Assistive technology

Assistive technology is ‘any item, piece of equipment, product or system, whether acquired commercially, off-the-shelf, modified or customised, … used to increase, maintain or improve [the] functional capabilities of individuals with cognitive, physical or communication disabilities’ (Marshall, 2000).

Much assistive technology is aimed at supporting people with dementia and their carers at home. Major benefits can be gained from introducing technology into residential facilities. People with dementia and staff benefit as jobs are made safer, easier and more supportive of person-centred care.

Assistive technology ranges from simple things like walking sticks to sophisticated equipment like satellite-based navigation systems to find people who have walked away from facilities. It includes kitchen technologies designed for residential care, nursing aids and new administrative software. Technology is useful at many levels.

Changes you can make now

Low cost

• Check existing technologies and plan to include new technologies that improve safety, promote people’s independence and support staff.
• Work out the long-term cost-effectiveness of new technology and include new technologies in your annual budget.

Moderate cost

• Put in movement-activated nightlights between the bedroom and ensuite toilet to assist movement and recognition.
• Put in motion sensors in bedrooms and other rooms used by people prone to fall.
• Set up devices for people’s freedom of movement without staff supervision.
• Update the facility’s mobility aids.
• Set up multi-media technologies and computer aids such as large screens and software for social use by people with dementia and family members.
• Replace stoves with induction cook-tops in kitchens accessible to people with dementia.

High cost

• In existing buildings put in wiring and cabling for efficient internet use and ability to include the latest technologies.
• Put in the latest range of safety-related sensors throughout the facility.
• Buy the latest software and handheld technologies to help staff work, including administration and nursing care.

Assistive technology uptake

While technology aimed at helping older people has grown rapidly, the aged care industry has only recently discovered how useful and cost-effective it can be.

Factors slowing down uptake seem to be lack of understanding of the meaning and possibilities of assistive technology, lack of awareness about its possible role in dementia care, and lack of knowledge about finding and putting in equipment. Assistive technologies:

• let people with dementia make more decisions for themselves
• offer safer and more secure livinggive people more privacy and dignity
• reassure family members about the level and quality of care
• are efficient and cost effective
• offset the need for some personal care.

Make sure you choose technology that is not noisy or humiliating. When thinking about technologies you use or planning to get new ones, think about the different types.

Fixed assistive technology

Changing or adding to existing structures, for example:

• grab rails
• light switches
• ramps
• showers
• stair lifts
• wheelchairs.

Portable assistive technology

Aids to daily living, for example:

• adjustable beds
• dressing aids
• hearing aids
• riser-recliner chairs
• walking sticks and other mobility-assist items.

Electronic assistive technology

Telecare and existing and new assistive technologies, for example:

• automated door openers
• alarms
• computers
• smart stove-tops
• Smart Wiring™
• smart toilets.

Using assistive technology

How you use assistive technology depends on a person’s needs and abilities and environmental factors.

Personal factors include:

• level and stage of cognitive impairment
• ability to carry out activities of daily living
• emotional factors like anxiety or depression
• wanting to walk away from a facility.

Environmental factors include:

• capacity of building structures
• design of new facilities
• relevance of technologies
• staff training
• family members’ understanding of the benefits of technology
• management commitment to long-term benefits, despite high initial costs.

Safety and security

There are new technologies to improve safety and security. A controversial one, electronic tagging, is being advertised for checking the safety of people with dementia living in the community. It is used in some facilities as an option to locked doors and medication for people who want to leave.

Using electronic tagging needs serious thought about if and how it might meet people’s needs (Robinson et al., 2006).

Wanting to leave

Other technologies include hidden switches and control lockouts, electric strikes and reed switches on outside doors giving people freedom of movement without staff supervision.

Sensors are another safety-related technology. They can detect:

• extreme temperatures: the device, useful in the kitchen, sends a warning signal if the temperature is very low, very high, or there is a rapid rise in temperature
• scalding baths: a temperature-regulated plug replaces the standard bath plug, changing colour from blue to bright pink at high temperatures
• gas: if gas is accidentally left on, the device shuts it off and raises an alarm
• falls: sensors worn on wrists can detect the impact of a person falling
• absences from bed or chair: the device alerts staff if a person gets up from their bed or chair and does not return for an unusual period of time
• night-time disturbances: a pressure mat sensor is put by the bed and activates an alarm when a person gets up during the night.

