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Gap Analysis/Aging and Dementia

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Contents

Note: This page is out of date. This page has been ported to the github version. If you have edits for this page please send them to the list or to Michael and Lisa.

Description

The Aging and Dementia Gap Analysis focuses on issues and techniques for improving inclusion and quality of life for people with dementia using ICT. Our strategy includes a key ambition to develop ICT techniques that will work better for people affected by dementia - and to define, develop and improve dementia and aging friendly ICT.

Many people are able to age in good health and remain active participants in society throughout their lives. But others experience physical and cognitive limitations, and may lose the ability to live independently. Although dementia mainly affects older people it is not a normal part of aging.

The most elder-rich period of human history is upon us. How we regard and make use of this windfall of elders will define the world in which we live.

A good phrase to remember regarding people with dementia; “If you’ve met one person with dementia, you’ve met one person with dementia” – largely attributed to the late Tom Kitwood although no direct source has been found..


Description of Aging and Cognitive Decline

NOTE: Need AGING definition here...... From Miriam Webster's Dictionary, the definition of aging is: Gradual change in an organism that leads to increased risk of weakness, disease, and death. It takes place in a cell, an organ, or the total organism over the entire adult life span of any living thing. There is a decline in biological functions and in ability to adapt to metabolic stress. Changes in organs include the replacement of functional cardiovascular cells with fibrous tissue. Overall effects of aging include reduced immunity, loss of muscle strength, decline in memory and other aspects of cognition, and loss of hair colour and elasticity in the skin. In women, the process accelerates after menopause.

Aging definition: an age-dependent or age-progressive decline in intrinsic physiological function, leading to an increase in age-specific mortality rate (i.e., a decrease in survival rate) and a decrease in age-specific reproductive rate (7) To sum it up, aging is a complex process composed of several features: 1) an exponential increase in mortality with age; 2) physiological changes that typically lead to a functional decline with age; 3) increased susceptibility to certain diseases with age. So, I define aging as a progressive deterioration of physiological function, an intrinsic age-related process of loss of viability and increase in vulnerability. (8)

Description of Dementia and Cognitive Decline

Dementia is defined as a severe loss of cognitive abilities that disrupts daily life. Symptoms include memory loss, mood changes, visual perception, focus challenges, and problems with communicating, decision making, and reasoning. Dementia is not a normal part of growing old. It is caused by diseases of the brain, the most common being Alzheimer's. Dementia is progressive, which means the symptoms will gradually get worse.


Description of Alzheimer's

Alzheimer’s disease (62% of those with dementia): A physical disease caused by changes in the structure of the brain and a shortage of important chemicals that help with the transmission of messages. In short, Alzheimer's is a brain disease that causes a slow decline in memory, thinking and reasoning skills.

NOTE: Statistics are from 2013 UK Study. Need to map with WHO and others.


Description of Less Common (Non-Alzheimer's)

Set of non-Alzheimer's Dementia diseases:

  • Vascular Dementia (17%): Caused by problems in the supply of blood to the brain, commonly cause by a stroke or a series of small strokes.
  • Mixed Dementia (10%): A type of dementia where a person has a diagnosis of both Alzheimer’s disease and vascular dementia.
  • Dementia with Lewy bodies (4%): One of the less common forms of dementia, it is caused by irregularities in brain cells. Leading to symptoms similar to Alzheimer’s disease and Parkinson’s disease.
  • Rarer causes of Dementia (3%): There are many rarer causes diseases and syndromes that can lead to dementia or dementia-like symptoms, including Corticobasal degeneration and Creutzfeldt-Jakob disease.
  • Fronto-temporal Dementia (2%): Rare when all ages are taken into account but relatively common in people under 65, it is a physical disease that affects the brain.

NOTE: Statistics are from 2013 UK Study. Need to map with WHO and others.


Cognitive Function

This section is a technical reference. Jump to the next section on Symptoms for more practical information.


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. Understanding the role of age and fluid intelligence in information search, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility, 119-126, S. Trewin, J.T. Richards, V.L. Hanson, D. Sloan, B.E. John, C. Swart, J.C. Thomas, 2012. (Contributed by Katherine Deibel)
  2.  ??
  3.  ??

Cognitive Function Decline Due to Dementia

Overview: The parts of the brain and cognitive functions affected depend upon the type of dementia.


Alzheimer's

Alzheimer’s: Specific Causes are being researched, but scientists note a buildup of two abnormal proteins (amyloid and tau) which damage nerve cells in the brain. The proteins form different types of clumps, plaques or tangles, which interfere with how brain cells work and communicate with each other. Plaques are usually first seen in the area of the brain that makes new memories (the hippocampus of the medial temporal lobe), but then moves to other parts of the brain as the disease progresses.


Auditory Discrimination

Whenever the temporal part of the brain becomes diseased, people with dementia have difficulty making sense of sounds. They may lose the ability to follow conversations or become abnormally sensitive to sound. People can also become uncertain about the location of sounds, and social situations and music may be more difficult to enjoy.

Visual Recognition Skills

In Posterior Cortical Atrophy, a rare form of Alzheimer’s, the parietal and occipital lobes of the brain are affected by the same abnormal proteins found in Alzheimer’s causing difficulty in seeing where and what things are.

Phoneme Processing

In frontotemporal dementia, the temporal lobe is affected causing difficulty with speech and language.

Cross-modal Association

People with Alzheimer’s disease have a buildup of abnormal proteins in the Hippocampus which causes it to malfunction, affecting the ability to recognize places and they may become disoriented.

Working Memory

In Alzheimer’s disease, the buildup of abnormal proteins in the Hippocampus affects the ability to store new memories.

When the temporal lobe is affected by fronto-temporal dementia, it causes difficulty in recollection of factual information.

Behavioral

Fronto-temporal dementia is thought to be caused by proteins building up in the frontal lobe of the brain and patients often experience changes in personality and behave inappropriately.

