DR. CHRISTOPHER J. JOHNSONTEXAS STATE UNIVERSITY

“THE RISING STAR OF TEXAS.”CLINI CAL PROFESSOR OF SOCIOLOGY

EMAIL : CJJ38@TXSTATE.EDU

M.S. DEMENTIA & AGING STUDIES (ONLINE)

F I R S T P R O G R A M O F I T S K I N D I N T H E U N I T E D S TAT E S

The Future of Aging Services

Online M.S. in Dementia & Aging Studies

Only 33 hours but packed with power!

First M.S. in Dementia Studies in America—blending “dementia citizenship” with “person centered” Euro-American social models of care & empowerment.

3 tracks are offered:A. Long Term Care

AdministrationB. PractitionerC. Research

Bobcat (“Dementia”) Village

Plans for the future for Dementia and Aging Studies:

Research based facilities Destigmatizing Persons with

Dementia (PWD) & elders U.S. Dementia Education and

Training Center at Texas State University in San Marcos: Empower PWD & elders

Dementia Village connected to Texas State Research Faculty

Background

There is an increased focus on aging with dignity and independence.

There are multiple circumstances affect the ability to live independently and with dignity. Especially for persons with dementia (PWD).

A majority of the U.S. aging population will experience declining health and functional incapacity.

Often, social networks often become unavailable (caregiver burdens, geographical distance, death of friends/family etc.)

Further complications such a memory loss often result in loss of autonomy and security.

Individual dignity and independence may be hindered by dynamic and complex issues that take place daily.

Most communities and care facilities are largely underprepared to respond.

Meaningful Involvement

Community based Community solutions Villages Natural Occurring Retirement Communities Culturally Sensitive Communities Inclusion

Aging in Place Universal Design “Dementia Citizenship”

Technological and Transportation Internet Automobile customizations and safety features Telecare

Health and Well-being

Community SolutionsCommunity Partnerships for Older Adults (CPFOA)

Community capacity is increased as well as increased quality of life for elders.

The main goal is to enhance the community to assist elders It also enhances local responses to their needs.

Examples Created travel voucher system for transportation.

Trained local public employees from the post office & local businesses to recognize signs of need in older adults they encounter daily.

Engaged the public school system to train high school students to assist older adults at home.

Black, K., D. Dobbs and T. Young. 2015. “Aging in the Community: Mobilizing a New Paradigm of Older Adults as a Core Social Resource.” Journal of Applied Gerontology 34(2):219-243.

Community SolutionsCenter for Civic Partnership (CCP)

There is proactive planning for large influx of aging Baby Boomers.*

There are reciprocal benefits for the general community as well as active and engaged older adults.

CCP created a toolkit for community planning, engagement, and action.

Toolkit includes: Planning overview Step-by-step data gathering activities Case studies Resources for communities to emulate throughout the nation

* CURRENT COMMUNITIES SERVED ARE IN CALIFORNIA. CCP SPONSORS THE CALIFORNIA HEALTHY CITIES AND COMMUNITIES PROGRAM

Village Model

This is a non-governmental approach, strictly consumer driven.

Most Villages rely primarily on member fees and donations.

This continues to be a promising model for addressing service needs among the middle class.

It provides a variety of support services to assist members age in

place, meet service needs, and promote health and quality of life.

There is questionable ability to meet needs of culturally and economically diverse seniors.

Scharlach, A., C. Graham, and A. Lehning. 2011. “The “Village” Model: A Consumer-Driven Approach for Aging in Place.” The Gerontologist 52(3):418-427

Innovative Service Areas (ISA) & Co-housing

ISA, a European approach, provides a range of co-located and locally integrated services in small communities. Research found that elders had greater satisfaction, feelings of security and longer housing independence among those who lived in ISA’s compared with other elders.

The ISA project model consists of housing providers, gerontologists, care providers, architects, researchers and local officials coming together to support the aging population. Housing is integrated into the local community.

This includes multi-dimensional support including various levels care (i.e. physical health and social support services) and participation from local citizens and government.

Co-Housing

The U.S. does not use the European ISA model, however, similar ISA approaches are are developing. Although the numbers are small in the U.S., the concept of “co-housing” is being explored.

