Dementia: Caregiving, Decision Support, and Pre-Screening
While caregiving for dementia patients is long-term and needs dementia-specific coping knowledge, healthcare technology is crucial in supporting caregivers to better care for their loved one with dementia. Such technology attempts to improve the wellness of both dementia patients and their caregivers by empowering caregivers with personalised intervention strategies and coping skills in care delivery. Technology applications for pre-dementia screening help people-at-risk to identify risk factors and prevent the development of dementia by recommending behavioural nudges and healthier lifestyles.
IHPC’s HealthTech efforts for dementia include caregiver/patient support, knowledge management, psychological-model-informed community care model design, and personalised behavioural intervention recommendations. By leveraging on a knowledge-based decision support system (Fig 5) with risk factor assessment, and psychological modelling, both the wellbeing of patients as well as their caregivers, could be better managed (e.g., enhancing emotional/physical health, stress management, promoting social engagement and healthy lifestyles).
Application areas include:
- Dementia management in community or at home
- Personalised decision support for dementia caregiving
- Caregiver stress management and coping strategies
- Dementia patient engagement and leisure activities
- Collaborative dementia caregiving
- Dementia service provider recommendation
- Pre-dementia screening for healthier lifestyles and behavioural nudges
Fig 5: Knowledge-based decision support system for dementia patients and caregivers
Cognitive Health Monitoring through Games
There has been an increased focus on “serious games” that displayed positive effects on the cognitive abilities of elderly (e.g., older adults aged 65 and above) which could allow them to monitor their health independently. Yet there were very few games specifically targeted at the elderly population.
Designing such games poses distinctive challenges since designers must take account of the potential cognitive, sensory, physical limitations of the elders, as well as their limited experience with gameplay interfaces and conventions compared to the younger generation. Cognitive abilities vary greatly among elders, especially among populations with a potential risk or already diagnosed with early-stage dementia. Hence, the purpose of each game should focus on different cognitive abilities targeting specific subgroups of the elderly population.
Towards this end, IHPC’s efforts in this area include the development of game design principles that involved cognitive abilities implicated at different stages of (normal and abnormal) cognitive ageing, and how these abilities would influence gameplay mechanics. With the effective design (depending on the type of game), the caretaker or medical professional could glean insights on users’ cognitive functions, such as executive functioning, prospective and working memory, hand-eye coordination and visuo-spatial tracking (Fig 6 & 7).
Fig 6: Townlife: Find and deliver items by solving simple puzzles in an appropriate sequence
Fig 7: Trains: Fix misaligned tracks across a land area to ensure trains reach destinations
• Fua, K.C., Gupta, S., Pautler, D., & Farber, I. (2013). Designing serious games for elders. FDG.
• Farber, I., Fua, K.C., Gupta, S., & Pautler, D. (2016). MoCHA: Designing Games to Monitor Cognitive Health in Elders at Risk for Alzheimer's Disease. ACE2016.
Motor-Rehabilitation Enhancement with Rhythmic Entrainment
IHPC has developed a motor-rehabilitation game system, known as MoMu
(Move with Music, Fig 8), which leveraged the empirically-established facilitatory effects of rhythmic entrainment to promote motor rehab in stroke patients (especially balance, reaching movements) and strengthening in elderly. Rhythmic entrainment is a phenomenon through which a person’s bodily rhythms (e.g., body movements) would take the cue of and synchronise with an externally perceived rhythm, such as human music. Each time you hear a catchy tune and find yourself bobbing around to the beats of the music, that’s rhythmic entrainment at work.
Besides rhythmic entrainment, MoMu was also designed to track the patients’ progress and performance. The added benefit of music in motivating and promoting the enjoyment of rehabilitative exercises had made it suitable for elderly use. Healthy participants on trial with MoMu have performed with encouraging success, and hence on-going efforts towards clinical trials are underway.
Fig 8: MoMu: A music-based motor rehabilitation game system in which motor rehabilitation & strengthening exercises are gamified with musical rhythms to promote recovery