Physical

In corticobasal degeneration, the cortex and basal ganglia become damaged, which is currently thought to occur due to the overproduction of the tau protein. This causes problems movement to be stiff or jerky and affects one or more limbs.

Consciousness

Dementia with Lewy bodies affects the cerebrum where small round lumps of proteins build up and can cause fluctuations of consciousness as well as hallucinations, delusions (firmly held beliefs in things that are not real) and false ideas (such as paranoia).


Symptoms

Overview: The parts of the brain affected and the specific symptoms depend upon the type of dementia.



Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??

Common Symptoms of Cognitive Decline Due to Both Aging and Dementia

  1. Difficulty remembering information, (tends to fluctuate as the day progresses, and decline over long periods of time)
  2. Difficulty with organizing thoughts
  3. Difficulty working within time limits
  4. Visual processing difficulties, which can affect the ability to recognize places.

Symptoms of Cognitive Decline Due to Aging

  1. Memory: Sometimes forgets names or appointments, but then remembers them later.
  2. Problem Solving: May make occasional errors when balancing a checkbook.
  3. Completing Tasks: May need occasional help to use the settings on a microwave or to record a television show.
  4. Confusion w/ Time or Place: May get confused about the day of the week but then figures it out later.
  5. Visual/Spatial/Temporal Understanding: May have vision changes related to cataracts, low vision and/or color/contrast perception. May have some hearing or speech loss. May have diminished motor ability and acuity. NOTE: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: Sometimes has trouble finding the right word.
  7. Misplacing Items: May misplace things from time to time and then need to retrace their steps to find them.
  8. Judgment: Makes a bad decision once in a while.
  9. Withdrawal: May on occasion feel weary of work, family and social obligations.
  10. Mood/Personality: May develop very specific ways of doing things and therefore may become irritable when a routine is disrupted.

Symptoms of Cognitive Decline Due to Dementia

Symptoms of Alzheimer's

  1. Memory: Often or completely forgetting names or appointments.
    1. Forgetting recently learned information
    2. Forgetting important dates or events
    3. Asking for the same information over and over
    4. Forgetting to check expiration dates on food
    5. May have problems recognizing familiar faces of family or friends
    6. Increasing need to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own
  2. Problem Solving: Changes in ability to develop and follow a plan or work with numbers.
    1. May have trouble following a familiar recipe or keeping track of monthly bills.
    2. May have difficulty concentrating and take much longer to do things than they did before.
  3. Completing Tasks: Often find it hard to complete daily tasks.
    1. May have trouble driving to a familiar location
    2. May have trouble managing a budget
    3. May have trouble remembering the rules of a favorite game
    4. May have difficulty in completing tasks that involve multiple steps (ex. laundry)
  4. Confusion w/Time or Place: Can lose track of dates, seasons, their location and the passage of time.
    1. May have trouble understanding something if it is not happening immediately.
    2. May forget where they are or how they got there.
  5. Visual/Spatial/Temporal Understanding: May have difficulty reading, speaking, hearing, judging distance and determining color or contrast. Often has diminished motor ability and acuity.
    1. Which may cause problems with driving
    2. May have difficulty understanding/distinguishing mechanical and electronic sounds and alerts. (including some of the very tools that are meant as memory aids) NOTE: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: Often has trouble following or joining a conversation.
    1. May stop in the middle of a conversation and have no idea how to continue or they may repeat themselves.
    2. May struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock").
    3. May lose ability to speak.
  7. Misplacing Items: Often puts things in unusual places.
    1. Often lose things and be unable to go back over their steps to find them again.
    2. Sometimes may accuse others of stealing their misplaced items (may occur with increasing frequency).
  8. Decreased Judgment: Experience changes in judgment or decision-making.
    1. Often uses poor judgment when dealing with money, giving large amounts to telemarketers.
    2. Often pays less attention to grooming or keeping themselves clean.
  9. Withdrawal: May start to remove themselves from hobbies, social activities, work projects or sports.
    1. May have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby.
    2. May avoid being social because of the changes they have experienced.
  10. Mood/Personality: Can become confused, suspicious, depressed, fearful or anxious.
    1. May be easily upset at home, at work, with friends or in places where they are out of their comfort zone
  11. Confabulation: “the production of statements or actions that are unintentionally incongruous to the subject’s history, background, present and future situation” Dalla Barba (1993)

Symptoms of Less Common Dementia (Non-Alzheimer's)

  1. Memory: Sometimes forgetting names or appointments, and sometimes remembering them later.
  2. Problem Solving: Makes occasional errors when balancing a checkbook.
  3. Completing Tasks: Often needs help to use the settings on a microwave or to record a television show.
  4. Confusion w/ Time or Place: May get confused about dates, seasons, their location, passage of time - but usually it comes back to them.
  5. Visual/Spatial/Temporal Understanding: May have difficulty reading, speaking, hearing, judging distance and determining color or contrast. May have diminished motor ability and acuity. NOTE: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: On occasion may have trouble following or joining a conversation and sometimes have problems finding the right word.
  7. Misplacing Items: May put things in unusual places, but can usually find them by retracing their steps.
  8. Decreased Judgment: On occasion may experience changes in judgment or decision-making.
  9. Withdrawal: May on occasion withdraw from work or social activities
  10. Mood/Personality: May on occasion become confused, suspicious, depressed, fearful or anxious.