Singelenberg, J., H. Stolarz, and M. McCall. 2014. “Integrated Service Areas: An Innovative Approach to Housing, Services and Supports for Older Persons Aging in Place.” Journal of Community & Applied Social Psychology, 24:69-73.

Naturally Occurring Retirement Communities (NORC)

The focus is promoting health and mental well being of the aging population through collaborative efforts of formal/informal home and community based services and support.

The idea occurred naturally where there was an “unintentional concentration of elders” (Hunt and Gunter-Hunt 1985).

There is much variation among the different types of NORCs. Some are in wealthy communities while other exist in subsidized low income neighborhoods.

There is concern of funding, as NORCs are built using government funds.

Research suggests that the increased expansion of additional NORCs, the health and well being of older adults will be maximized. This ultimately reduces costs associated with the rapidly growing adult population.

NORCs are considered a innovative approach for seniors as they age.

Hunt, M. and G. Gunter-Hunt. 1987. “Naturally Occurring Retirement Communities.” Journal for the Elderly 3(3/4):3-21.

Guo, K. and R. Castillo. 2012. “The U.S. Long Term Care System: Development and Expansion of Naturally Occurring Retirement Communities as an Innovative Model for Aging in Place.” Aging International 37:210-227.

Healthy Aging Resources and Programs (SHARP)

This program targets undergraduate college students, current care-givers (aging services and community), and others interested in retraining.

It consists of four competency-based courses focusing on healthy aging, behavior change strategies, program management, an internship, and an option for leader training. Content includes bio psychosocial aging ( e.g. sex and race differences, chronic illnesses, disabilities) and communication skills, motivational theories, and group dynamics.

Five pilot programs have shown statistically significant improvements among faculty and students after training. The program provides a well-tested, evidence based, effective model for addressing workforce preparation in support of healthy aging service programs.

Frank, J., M. Altpeter, J. Damron-Rodriguez, J. Driggers, L. Lachenmayr, C. Manning, D. Martinez, R. Price, and P. Robinson. 2014. “Preparing the Workforce for Healthy Aging Programs: The Skills for Healthy Aging Resources and Programs (SHARP) Model.” Health Education & Behavior 41(15):195-265.

Smart Features for Older Drivers (SFOD)

AAA & University of Florida teamed up to identify SFOD, to optimized their comfort and safety.

Safety features include seat belt positioning and types of airbags.

Ergonomics that reduce operator fatigue and discomfort, such as adjustable pedals and seats.

Comfort, such as ease of entry and exit, leg room, and size of control buttons.

Value which includes total cost of ownership to include price, operating and maintenance costs. It also includes the vehicles reliability, fuel economy and resale value.

AAA has a dropdown section on their website that allow a person to explore vehicle features that may further assist and aging driver. Various individual considerations include:

Limited knee range of motion; hip or leg pain Short-statured or overweight Arthritic hands; diminished motor skills Limited upper body rang of motion: back, neck, shoulders, arms Diminished vision Cognitive decline or reduced mental capabilities

AAA also provides vehicle suggestions based on individual considerations.

American Automobile Association. 2011. Find the Right Vehicle for You. Retrieved 9/1/2015 http://seniordriving.aaa.com/maintain-mobility-independence/car-buying-maintenance-assistive-accessories/find-right-vehicle-you.

Transportation & Mobility: Car-Fit

Car-Fit is an educational program offering older adults the opportunity to check how well their personal vehicles their vehicles “fit” them. Car-Fit works in conjunction with AAA, The American Occupational Therapy Association, and AARP-Drivers safety.

Older drivers can improve their safety by ensuing their cars are properly adjusted for them.

Car-Fit events are offered throughout the U.S. Trained technicians and/or health professionals work with each driver and their vehicle to ensure they “fit” their vehicle properly with maximum comfort and safety.

Car-Fit. 2015. Helping Mature Drivers Find their Safest Fit. Retrieved 9/7/2015 http://www.car-fit.org.

Communication & Information

The Internet is a new window into the world which facilitates communication and cognitive activity for the elderly. Contributes to their greater autonomy, satisfaction, and provides space and re-establishes

their social voice. It provides a dynamic environment, i.e. email, social media, information.

