 Understand the administration of
  medication to individuals with dementia using a
  person centred approach
• DEM 308 Understand the role of communication and
  interactions with individuals who have dementia
• DEM 310 Understand the diversity of individuals
  with dementia and the importance of inclusion

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If you wish to find out more regarding ALT

• Skills for Cares Assisted Living Technologies
  Learning and Development Framework.
• There are a number of resources available that
  may be of use.

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Further reading

• www.dementia2010.org
• Alzheimer's Society Assistive technology May 2011
• Housinglin.org.uk- Assistive technology as a
  means of supporting people with Dementia A
  Review. (2012)
• JIT (2010) Telecare and Dementia Using telecare
  effectively in support of people with dementia.
• Alzheimer's society (2012) Dementia 2012 A
  National challenge
• MCA - Making decisions A guide for people who
  work in health and social care http//www.justice.
  gov.uk/downloads/protecting-the-vulnerable/mca/opg
  -603-0409.pdf
• SCIE. Using ICT in activities for people with
  dementia -
• http//www.scie.org.uk/publications/ictforde
  mentia/files/ictfordementia.pdf

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Further reading

• www.skillsforcare.org.uk/assistedlivingtechnologie
  s
• www.skillsforcare.org.uk
• www.skillsforcare.org.uk/assistedlivingtechnologyr
  esourcehub
• Hornby S and Atkins J (2000) Collaborative care
  interprofessional, interagency and interpersonal.
  Oxford Blackwell publishing

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www.skillsforcare.org.uk