Typical behaviours exhibited by people with Dementia

  1. Repetitive Behaviour - Asking the same question over and over again - As well as memory loss, this can be due to the person's feelings of insecurity or anxiety about their ability to cope. Repetitive phrases or movements - This can be due to noisy or stressful surroundings, or boredom. It can also be a sign of discomfort, e.g. too hot or cold.
    1. Repetitive actions - Actions such as repeatedly packing and unpacking a bag, or rearranging the chairs in a room, may relate to a former activity.
    2. Repeatedly asking to go home - This can be a sign of anxiety, insecurity, fear or depression. The concept of 'home' might evoke memories of a time or place where the person felt comfortable or safe – they may not recognise their present environment as their home even if it is the place where they live.
    3. Multiple phone calls - Some people with dementia phone their loved ones over and over again - particularly in the middle of the night, they may forget that they have already called, or may be insecure or anxious.
  2. Restlessness
    1. Pacing up and down - Pacing may indicate that the person wants to use the toilet but is unable to tell you or they may be feeling frustrated and want some fresh air.
    2. Fidgeting - Someone with dementia may fidget constantly.
  3. Shouting and Screaming
    1. The person may continually call out for someone, shout the same word, or scream or wail over and over again.
    2. They could be experiencing difficulties with visual perception or hallucinations.
    3. A person with dementia may feel lonely or distressed, if their short term memory is damaged they may not remember that you are in the next room and believe they are alone. They may feel anxious about their failing memory, bored, or stressed by too much noise and bustle.
  4. Lack of inhibition
    1. Some people with dementia may undress in public, having forgotten when and where it is appropriate to remove their clothes.
    2. Apparently inappropriate sexual behaviour may be a result of the physical damage to the part of the brain that allows us to recognise acceptable social behaviours.
    3. Some actions, such as lifting a skirt or fiddling with flies may simply be a sign that the person wants to use the toilet.
    4. The person may behave rudely - for example, by insulting people or swearing or spitting.
  5. Night-time Waking
    1. Many people with dementia are restless at night and find it difficult to sleep. Older people often need less sleep than younger people in any case. Dementia can affect people's body clocks so that they may get up in the night, get dressed or even go outside.
  6. Trailing and Checking
    1. Living with dementia makes many people feel extremely insecure and anxious. This can result in the person constantly following their carers or loved ones around, or calling out to check where they are. A few moments may seem like hours to a person with dementia, and they may only feel safe if other people are nearby.
  7. Hiding and Losing things
    1. People with dementia sometimes hide things and then forget where they are - or forget that they have hidden them at all. The wish to hide things may be due to feelings of insecurity and a desire to hold on to what little the person still has.
  8. Suspicion
    1. Some people with dementia can become suspicious. If they have mislaid an object they may accuse someone of stealing it, or they may imagine that a friendly neighbour is plotting against them. These ideas may be due to failing memory or an inability to recognise people,
  9. Sleeplessness and ‘sundowning’
    1. Many people with dementia, especially in the middle stages, experience periods of increased confusion at dusk, with their disorientation continuing throughout the night. These periods of what is known as 'sundowning' usually diminish as the dementia progresses. (1)

ICT Challenges


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. Design recommendations for tv user interfaces for older adults: findings from the eCAALYX project, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on computers and accessibility, 41-48, F. Nunes, M. Kerwin, P Alexandra-Silva, 2012. (Contributed by Katherine Deibel)
  2. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
  3.  ??


  • Remembering steps to complete a task, e.g. "How do I send an email?"
  • Overwhelmed by too many functions, complex UIs.
  • Copying information correctly.
  • Difficulty figuring out new UI metaphors.
  • Too many steps to complete a task.
  • Advertising prompts added before getting to a web page are confusing.
  • Menu systems are difficult to navigate and find the right path.
  • 15% of people living with dementia – an estimated 112,500 people (in the UK) – have been victims of financial abuse such as cold calling, scam mail or mis-selling
  • 62% of carers reported that the person they care for had been approached by cold callers or doorstep sales people
  • 70% reported that telephone callers routinely targeted the person they care for. Not only have people lost money, but they and their families have also been suffering stress, exhaustion and frustration as a result.
  • 76% of people reported having trouble managing their money, with a range of issues highlighted such as the challenges of bank’s security procedures, and a lack of dementia awareness in banks and other financial services organisations. UK ONLY (4)
  • Mood/Personality: Controlling confusion and irritability when changes are made to their routine, environment or location. Difficulty in feeling safe.

Scenarios and Use Cases that address Key ICT Challenges


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. Understanding the role of age and fluid intelligence in information search, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility, 119-126, S. Trewin, J.T. Richards, V.L. Hanson, D. Sloan, B.E. John, C. Swart, J.C. Thomas, 2012. (Contributed by Katherine Deibel)
  2. Basic senior personas: a representative design tool covering the spectrum of European older adults, ASSETS '12 Proceedings of the 14th international ACM SIGACCESS conference on computers and accessibility, 25-32, B. Wockl, U. Yildizoglu, I. Buber, B. Aparicio-Diaz, E. Kruijff, M. Tscheligi, 2012. (Contributed by Katherine Deibel)
  3. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)

Scenarios

  • Struggling to remember recent events but easily recalling things from the past
  • Finding it hard to follow conversations or programs (on TV, web, video, webcast)
  • Forgetting the names of friends or everyday objects
  • Repeating yourself or losing the thread of what you are saying
  • Problems with thinking and reasoning
  • Feeling anxious, depressed or angry about forgetfulness
  • Other people starting to comment on your forgetfulness
  • Confused even when in a familiar environment (in space and on TV, web, video, webcast)
  • A decline in the ability to talk, read or write

Scenario A: Sending an Email

Scenario A is an elderly person who has limited familiarity with computer devices (desktop, tablets, mobile). A would like to send an email to a family member. A needs to be able to find the mail program easily, interact with the user interface to compose and send an email, know that it has been sent, and, then know if the email has been replied to. A starts by turning on the computer.

Step

Challenges

Turn on computer

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons; firstly the user may find it hard to identify the power button as they may have forgotten what it looks like. Secondly some power buttons can be quite small which may be difficult for elderly people to press, especially those who have arthritis or a tremor in their hands.

Launch email application

This requires the user to be able to identify the correct icon for their email application. Although there is a certain amount of intuitiveness surrounding the design of icons, sometimes for the elderly this can still be a problem. In this case typing in the name of the email application (if that can be remembered) into the search bar on the start-up menu may help.