The results of one study (Llorente-Barroso et al. 2015) show elders are becoming more interested in the Internet and technological devices. They are beginning to make them part of their lives as they have discovered the possibilities they offer such as communication with others and independent information seeking.

The Internet can improve their cognitive activity and facilitate a positive attitude, which strengthens their self-esteem. Ex. Luminosity Brain Games

Llorente-Barroso, C., Viñarás-Abad, M., and Sánchez-Valle, M. (2015). “Internet and the Elderly: Enhancing Active Ageing.” Comunicar, 23(45): 29-36.

Universal Design

Universal design homes enables the use by virtually anyone, regardless of their abilities or disabilities.  Features: Raising electrical outlets and lowering light switches; use lever-handle

knobs instead of round doorknobs; minimizing steps; eliminating barriers; and accommodations for single-floor living.

Further modifications are tailored to specific needs of resident: Kitchen work spaces/countertops that allow for wheelchairs. Doors at least 36 inches wide for those using an assisted device. Wall-mounted cabinets eliminating the toe kick. Color selections to reduce glare and or confusion.

Any room in a house can be modified to fit individual needs.

Evans, L. 2013. Exisiting Homes can be Friendlier to Aging. Retrieved 9/10/2015 http://www.homeadvisor.com/article.show.Universal-Design.8330.html Brunet, A.M. (N.d. ) Optimal Space Planning for Universal Design in the Kitchen. Retrieved 9/10/2015 http://www.houzz.com/ideabooks/4580854/w/sid=1/list/Optimal-Space-Planning-for-Universal-Design-in-the-Kitchen

Home-Based Telecare Services

Telecare has the potential to improve intractable problems in health care; including limited access, inconsistent quality of care, and cost inflation. Home-based telecare service items and products are based on four orientation categories: (1.) Functional, (2.) Social-psychological, (3.) Educational, and (4.) Integrated.The complete list is found in Wu and Lu’s 2014 research.

Medical reminder: Reminder to take medicine to prevent the wrong dosage and or taking medication at the wrong time.

Healthy diet reminder: Platform that provides meal ordering and delivering, including healthy and special diets for appropriate nutrition.

Social supportive network: A link between elderly people and social supportive network providing adequate social welfare and aid in the communities.

Medication guide: An interactive surface for inquiry medication guide including usage and side effects. Self-Rehabilitation: A platform providing home rehabilitation guide to assist those who have needs. This may improve the completion of rehabilitation course and prevent unnecessary visits to the hospital.

Outpatient arrangement: A link between ambulatory services and the elderly in need of help arranging and reminding them of visits.

Visual health consultation: A camera system providing visual consultations with professional medical staff such as nurse or nutritionist.

New technologies will bring healthcare and social connections to elders where they live, making it possible to live more independently and age in place in the comfort of their own homes.

Wu, Y.H. and Y. Lu. 2014. “Qualitative Research on the Importance and Need for Home-Based Telecare Services for Elderly People.” Journal of Clinical Gerontology & Geriatrics 5:105-110.

Culturally Sensitive Communities

Residents share a common culture, language, and belief system.

Architecture, landscaping, and color schemes are representative of home culture and are integrated within the care facility.

Especially important for those coming from gerontocratic cultures such as Koreans, Hindus, Chinese, and Japanese.

Residential communities and adult daycare programs may include familiar music, dance, cuisine, and cultural events, to include caregivers speaking the same language and understand norms and taboos.

As the United States continues to be more ethnically diverse, these communities may help to empower the elders and create stronger social connections.

Rosenfeld, J. and J. Popko. 2010. “Home Community, and Gerontocracy: Forecasting the Future of Senior Housing.” Journal of the American Society on Aging 34(3):61-68.

Electronic Memory Aids (EMA)

Research by Oriani et al. (2003) Italy – England, evaluated the utility of external electronic support of prospective memory in mild-to-moderate AD patients.

Findings suggest that EMA may be effective in supporting prospective memory in AD patients, reducing significantly prospective memory errors.

A patient may, without supervision, use the device to remember to take medication at the correct time, have dinner at the right time, or for particular appointments, such as doctor visits and birthdays.

There is the potential to use the device in the early stages of dementia to improve the quality of life for patients and their families, by limiting the need for constant supervision and support of family care giver.