Passive infra-red systems, giving ‘notification by exception’, are another innovation. While costly, they are cost effective over time. Activated in the evening, they check movement in the bedroom and bathroom. Sensors respond to unusual behaviour, such as agitated movement or a person staying too long, for example in the bathroom. They alert staff via a vibrating pager. Infra-red sensors are supported by a computer system that can be tailored to people’s needs.

Technology for everyday living

Technologies successful in domestic settings are useful in facilities. For example:

• automatic lighting control
• stove-top monitors and automatic shut-offs
• automatic taps that turn off if users forget
• time-orientation support
• place and time reminder, a device giving verbal reminders to a person with dementia as they approach a door, for example, ‘It is still night-time. I should go back to bed’
• bed use sensors.

When including working or activity kitchens in a facility, think about induction cook-tops. Induction cook-tops use a magnetic field to heat saucepans that then heat pan contents and the cook-top stays quite cool. Because they are not directly heated, cooking surfaces cool more quickly. There are no open flames or fumes produced with induction cooking. If a unit is on and there is a pot, the surface is cool to touch.

Mobility aids are a form of assistive technology. They need careful thought about individual appropriateness. There are many different walkers, wheelchairs, handrails and walking sticks to meet different needs.

Smart toilets

Smart toilets have technology that can check blood pressure, heart rate and sugar in urine. Information is gathered and sent to a GP or other health professional. An optional feature has verbal prompts and speech recognition. Smart toilets can be tailored to meet personal needs.

Another new technology in smart toilet design involves an altered seat fitted to an existing toilet. It cleans and dries sensitive body areas with a warm spray of water and warm airflow, both with adjustable temperatures. This is done through two self-cleaning nozzles. The heated seat can be preset as desired.

An assessment of this toilet showed it lessened staff and resident stress, mental and physical, around toileting and reduced bacterial growth in urine. Smart toilets have weaknesses needing further improvement, but they can greatly help toileting care.

Other innovations relating to continence include:

• a plastic ring put under the toilet seat, raising it up 10 cm to help transfer on and off the toilet
• personal sensor and radio transmitters alerting staff to an incontinence episode and storing information on a central computer
• biofeedback machines that move pelvic muscles to help bladder control.

Continence checklist

Computers

Advances in computer technology make it easier for people with impairments to better use computers. These include:

• larger keys or keyboards, different key displays and onscreen keyboards
• touch screens rather than a mouse or keyboard
• screen enlargers and screen magnifiers
• speech and voice recognition programs rather than a mouse or keyboard
• screen readers that read out everything on the screen, including text, graphics, control buttons and menus
• software programs that use speech synthesisers for auditory feedback about what is being typed.

Multimedia computer technology can promote more meaningful contact between staff and people with dementia. For example, people can look at databases of video clips, music, songs and photographs together. Users have a limited number of choices using a touch screen and pick the media format they want. It is ‘failure-free’ because there is no ‘right’ choice. Large screens help joint use.

Multimedia technology can help with cognitive issues. For example, it can create reminiscences, support enjoyable experiences, and give options for success and mastery. Staff may be surprised at what people with dementia can do. Staff can learn more about a person with dementia and see them in a different light through shared multimedia experiences.

Additional computer-aided technologies include:

• wireless nurse-call systems
• wireless laptops
• palm pilots to collect and send data
• emergency call systems and computers wired from unit to unit in cluster-designed facilities.

Computers at regular intervals around a facility can be useful, letting staff quickly and easily access information.

New residential facilities

Staff support through physical design

Example - computer hutch

The photo shows a computer on a desk inside a tall cupboard that has a roller door.

The cupboard or ‘hutch’ is located in a corridor of the residential facility and the computer is for staff use.

To the right of the computer hutch there is a hand basin for staff hand washing.

The computer hutch can be closed without needing to pack up any computer related work. When closed the computer hutch is effectively disguised to not look like a door or a cupboard that people with dementia may want to investigate.

Staff can access the computer for administrative work easily and quickly while still being in close proximity to residents.