Select button to compose new email

The majority of buttons with an email application are labelled and therefore the user must simply read the icon labels until they find the correct one for ‘new email’

Type in address of recipient

If the user is able to remember the email address of the recipient they can then type the address in the box labelled To. If the user must access their address book to find the email address they must select the address book (or contacts list) icon and then type in the name of the person they wish to email and their address should then come up. All of the above requires recognition and retrieval of information from the long term memory which could be a problem for those with memory problems.

Type in email subject

Type a title for your email into the subject box. This field is not mandatory and therefore if the user is unable to enter any text in this field it will not affect the actual sending of the email. However most applications will show a warning message such as ‘do you wish to send this email without a subject’ however it will still enable you to press send successfully.

Type content of email

This should be fairly simple provided the user can remember what they wished to say in their email.

Send email

The majority of email applications will have a clearly labelled button for sending the email.

Return to inbox

This step happens automatically after an email has been sent in the majority of email applications.

Minimize email application to background

By selecting the third button from the left in the top right hand corner of the email application the user is able to minimize their emails, however if the user cannot remember what the minimize button looks like or where it is located, this could be a problem for them.

Open email application from time to time to check if reply has been received

The challenges associated with this step will be the same as the challenges associated with step 2.

Scenario B: Buying a Train Ticket Online

Scenario B is a gentleman in his early 50s who has recently been diagnosed with frontotemporal dementia (early onset). He is trying to buy a train ticket online for a return journey the following day. At any point during this process the user may forget what they are doing which could result in either no ticket being purchased, or alternatively they may buy the wrong ticket, for example they may wish to travel tomorrow but purchase a ticket for the following week.

Step

Challenges

Turn on computer

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons; firstly the user may find it hard to identify the power button as they may have forgotten what it looks like, to extend this further the user may have entirely forgotten what the computer is for or where to find it. In this instance the task becomes impossible until their memory returns. Secondly some power buttons can be quite small which may be difficult for those with reduced dexterity, particularly for those who are older and may have arthritis or a tremor.

Open internet browser

Navigate home screen with mouse and identify web browser icon and select to open. Typical memory problems

Type in URL for train ticket booking website

Typing in the first few letters of the web address in the search bar should

Select icon for booking train tickets

If the icon is not labelled this could be difficult if the user forgot what the icon to buy tickets looked like, however most icons for booking train tickets are clearly labelled, therefore the only issue for the user should be recognizing the correct label and remembering what they are doing.

Tick box for ‘return’

The user needs to remember that they need to purchase a return ticket in order to get home.

Type in from and to destinations

Given that the user is starting from their home address it can be hoped that their nearest train station is securely stored in their long term memory and can be remembered. With regards to the destination they are going to the user is likely to have written this down when arranging the outing which should help them remember the destination.

Select date and time for outbound & return journeys

Choosing appropriate times for travel may be difficult for people with dementia however most train ticket booking websites do not allow you to book a return journey prior to your outbound journey so at least this potential problem is guarded against.

Select number of adult & child passengers

In this instance only 1 person is travelling however when more than 1 person is travelling there is a higher possibility of the wrong number of tickets being purchased.

Tick box for railcards Select railcard type and number that apply for this journey

The user is likely to have a senior or disabled person rail card and therefore must remember to apply their railcard discount to the journey in order to get a discount.

Select continue

-

Tick box for outward & return journeys (details to look at: time, price, class & single/return)

This step involves selecting which type of ticket you wish to purchase, although all the options are laid out in a table sometimes it can be difficult to work out exactly which ticket you wish to buy and how much it costs.

Select ‘buy now’

-

Tick box to reserve seat and if so select seating preferences - optional

This is optional and therefore if the user does not understand it is perfectly fine for them to ignore this step.

Tick box to either; collect tickets from self-service ticket machine and select station or, have tickets sent by post

Self-service ticket machines tend to be fairly complicated therefore as long as there is enough time (7 days prior to start of journey) it is advisable to have the tickets sent by post.

Select ‘continue’

-

Tick box new user

If the user has not used this particular ticket booking site before they must enter all of their personal details, otherwise they just need to remember their email address and password.

Type in personal details (Name, Address, Email, etc.)

Personal details need to be remembered.

Tick box payment card type (Visa, MasterCard, etc.)

On the payment card there is a symbol to indicate which type of card it is, this information must be entered by way of ticking the correct box.

Enter card details (number, expiry date, name, security code)

These are written on the payment card so there is no issue with memory impairment here, however as with each step throughout this process- if the user forgets what they are trying to achieve at any point they are unlikely to be successful in this task.

Type in post code and tick box find billing address

Tick box to agree to terms and conditions and select ‘buy now’

Enter payment card secure bank password

Order complete

Scenario C: Online Supermarket Shop

Scenario C is a woman with dementia in her early 70s. She finds it easier to do her supermarket shopping online as she often gets confused in the shop and forgets what she wants to buy.

Step

Challenges

Turn on computer

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons; firstly the user may find it hard to identify the power button as they may have forgotten what it looks like. Secondly some power buttons can be quite small which may be difficult for elderly people to press, especially those who have arthritis or a tremor in their hands.

Open internet browser

Navigate home screen with mouse and identify web browser icon and select to open. Typical memory problems

Type in URL for supermarket shopping website

Typing in the first few letters of the web address in the search bar should populate with previous history; however if its the first time a person may not understand how the automatic population of text works.

Select ‘food and drink’ and then ‘buy groceries’

Finding products and selecting a quantity may pose difficulty depending on the user interface.

Log in with username and password

It may be difficult to remember the username and password associated for this online store.

Delete old payment card

Select ‘add payment card’

Type in the card details

These are written on the payment card so there is no issue with memory impairment here, however as with each step throughout this process- if the user forgets what they are trying to achieve at any point they are unlikely to be successful in this task.

