Cognitive decline, as well as sensory changes in vision, hearing, and proprioception* can increase the risk of accident and injury in older adults with dementia. Increasingly, technology has become a potential resource for improving safety and supporting independence for older adults with dementia.
*Proprioception: a sense or understanding of the position and movement of our bodies in space.
Technologies for aging are typically designed to support or enhance activities of daily living, personal health or safety, mobility, communication, and physical activity. Specific examples include vital signs monitoring and fall detection devices, mobile phones designed for seniors, and medication reminders (Peek et al., 2019).
In recent years, interventions that include a combination of new technologies and more “traditional” care services have become increasingly popular in the field of dementia care. Because caregiver oversight constitutes the largest share of informal caregiving, new technologies for environmental safety and control can potentially reduce the time needed for supervision (Malmgren Fänge et al., 2017).
Did You Know. . .
Leading causes of preventable death in the home and in the community include:
- Poisonings (37%)
- Firearms (29%)
- Falls (23%)
- Choking and suffocation (5%)
- Drownings (3%)
- Home fires (2%)
National Safety Council, 2020
Elements of a Safe Environment
Safety is the ability to keep a person safe from harm. A safe environment is one in which a person is protected from anything that is likely to cause injury. As a person’s dementia progresses, safety becomes more of a concern. Caregivers must (1) think prevention, (2) adapt the environment, and (3) minimize dangers.
Technologies that support people with dementia are often called “assistive technologies”, and can be grouped into three overlapping categories:
- Devices used for prompts and reminders.
- Devices that support communication and reminiscence.
- Devices used to monitor activity, movement, and location.
Care homes tend to favor technologies used “on” residents, primarily to enhance safety and help with care. These technologies include systems that incorporate wearable or environmental sensors to detect bed occupancy, falls, entry and exit through doorways, and provide location monitoring, activity, or physiological changes. These items alert staff when assistance is needed and provide data for analysis. There is growing interest in video technology, partly to address fears of malpractice, but also to record unwitnessed incidents such as falls or altercations between residents (Hall et al., 2019).
Safety in an Adult Day Care Center
Safety is a joint responsibility, shared by center operators, managers, healthcare workers, and volunteers. Safety policies and procedures must cover environmental safety, infection prevention, emergency procedures, handling of hazardous materials and chemicals, and creation of a disaster plan. The building’s design must include safety features such as grab bars, ramps, wandering paths with ample seating, standing stations for exercise and stretching, and features that encourage independence while also ensuring safety.
Because specialized adult day care centers have clients experiencing cognitive decline, safety policies and procedures must take into account needs and behaviors unique to that clientele. This means the center must have safety policies that address wandering, falls, aggressive behaviors, swallowing disorders, food preferences, and transportation safety, as well as staff training in these areas.
A day care center that provides services to people with dementia can provide a feeling of safety for clients and their family members. In a Norwegian study involving 17 family caregivers of people with dementia who attended an adult day care program, caregivers described the center as a service that represented something safe and routine for the person with dementia (Tretteteig et al., 2017). Centers also contribute to safety by providing caregiver training and information about assistive equipment, transfer techniques, and safety planning in the home.
Technologies Related to Safety
For people with dementia, technologies related to safety can be something as simple as a grab-bar or a safety razor. In a healthcare center as well as in the home, safety technologies might include rails, barriers, alarms, gait belts, non-skid surfaces, comfortable seating systems, walkers, canes, and wheelchairs.
Computer-based technologies are increasingly being used to address safety concerns. Cameras, global positioning devices, text messaging, and wearable electronic devices that alert caregivers when a person is trying to leave a designated safe area can be useful.
Technologies recommended by dementia experts include:
- Analogue clock
- Personal management planners
- Pre-packaged medication system
- Electronic pill reminder
- Large number LED wristwatch
- Passive infrared beam to attract a person’s attention and provide reminders
- Flood detectors
- Personal phone alarms
- Wireless remote key locator
- Internet mobile phone tracking device (Dementia Australia, 2020)
Usability and Acceptance of Safety Technologies
Usability and acceptability are key issues when considering a new technology intended to be used by older adults with dementia. Usability is the level at which a device can assist users without interfering with their normal activities of daily living (Abbate et al., 2014). In the context of dementia care, acceptability is the degree to which a technology is pleasing and agreeable to the user. Usability and acceptability are related to:
- Willingness to use
- Ease of learning
- Time to accept
- Willingness to keep
- Number of errors due to incorrect interactions
- Level of satisfaction (Abbate et al., 2014)
Despite the sophistication of healthcare technologies, little effort has been made to assess their usability and acceptability before deployment. To be useful, the design of safety devices must consider the users’ needs, fears, mental models, self-learning ability, social behavior, lifestyle, and fashion tastes (Abbate et al., 2014).
Monitoring Wandering with a GPS Device
Wandering outside the home can put a person at risk of exploitation and injury and cause caregiver stress and anxiety. Often, however, the person does not wander far from home, may be in familiar territory, can find their way home, and may be at relatively low risk. Locking people inside a home or facility must be balanced against the potential benefits of physical exercise, social contact, informal supervision by neighbors and local shopkeepers, and the perception of autonomy afforded by “safe walking” (Milne et al., 2014).
One possible intervention to support safe walking is the use of electronic location devices such as Global Positioning System (GPS) navigation. In theory these devices can provide the exact coordinates of a person carrying a GPS device. Safe areas and times can be set up that allow the person to move around through familiar areas but will set off an alert if a geo-temporal limit (or “geo-fence”) is breached. Additional services such as an operator to phone the person and using GPS to guide them home have also been described (Milne et al., 2014)
Using Technology to Prevent Falls
Technology-based interventions have been deployed in a wide range of falls prevention contexts and include diagnosing and treating fall risks, increasing adherence to interventions, detecting falls, and alerting clinicians in case of falls. Technology also has the potential to play a role in enabling older adults to self-assess, giving them the opportunity to perform self-assessments (Hamm et al., 2016).
Pre-fall prevention interventions are technology applications that focus on supporting patients who have not yet experienced a fall but may be at risk of falling. They take a pro-active approach via the development of applications, which support the delivery of targeted physical activities, exercises, and education programs that increase awareness of fall risks and help develop strategies to identify and overcome environmental fall hazards and the complications that may arise after having a fall (Hamm et al., 2016).
Post-fall prevention interventions are applications of technology which focus on individuals who have already experienced a fall and aim to help assess and deliver interventions to reduce the future risk of repeated falling episodes. Interventions share similarities with the pre-fall program emphasizing applications that support the delivery of exercise and education programs with a view to overcoming intrinsic and extrinsic fall risk factors (Hamm et al., 2016).
Technology platforms that falls prevention systems use are:
- Game consoles: self-contained platforms in which specific game applications are utilized by falls prevention systems to deliver falls prevention related games.
- Nintendo Wii and Microsoft Kinect: for intervention types such as physical activities, game consoles and sensor devices such as are often used.
- Desktop computers.
- Smart phones: with integrated sensors and communication features.
- Tablets: which includes inertia measurement units, sensors (accelerometer, gyroscope, GPS), camera and touchscreen display.
- Virtual reality devices. (Hamm et al., 2016)
Promising Practice for Older Adults
The Federal Highway Administration has developed a “Handbook on Designing Roadways for the Aging Population” which incorporates road design, retroreflective and larger signage, and engineering best practices to address functional challenges faced by older drivers and pedestrians. Florida, Iowa, and Michigan are currently leading the way in adopting these recommendations, part of a safe systems design approach for all road users.
National Safety Council, 2020