Their usefulness in the AD patient's everyday life depends on the methodology that is adopted to help the patient learn how to use these methods. In the learning process of using an EMA, which is typically introduced by their therapist and then by their caregiver, two aspects are important: (1) The AD patient needs to be trained to respond correctly to the external aid and (2) the patient needs to use the aid as independently as possible in everyday situation.

The study demonstrates that it is possible to train a person with mild-to-moderate dementia to respond correctly and to use an EMA to remember to do tasks at certain times. Patients with mild-to-moderate dementia, use of an EMA is superior to use of a written reminder, and that attempting to use a written reminder for prospective activities may, for some patients, as ineffectual as trying to commit the activities to member with no external support.

Oriani, M., Moniz-Cook, E., Binetti, G., Zanieri, G., Frisoni, G., Geroldi, C., De Vreese, L. and Zanetti, O. 2003. “An Electronic Memory Aid to Support Prospective Memory in Patients in the Early Stages of Alzheimer's Disease: A Pilot Study.” Aging & Mental Health 7(1):22-27.

COGKNOW Day Navigator (CDN)

Research in the Netherlands and Sweden evaluated a newly developed integrated multifunctional digital prosthetic (CDN).

The COGKNOW Day Navigator consists of a touch screen, a mobile device, sensors, a home hub and a central server. Several features such as colors and icons can be adjusted to personal preferences.

Findings suggest that persons with dementia and caregivers valued the CDN overall as user-friendly and useful.

The memory support (day and time indication, reminders), picture dialing and the radio control in particular were perceived as helpful by PWD. The mobile device was also valued positively. Caregivers considered the reminders, radio control and music player the most helpful. PWD and caregivers are willing to accept assistive technology, provided they can rely on the technical performance and stability of the device. Although further studies are needed, the CDN is expected to be a useful tool for supporting community dwelling persons with mild dementia and their caregivers.

Meiland, F., Bouman, A., Sävenstedt, S., Bentvelzen, S., Davies, R., Mulvenna, M., Nugent, C. Moelaer, F. Hettinga, M., Bengtsson, and Dröes, R. 2012. “Usability of a New Electronic Assistive Device for Community-Dwelling Persons With Mild Dementia.” Aging & Mental Health 16(5):584-591.

COGKNOW Day Navigator (CDN)

Meiland, F., Bouman, A., Sävenstedt, S., Bentvelzen, S., Davies, R., Mulvenna, M., Nugent, C. Moelaer, F. Hettinga, M., Bengtsson, and Dröes, R. 2012. “Usability of a New Electronic Assistive Device for Community-Dwelling Persons With Mild Dementia.” Aging & Mental Health 16(5):584-591.

COGKNOW touch screen with handset COGKNOW mobile device

COGKNOW Day Navigator (CDN)

Image courtesy of NCBI http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874241/bin/nihms475305f3.jpg

Diagram of the COGKNOW system network between caregivers and patients using handheld and desktop devices.

Way finding Aid

PWD tend to fail in planned way finding. Its common they cannot position themselves accurately and have difficulties in finding and retracing their steps to retour back home. Unfamiliar environments have been found to be especially challenging.

Research in Finland evaluated the prototype of a way finding aid using predefined routes; modalities included were visual, audio, and tactile signals. The findings from their study conclude, in most cases, the orientation with the way finding aid on predefined routes succeeded. The severity of dementia did not seem to predict success in orientation with the way finding aid. Using the landmarks wasn’t as successful as using “left”, “right” and “go straight on” commands as the way finding advice.

Sorri, L., E. Leinonen, and M. Ervasti. 2011. “Wayfinding Aid for the Elderly with Memory Disturbances.” ECIS 2011 Proceedings Paper 137.

Mobile Robots

Research by Matthews et al. (2010) examined if mobile robotic devices have the capability of providing physical and cognitive assistance with navigation.

During a field trial, the researchers observed the responses of persons with and without cognitive and physical impairments, when navigational guidance was given by two mobile robots through audio, video, and gestural cues. N= 28 adults. Seven males and 21 females. Mean age: 82.82±4.96 years.

Two separate robots were used, a humanoid robot known as Pearl and a robotic walker named Intelligent Mobility Platform. BOTH robots were rated highly for ease of use, comfort, security, walking stability, and confidence in the robot's ability to provide guidance to an unknown destination.