Tick box ‘make this my preferred payment card’

Select ‘save’ and then either continue shopping or log out


User Stories

Scenario A: Send an Email

Assumption: User has the screen in front of them and it is already turned on.

Scenario A is an elderly person who has limited familiarity with computer devices (desktop, tablets, mobile). A would like to send an email to a family member. A needs to be able to find the mail program easily, interact with the user interface to compose and send an email, know that it has been sent, and, then know if the email has been replied to. A turns on the computer.


Table of ICT Steps and Challenges for Sending an Email
Step Challenge Solutions Comments
1. Find the mail program Search to find. What's the name/icon for the mail program?
2. Activate/open the program Remember how to start up
3. Navigate the UI Familiarize/remind themselves how to use it, understand icons/text labels,

understand how to increase the font size

4. Locate email editor Remember/find correct name for composing (compose, new)
5. Familiarize with the fields Remember what each is used for/find the ones that are really needed vs. optional
6. Insert Email addresses How do I do that, what is an email address and what is its format,

trouble remembering the name or email address for the person to send note to, confusion with prepopulating and word prediction, interaction with the Contacts feature, understand or ignore CC and BCC fields (solution: keep out), how to fix a wrongly entered email address

7. Subject Line Know that one is needed maybe pre-populate
8. Write the Email Not know/understanding email conventions, confusion with spellchecking,

not understanding editor features (bold, italic, color), adding an image/file challenges, how to edit what has been written or how to start over, confusion if time-out occurs

spellcheck - maybe turn off by default
9. Send the email Knowing when you are done (after it goes, where does it go, do you wait for the recipient to respond immediately - is it like a phone call?)
10. Closing the Program Remember how to do that, remembering that you need to do that
11. Getting a Reply How do you know that you have one? May be out of scope for this use case

Scenario B: Turn up the Heat (using thermostat app)

Assumptions: User knows they can do this from a remote device, they have the screen in front of them, it is already turned on.

Scenario B is an elderly person with early dementia. Their daughter has shown them how to use a web-enabled mobile application to change the temperature of the house. Winter has arrived and they would like to turn the heat up to keep the house warm enough. B needs help recalling how to access the temperature program, the work flow to change the temperature, and understand the elements of the user interface.

Table of ICT Steps and Challenges for Turning up the Heat
Step Challenge Solutions Comments
1. Find the thermostat program (i.e. Nest) Search to find that control, remember what the control is called, remember where it is
2. Activate/open the program Remember how to start up
3. Navigate the UI Familiarize/remind themselves with it, understand icons/text names, Understand how to increase font size
4. Locate Temperature Control Feature Remember/find correct name for changing (many UI versions, might be slider, button, how do I use that - maybe unfamiliar non-intuitive for them), understand icons/text labels
5. Manipulate the control up or down How to control the level of the Heat (is there a 2nd control?), is that in degrees F or C?, how to use/understand a slider feature
6. Setting the desired temperature How do I do that?,

Understanding that a change has been set, does it save it automatically or do I have to do something to save it?, confusion if time-out occurs

7. Closing the Program Remember how to do that, remembering that you need to do that

Personas

  • “I have great difficulty remembering things, working things out and interpreting things. I use a Dictaphone which helps considerably. I can’t use a normal watch so I’ve gone digital, but that has its limitations. I can’t read very well so I use audio books. I can’t count money, but I haven’t found a way around that yet so any suggestions will be gratefully received! So, I’ve developed strategies to help. These can be very simple but effective if they work. Often it is the simplest things that get the better of us – things we have done all our lives without a problem. But now, because we can’t do them, it is very frustrating.” – Extract from a speech by Ann Johnson at the Uk Dementia Congress November 2010.


How they use the web and ICT to include: Email, apps, voice systems, IM


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??


To do: Add table.

Task Description

How people with Aging and Dementia can use optimized content and special pages

To do: Add examples with descriptions of features that could optimize content for users


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??

Characteristics of Content Optimized for Aging and Dementia

Content for people with dementia and the elderly with cognitive decline then to have:

  1. Large clear buttons with simple graphics and text
  2. Limited features
  3. High contrast
  4. Clear, step by step, instructions
  5. Rapid and direct feedback
  6. Simple, clear writing style.

(Conclusions form The 14th international conference ICCHP 2014 - See below)

Summary of Existing Research and Guidelines - Research Sources

Key features from Phiriyapkanon:

  1. Reduction of complexity: Factions that are rarely used or not necessary should be removed
  2. Clear structure of task: The starting point of tasks and every step should be easily recognized and understood
  3. Consistency of information: Avoid contradictions and inconsistencies of information arraignment
  4. Rapid and direct feedback: Applications should continuously provide easily recognizable feedback of success or failure with every action

They also quote minimize errors, provide onscreen help and high recover-ability Phiriyapkanon t. Is big button interface enough for elderly users, P34, Malardardalen University Press Sweden 2011

K Dobsz et. al. recommends:

  1. Strong contrast of images with content
  2. Simple and large graphics
  3. Sound conformation of accepted and rejected operations
  4. Automatic voicing reading tasks (instructions)

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer (pages 401). Paper: Tablets in the rehabilitation of memory impairment, K Dobsz et al.

Key features from other guidelines:

  1. To help with difficulties in completing complex tasks, one should weight until the elder completes one task before proceeding to the next step
  2. Place tasks in step by step order -

but balance this because too many steps can give a feeling of getting lost.

