Research & Background Information
Objective
The goal of this study was to improve dementia patient care management and indoor guidance systems through an IoT wearable device that helps elders with dementia navigate indoor spaces.
Purpose
This study aims to
Decrease wayfinding response time = time elders take to reach their destination
Improve accuracy of guidance = reduce the number of errors in wayfinding
To decrease the stress of their caregivers *decided to also focus on their caregivers because patients with dementia tend to be more dependent on them, thus requiring significant dedication to their work.
Justification
There are 50 million patients with dementia in the world and this number is expected to continue rising. Due to their cognitive spatial and memory impairments, patients with dementia suffer from *wandering. This includes struggling with recognizing landmarks, mapping out and completing their route to their destinations, and forming memories to navigate a new environment. These behaviour interfere with their daily routines, preventing them from completing basic tasks like going to the toilet, going to bed, eating, etc. and possibly leading to emotional distress. Moreover, it puts patients at risk of getting into accidents, getting lost and possible getting injured when wandering into dangerous areas without the supervision of their caregivers.
Therefore, patients with dementia need additional help in navigating indoor and outdoor spaces. Compensatory information on landmark should be strategically placed in their living spaces to help them recognize paths to their possible destinations and build self-centered cognitive maps.
*Wandering: when individuals become lost in their own environment. It is a result of the spatial and memory impairment of patients with dementia. It is the second most frequent behavior of dementia and of the main difficulties caregivers have to deal with.
A previous study by the same authors observed dementia patients and carriers in a nursing center and identified unmet needs such as:
Offering indoor user-centered guidance
Proving the isntant location of elders with dementia to caregivers,
Landmark setting
Assistance notification
Environmental route planning
Use of a wearable device as a guide for indoor route guidance
They felt it was necessary to address these in order to improve the quality of life of patients and caregivers.
Target Users
Primary users: elders with mild to moderate dementia
Secondary users: primary caregivers of patients with dementia
Device
To improve the wayfinding efficiency of dementia elders and reduce stress of caregivers, they developed the Dementia Elderly Care Management and Guidance Security System (DECMGSS).
"The indoor interactive landmark device developed in this study can be described as a combination of audio, text display, and pictorial guidance; it is combined with the ESP-01S-tag wearable device and the Sony smartwatch to directly guide patients with dementia to the target location."
This system consists of three subsystems and one wearable device:
Indoor Guidance system (IGS): uses Esp-01s Wi-fi signal and a UWB chip modul for indoor positioning. It can detect the location of the smartwatch worn by dementia patients.
Guiding Landmark and Interaction system (LIS): display way-finding information. It is composed of a touch screen and NFC sensor, located frequented spaces by the patients. The sensor connects to the smartwatches to determine the starting point of their route.
Monitoring System with app: allows caregivers to know the patient's exact location at any time, warns them about any critical situations and informs the completion of their daily activities (drinking water, toilet, eating, rest and social interaction)
Hypothesis
DECMGSS can reduce the wayfinding time and accuracy
DECMGSS can reduce caregivers' stress value of caring for patients with dementia
Experimental Design
Patients underwent two wayfinding tasks, (1) the control and experimental task, which measured the wayfinding time, and (2) the physical landmark task, to measure the number of errors.
(1.1) Control task: Complete the assigned path without any auxilary products. *conducted for a week (1.2) Experimental task: Wear the smartwatch and UWB positioning tag and complete the assigned path through the DECMGSS. *conducted for a week *CV 1: Two paths wear designed, a red and a green one and were randomly assigned to each task to prevent any difference in difficulty. *CV 2: When changing from the control to the experimental task, the path was changed to prevent any practice effect. (2) Physical landmark task: After a 1 week of intervention/non-intervention, both the control and experimental group were given the task to reach their destination without ANY auxiliary products. They were only guided through physical landmark pictures and directional guidance placed at every corner. Multiple locations were shown at the same time, and the participants needed to judge the destination and direction. This test was done to see if the regular use of DECMGSS could help elders with dementia develop their cognitive spatial awareness.
Meanwhile, the stress of caregivers taking care of patients during this time was measured before and after the intervention period.
Caregiver Stress Scale Task: To measure the impact on the caregivers stress, they used a modified Caregiver Stress Scale (CSS). This is a questionarie consisting of 22 questions that measure caregivers stress according to 4 categories: personal repsonse, job concern, job competence, and inability to perform private work. Questions that pertained to home-based dementia care were not included because they were not relevant to the target population of the study. Each question was scored on a five-point Liker scale, with higher scores indicating higher levels of work stress.
Sampling
Elders with dementia and their respective caretakers were recruited from two private nursing facilities in Yunlin County, Taiwan and divided into experimental and control groups. The patients and the caregivers had different experimental tasks. The experimental group completed the tasks with the intervention of DMCGMSS, while the control group completed them without any intervention. This was done in order to compare how significant the change in wayfinding time and number or errors as well as the stress scale is with the intervention of DMCGMSS.
Sampling for the Wayfinding Tasks
Quota
65+ years old
mild to modrate dementia (measured using the Min-Mental Scale Examination
ability to move around the room independently
no visual impairment
Sampling size: 10 (experimental group), 10 (control group)
Sample demographics for experimental group
3 males, 7 females
avg. age of 72 years, ranging from 68 to 93
Sampling for the Caregiver Stress Scale Task
Quota
primary caregiver of a resident with ementia
at leas one year of caregiving experience at the facility
Sampling size: 10 (experimental group), 10 (control group)
Sample demographics
2 males, 18 females
Results
Time difference and number of errors between experimental and control groups for the two wayfinding tasks was compared:
Control group
average wayfinding time without any assistance: 130.70 s
average number of errors: 1.6
difference between pre-test and post-test CSS score: -1.7
Experimental group
average wayfinding time with DECMGSS intervention: 106.10
average number of errors after DECMGSS intervention: 1.4
mean pre-test CSS score: 68.4
mean post-test CSS score: 64.7
difference between pre-test and post-test CSS score: -3.7
Conclusion
Significant decrease in the wayfinding time, but no significant decrease in the number of errors
Significant difference between the experimental's pre-test and post-test scores, but no significant difference in the control groups scores. Thus, we can conclude the DECMGSS was effective in reducing stress of caregivers. More specifically. the points of difference were traced back to the items related to personal response and time dependence: decrease in the scoring of “I feel anxious about taking care of residents," “I need to keep an eye on the patient,” “Taking care of the patient gives me no time to rest”. Therefore, it can be said that DECMGSS reduced anxiety, nervousness and improved their time management.
Our Takeaways
In their literature review, they identified what techniques have being more efficient in addressing cognitive impairments through technology-assisted care:
text display is more efficient than images
sound prompts increase efficiency of guidance
rotating the sound, distance, orientation, and image improves the accuracy and reduces reaction time
direction indicators reduce errors and increase ease of use
good to use familiar objects to present landmarks
changing floors can disorientate patients again
Possible technologies we can use:
Infrared rays and bluetooth to detect the movement trajectories
Acceleration sensors for fall detection
DW1000 flower UWB chip plus Esp-01s Wi-Fi for indoor positioning system (precise to the cm)
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