Date Presented 03/27/20
Veterans with mild cognitive impairment (MCI) or early Alzheimer’s disease and related dementias were asked to identify possible technological solutions to increase independence of those living at home with MCI or dementia. Most did not identify technology that could assist with future cognitive challenges. Understanding this poor insight and difficulty with forward thinking may inform OT practice when collaborating with families for dementia management.
Primary Author and Speaker: Jaye McLaren
Contributing Authors: Marlena Shin, Lauren Moo
PURPOSE: We will discuss interview results of participants with MCI/early stage dementia regarding forward thinking and insight when asked to project about future functional and cognitive abilities. Results will inform OT goals of helping persons with dementia maintain independence in the community.
DESIGN: This was a qualitative study asking Veterans with MCI or e-ADRD questions regarding potential technology solutions to allow people with memory problems to remain safe and independent at home. Community-dwelling Veterans ≥ 50 years old with MCI or e-ADRD who either lived alone or were left home alone for long stretches were recruited.
METHOD: Six Veterans participated in a 60-90 minute semi-structured qualitative interview during which we elicited opinions regarding technology use, specifically the potential use of a telepresence robot to increase independence in the community for those with memory problems. Two questions from the interview guide were: 1) What technology could help you with day to day functioning... and what about in the future? And 2) What are the main things you think might prevent people with memory problems or dementia from staying home alone safety? Interviews were audio-recorded for transcription purposes.
RESULTS: When asked about technology that could help with day-to-day functioning, only 1 of 6 Veterans identified technology that would assist with memory problems commonly experienced by this population. Most Veterans spoke only of technology to address physical limitations of the task (e.g. assistance with IADLs like housework and picking up medication). Even when Veterans were specifically asked to imagine what technology might assist people with memory problems, only 2 of 6 Veterans were able to identify potential technology (e.g. medication reminders and timers when cooking). With prompting from interviewers offering suggestions of potential technology assistance (e.g. emergency help access, medication and schedule reminders, communication assistance with family and doctors, and social stimulation) 5 of 6 Veterans were able to agree that some technology may be helpful for cognitive barriers experienced by individuals with MCI or ADRD. Throughout the interviews, 3 of 6 Veterans independently mentioned knowing someone close to them who had ADRD and whom they had watched go through the disease progression and pass away from dementia.
CONCLUSION: Responses showed that participants had a limited ability to independently identify potential cognitive challenges and suggest technology that could be of assistance for cognitive declines now and in the future. These findings demonstrate both a decrease in insight and suggest potential deficits in forward thinking regarding cognitive abilities, specifically projecting in the future as the disease progresses. Veterans who reported having witnessed someone progressing through the stages of dementia were more likely to identify at least one potential technological solution for cognitive challenges. The data provide valuable insight into the person living with the disease and their perspectives on function and ability now and in the future. This information can allow a more person-focused and dementia-focused OT intervention to support independence, functional participation, and safety at home. Results may inform current elements of OT practice specifically helping to guide practitioners’ thinking when collaborating with families and other stakeholders to provide education, set-up supports and offer modifications and adaptations. Consideration of the individuals’ (lack of) understanding of their own illness is crucial when caring for this population to help understand the complexities and ever-changing nature of dementia care management.
References
Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures 2017 [cited 2017 Nov. 11]. Available from: https://www.alz.org/facts/overview.asp
Thompson, C. A., Spilsbury, K., Hall, J., Birks, Y., Barnes, C., & Adamson, J. (2007). Systematic review of information and support interventions for caregivers of people with dementia. BMC geriatrics, 7(1), 18.