  1. One has to be consistent in naming steps such as naming all steps begin with a verb (such as "press the button")
  2. Orientation impairments causes elderly to unlearn how to find their way in new surroundings. Therefor:
    1. Menus and useability interfaces need to be simplified to minimize the amount of information that needs to be memorized
    2. An application should work independent of other applications
    3. The screen should not have distracting elements (wallpaper, buttons etc)
  3. Information should be broken down into discreet chunks that the elderly can absorb
  4. Content and information give needs to be consistent
  5. Avoid stress which will further imper cognitive function

Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer (pages 401). Paper: Never Too old to use a tablets, L. Muskens et al. pages 392 - 393


Key features for using tablets for the elderly from Dahn et.al:

  1. The user interface should use widgets or large buttons rather then standard apps. Moving between screens should be possible using tabs or buttons and not just gestures.
  2. Dedicated user interfaces often fall short of user requirements. Instead populate the tablet with standard apps with simple interfaces.
  3. Offer a PC like mode with "file explorer" and familiar PC interface features
  4. Supply have a printed manual
  5. Privacy policies should be transparent to build trust
  6. Supply a scaffolding approach to help and support but should allow flexible entry points.


Computers helping people with special needed, 14 international conference ICCHP 2014 Eds. Miesenberger, Fels, Archambault, Et. Al. Springer ( part 2 page 329). Paper: Supporting seniorr citizens in using tablet computors tablets,Dahn et.al

Lisa Seeman (talk)



  1. Older Equipment and Software
    Some people who are aging or have dementia will be using older browsers and devices that might not be as capable or fault tolerant as current technologies - or may be missing some of the customized and interactive content provided by newer technologies.

Specific Technologies (reference section below and how they use it differently)

To do: Add section


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1. How voice augmentation supports elderly web users, ASSETS '11 The proceedings of the 13th international ACM SIGACCESS conference on computers and accessibility, 155-162, D. Sato, M. Kobayashi, H. Takagi, C. Asakawa, J. Tanaka, 2011. (Contributed by Katherine Deibel)
  2.  ??
  3.  ??



Summary of Existing Research and Guidelines

To do: Add literary summary and insert guidelines and or references

Use of Language and Communication for Dementias

[#LANG]

  • Avoid use of voice recognition or spoken commands from the end-user.
  • In either spoken or written information, use simple words, avoiding abstract, unfamiliar vocabulary.
  • In either spoken or written information, use simple sentences with just one idea per sentence. Avoid long sentences with embedded ideas.
  • Avoid pronouns or other forms of language which rely on the end-user having to recall information which they have just read or heard.
  • Support writing with clear visual images to account for potential vision deficits impacting on reading ability.

Extent to which current needs are met

   To do: Review challenges and describe where needs are met. Identify gaps 

Potentials and Possibilities (including current WCAG 2 Techniques)

Overview: This section maps higher-level challenges to existing WCAG 2 Techniques so that we can see where there are clear gaps that will need to provide techniques for.


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??


To do: Add ideas for filling gaps 


  1. Memory:
    1. enhanced use of color
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element Perceivable
    2. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
    3. prompts and cues
    4. index or table of contents
    5. support text with redundant visual and auditory elements
      1. 1.1.1 - Non-text Content (A) says "a text alternative that serves the equivalent purpose" is required Perceivable
      2. 1.3.1 - Info and Relationships (A) says "information, structure, and relationships" to be made available, for example to text-to-speech software Perceivable
      3. Software that visually highlights spoken text
    6. help index
    7. Context Sensitive (support and) Help
      1. 3.1.3 Unusual Words (Level AAA) Understandable
      2. 3.1.4 Abbreviations (Level AAA) Understandable
    8. grouping and symmetry (to leverage visual perception and attention)
    9. Intuitive Design - Ease of Interaction (to leverage spatial memory)
      1. 2.1.1 - Keyboard (A) says "the content is operable through a keyboard interface" Operable
      2. 2.1.2 - No Keyboard trap (A) makes sure that keyboard focus "can be moved away from that component using only a keyboard" Operable
      3. 2.1.3 - Keyboard (No Exception) (AAA) says "all functionality of the content is operable through a keyboard interface" Operable
      4. 2.4.1 - Bypass Blocks (A) says "a mechanism is available to bypass blocks of content that are repeated" Operable
      5. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      6. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      7. 3.3.2 - Labels or Instructions (A) says that labels should be provided "when content requires user input" Understandable
    10. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    11. consistent identification
    12. simplified user controls
    13. error prevention and recovery
    14. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  2. Problem Solving:
    1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
    2. prompts and cues
    3. logical workflow with redundant text, visual and auditory cues
    4. grouping and symmetry (to leverage visual perception and attention)
    5. Intuitive Design - Ease of Interaction (to leverage spatial memory)
    6. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    7. consistent identification
    8. easy user customization
    9. simplified user controls
  3. Completing Tasks:
    1. prompts and cues
    2. grouping and symmetry (to leverage visual perception and attention)
    3. Intuitive Design - Ease of Interaction (to leverage spatial memory)
    4. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    5. simplified user controls
    6. error prevention and recovery
    7. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  4. Confusion w/ Time or Place:
    1. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
    2. identify current state
    3. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    4. consistent identification
    5. simplified user controls
    6. error prevention and recovery
    7. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  5. Visual/Spatial/Temporal Understanding: NOTE: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
    1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
    2. large selection targets
    3. zoom controls, large fonts
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
    4. close proximity
    5. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability" Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible" Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone" Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available" Operable
      7. 2.4.2 - Page Titled (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing) Operable
    6. prompts and cues
    7. support text with redundant visual and auditory elements
    8. help index
    9. context sensitive help
    10. plain language
    11. grouping and symmetry (to leverage visual perception and attention)
    12. Intuitive Design - Ease of Interaction (to leverage spatial memory)
    13. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    14. consistent identification
    15. enhanced use of color and contrast
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element Perceivable
      2. 1.4.3 - Contrast (Minimum) (AA) requires a contrast ratio of at least 4.5:1 for the visual presentation of text and images Perceivable
      3. 1.4.6 - Contrast (Enhanced) (AAA) requires a higher contrast ratio of at least 7:1 for the visual presentation of text and images Perceivable
    16. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    17. simplified user controls
    18. error prevention and recovery
    19. Avoid Distractions and Seizures
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio" Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed" Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  6. Conversation:
    1. text
    2. support text with redundant visual and auditory elements
    3. simplified user controls
  7. Misplacing Items:
    1. site map
    2. index or table of contents
    3. help index
    4. context sensitive help
    5. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    6. consistent identification
  8. Judgment:
    1. prompts and cues
    2. support text with redundant visual and auditory elements
    3. grouping and symmetry (to leverage visual perception and attention)
  9. Withdrawal:
    1. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    2. simplified user controls
    3. error prevention and recovery
    4. emotional expression (EmotionML)
  10. Mood/Personality:
    1. encouragement
    2. immediate positive feedback
    3. safety controls
    4. grouping and symmetry (to leverage visual perception and attention)
    5. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages" Operable
    6. consistent identification
    7. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    8. simplified user controls
    9. error prevention and recovery
    10. emotional expression (EmotionML)

Prevalence


Research Sources

These resources are relevant to this section and for our next draft components of these articles will be incorporated into this section where applicable:

  1.  ??
  2.  ??
  3.  ??


Prevalence of Dementia

  • UK (2013 Study)
    • Alzheimer’s Society estimates that there are 428,000 people in the UK who are living with dementia that haven’t been formally diagnosed.
    • Two thirds of people with dementia are women
    • One in three people over 65 will develop dementia
    • 40-64 years: 1 in 1,400
    • 65-69 years: 1 in 100
    • 70-79 years: 1 in 25
    • 80+ years: 1 in 6
    • Future Projections: The number of people in the UK with dementia will double in the next 40 years.
      • 800,000 people with dementia in 2012
      • 1,000,000 people with dementia in 2021
      • 1,700,000 people with dementia in 2051

Worldwide

  • There are an estimated 35.6 million people with dementia worldwide. by 2050 this figure will rise to over 115 million (2)
  • There are 7.7 million new cases every year (9)
  • Alzheimer's disease is the most common form of dementia and may contribute to 60-70% of cases (9)
  • In 2010 dementia had an estimated global cost of US$604 Billion, 1% of of global GDP (3)

By Gender

  • A study cited by the European Collaboration on Dementia (EuroCoDe) states that in Europe approximately five million women have dementia compared with 2 and half million men (5) – cognitive decline is often accelerated in women following menopause.(6)

Prevalence of Aging

  • World Health Organization: 2012 Study
    • The world population is rapidly aging
      • Between 2000 and 2050, the proportion of the world's population over 60 years old will double from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
    • The number of people aged 80 and older will quadruple in the period 2000 to 2050
      • By 2050 the world will have almost 400 million people aged 80 years or older.
    • By 2050, 80% of older people will live in low- and middle-income countries
    • The main health burdens for older people are from non-communicable diseases while the greatest causes of disability are visual impairment, dementia, hearing loss and osteoarthritis.
    • Older people in low- and middle-income countries carry a greater disease burden than those in the rich world
    • The need for long-term care is rising
      • The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050.
    • Effective, community-level primary health care for older people is crucial
    • Supportive, “age-friendly” environments allow older people to live fuller lives and maximize the contribution they make
      • Creating “age-friendly” physical and social environments can have a big impact on improving the active participation and independence of older people
    • Healthy aging starts with healthy behaviors in earlier stages of life
    • We need to reinvent our assumptions of old age
      • Society needs to break stereotypes and develop new models of aging for the 21st century. Everyone benefits from communities, workplaces and societies that encourage active and visible participation of older people.



References to Research

References on Aging

References on Dementia

References on Alzheimer's


References on Less Common Dementia (Non-Alzheimer's)

Less Common Dementia (Non-Alzheimer's

(1) (http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=159) (2) Alzheimer’s Society International (3) Alzheimer’s disease International (2010). ‘World Alzheimer Report 2010.’ London: Alzheimer’s disease International. (4) Alzheimer’s Society - ‘Short changed: Protecting people with dementia from financial abuse’ Alzheimer’s Society undertook the largest ever survey carried out on this subject, and analysed responses from 104 carers and 47 people with dementia as well as focus groups and interviews with professionals . (5) EuroCoDe, 2006-2008 (6) http://www.ncbi.nlm.nih.gov/pubmed/19811879 (7) Fabian, D. & Flatt, T. (2011) The Evolution of Aging. (8) www.senescence.info - Joao Pedro de Maglahaes (9) http://www.who.int/mediacentre/factsheets/fs362/en/



References from literature reviews on Dementia and ICT from Peter Cudd

INDIVUI
How Individual Should Digital AT User Interfaces Be for People with Dementia. Peter Cudd, Philippa Greasley, Zoe Gallant, Emily Bolton and Gail Mountain. AAATE proceedings 3012

Abstract. A literature review of papers that have explored digital technology user interface design for people with dementia is reported. Only papers that have employed target user input directly or from other works have been included. Twenty four were analysed. Improvements in reporting of studies are recommended. A case is made for considering the population of people with dementia as so heterogeneous that one design does not suit all, this is illustrated through some case study reports from people with dementia. Furthermore it is proposed that by grouping people into functionally similar sub-groups interfaces may be designed for these groups that will collectively establish a sequence of ‘stepping stone ‘ interfaces that better address appropriate functioning and maintain self-efficacy. Fundamentally people living with dementia are unique individuals with unique specific needs. A priori, in life experiences, interests, willingness to learn, environmental factors and co-morbidities they are as varied as any of their age peers. One thing they do not share with those peers is the degenerative consequences of the specific dementia they have. The progression of their disease also follows a unique timeline – even if the general symptoms (and thus perhaps functional ability) change in a fairly predictable order. In the face of these statements it might be inferred that it is most likely that people with dementia require individual but adaptive (to progression of the disease) bespoke solutions for sustained independent living.

Given the breadth of individuality in people, the effects of dementias and indeed their progression it is impossible to view them as a single homogeneous population in terms of specifying a single user interface. In consequence rather than simply designing for all people living with dementia it is suggested that design for populations at stages of functional ability be investigated. Methods that set out to identify shared and bespoke requirements are needed to systematically establish any generalizability. Currently studies on design of digital AT and indeed other ICT for people living with dementia need to report much more detail on: describing their participants; details of user interface features that worked well; how much and what form carers help took. More attention also needs to compare strategies and features that work to identify those that are best or at least best for specific functional ability or tasks.

Key refs (as indicated by title)
[INDIVUI_10]
Making software accessible to people with severe memory deficits. N. Alm, R. Dye, A. Astell, M. Ellis, G. Gowans, J. Campbell. Proceedings of Accessible Design in the digital world, Dundee, 23-25 August 2005.
[INDIVUI_12]
Developing smartphone applications for people with Alzheimer's disease. N. Armstrong, C.D. Nugent, G. Moore, D.D Finlay. Proceedings of the IEEE/EMBS Region 8 International Conference on Information Technology Applications in Biomedicine, ITAB. 2010.
[INDIVUI_13]
Working with people with dementia to develop technology: The CIRCA and Living in the Moment projects. A.J. Astell, N. Alm, G. Gowans, M.P. Ellis, P. Vaughan, R. Dye, J. Campbell. Journal of Dementia Care, 17, 1. 2009, 36-39.
[INDIVUI_25]
Functional requirements for assistive technology for people with cognitive impairments and dementia F.J.M. Meiland, M.E. De Boer, J. Van Hoof, J. Van Der Leeuw, L. De Witte, M. Blom, R.M. Dröes. Communications in Computer and Information Science 277 CCIS. 2012, 146-151.
[INDIVUI_26]
Video reminders as cognitive prosthetics for people with dementia. S.A. O'Neill, S. Mason, G. Parente, M.P. Donnelly, C.D. Nugent, S. McClean, D. Craig. Ageing International36(2). 2011, 267-282.
[INDIVUI_27]
Designing technology to improve quality of life for people with dementia: User-led approaches. R. Orpwood, J. Chadd, D. Howcroft, A. Sixsmith, J. Torrington, G. Gibson, G. Chalfont. Universal Access in the Information Society9(3). 2010, 249-259.
[INDIVUI_14]
“Living in the Moment”: Developing an interactive multimedia activity system for elderly people with dementia. A.J. Astell, M.P. Ellis, N. Alm, R. Dye, G. Gowans, P. Vaughn, Proceedings of the International Workshop on Cognitive Prostheses and Assisted Communication. 2006, 16-20.
[INDIVUI_17]
A user driven approach to develop a cognitive prosthetic to address the unmet needs of people with mild dementia. R.J. Davies, C.D. Nugent, M.P. Donnelly, M. Hettinga, F.J. Meiland, F. Moelaert, R. Dröes. Pervasive and Mobile Computing, 5(3) 2009, 253-267.
[INDIVUI_19]
Usable User Interfaces for Persons with Memory Impairments. R. Hellman. Advanced Technologies and Societal Change. 2012, 167-176.
[INDIVUI_20]
Requirements guideline of assistive technology for people suffering from dementia. J. Hyry, G. Yamamoto, P. Pulli. ACM International Conference Proceeding Series. ISABEL '11 Proceedings of the 4th International Symposium on Applied Sciences in Biomedical and Communication Technologies, Article No. 39. 2011.
[INDIVUI_21]
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LANG
Language and Communication in the Dementias: Implications for User Interface Design. Philippa Greasley and Peter Cudd. AAATE proceedings. 2013

Abstract. The design of user interfaces for people with dementia does not appear from the literature to take into account the concomitant language and communication deficits when choosing the language used in the interfaces. A systematic approach was used to search databases for studies relating to language and communication in the four most common forms of dementia (Alzheimer’s disease, vascular dementia, fronto-temporal dementia and dementia with Lewy bodies). Studies identified were used as a basis for the commentary in this paper. Communication deficits are common in dementia. From the earliest stages of the disease, the person with dementia’s capacity for communication declines as difficulties emerge with all aspects of language and functional communication. These deficits have implications for the successful interaction with assistive digital technology designed to improve the quality of life of people with dementia. More consideration should be given at the design stages to the potential impact of communication difficulties on interaction with technology

it is important to note that the authors have not been able to find to date any conclusions about what impact these impairments may have on user interface design.

The results of this review have highlighted areas of strength (reading) and areas of difficulty (spoken language output and understanding some aspects of spoken and written language) in the communication abilities of people living with dementia. Those who design interfaces for this client group should consider the impact that their language and communication choices might have on end-users with dementia. In particular, the following general guidelines should be taken into account, in order to maximise the accessibility of the language of interfaces for people with dementia:


Key refs (by title)
[LANG_3]
Review of ICT-based services for identified unmet needs in people with dementia. S. Lauriks, A. Reinersmann, H.G. Van der Roest, F.J.M. Meiland, R.J. Davies, F., Moelaert, R. M. Dröes. Ageing Research Reviews, 6(3), 200) 223-246.
[LANG_6]
Functional requirements for assistive technology for people with cognitive impairments and dementia. F.J.M. Meiland, M.E. De Boer, J. Van Hoof, J. Van Der Leeuw, L. De Witte, M. Blom, R.M Dröes. Communications in Computer and Information Science 277 CCIS, 2012, 146-151.
[LANG_8]
Designing an interface usable by people with dementia. N. Alm, R. Dye, G. Gowans, J. Campbell, A. Astell, and M. Ellis. In Proceedings of the 2003 conference on Universal usability (CUU '03).ACM, New York, NY, USA, 2002 156-157.
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ICT Interface Design for Ageing People and People with Dementia. J. Wallace, M. D. Mulvenna, S. Martin, S. Stephens, W. Burns. In: M. D. Mulvenna & C. D. Nugent (eds). Supporting People with Dementia Using Pervasive Health Technologies, London: Springer-Verlag. 2010