Both robots were well received by participants.

Mobile robots have great potential for assisting persons with dementia with wayfinding and the ability to move with purpose from one place to another. More research is needed.

Matthew, J. S. Sereika, S. Engberg, J. Rogers, and S. Thrun. 2010. “Responsiveness of Older Adults to Navigational guidance from Mobile Robots in Retirement Communities.” Gerontechnology 9(2):308.

Mobile Robots

Matthew, J. S. Sereika, S. Engberg, J. Rogers, and S. Thrun. 2010. “Responsiveness of Older Adults to Navigational guidance from Mobile Robots in Retirement Communities.” Gerontechnology 9(2):308.

Pearl IMR – Intelligent Mobility Platform

Robotic Pets: also called emotional , companion , or therapeutic robots

Pet therapy has been widely used with PWD. Research has shown that the presence of a dog enhanced socialization (e.g., increases in verbalization, smiles, looking, etc.) in residents with dementia.

While traditional pet therapy has been shown to enhance well-being, there are situations where a substitute artificial companion, such as robotic pet, may be a better match.

The advantages of robotic pets have been listed as the highly imitative, life-like behavior; modeling of emotional states usually experienced by humans; and provision of alternative models of communication.

Studies have reported improvements in quality of life, relationships, and loneliness in elders who have interacted with robotic pets.

Moyle, W., M. Cooke, E. Beattie, C. Jones, B. Klein, G. Cook, and C. Gray. 2013. “Exploring the Effect of Companion Robots on Emotional Expression in Older Adults With Dementia: A Pilot Randomized Controlled Trial.” Journal of Gerontological Nursing (5):46.

Robotic Pets: PARO

PARO, a therapeutic robotic seal, has been shown to have a psychological effect on PWD. Enhanced relaxation, motivation and improved improving the socialization of PWD with others, including caregivers.

PARO has tactile sensors and moves its tail and flippers and opens its eyes when petted. Artificial intelligence software changes the robot's behavior based on a host of sensors that monitor sound, light, temperature, and touch. It responds to sounds, can learn its name, and learns to respond to words its owner uses frequently. It can show emotions such as surprise, happiness, and anger, and will cry if it is not receiving sufficient attention. It produces sounds similar to a real baby seal and is active during the day and sleeps at night.

Moyle, W., M. Cooke, E. Beattie, C. Jones, B. Klein, G. Cook, and C. Gray. 2013. “Exploring the Effect of Companion Robots on Emotional Expression in Older Adults With Dementia: A Pilot Randomized Controlled Trial.” Journal of Gerontological Nursing (5):46.

Robotic Pets: PARO

A pilot study in Australia (2013) aimed to compare the effect of companion robots to participation in an interactive reading group on emotions.

Findings suggested PARO may be useful as a treatment option for PWD creating enhanced well-being.

Moyle, W., M. Cooke, E. Beattie, C. Jones, B. Klein, G. Cook, and C. Gray. 2013. “Exploring the Effect of Companion Robots on Emotional Expression in Older Adults With Dementia: A Pilot Randomized Controlled Trial.” Journal of Gerontological Nursing (5):46.

Robotic Pets: CATS – NeCoRo vs. Plush

A pilot study compared the benefits of a robotic cat and a plush toy cat as interventions for PWD. Interacting with the cats were linked with decreased agitation and increased pleasure and interest.

Similar trends were seen for the two cats. Both types of cats held the participants’ interest, with the robotic cat also producing significant increases of pleasure. Persons with severe dementia can be engaged in interactions with a robotic cat as well as a plush cat.

Study participants with higher levels of cognitive impairment tended to be engaged with the robotic cat for a shorter duration than those with higher levels of cognitive functioning, however, cognitively impaired residents were, in fact, engaged with the robotic cat.

Libin, A. and J. Cohen-Mansfield, J. 2004. “Therapeutic Robocat for Nursing Home Residents with Dementia: Preliminary Inquiry.” American Journal Of Alzheimer's Disease And Other Dementias 19(2):111-116.

Robotic Pets: CATS – NeCoRo

Libin, A. and J. Cohen-Mansfield, J. 2004. “Therapeutic Robocat for Nursing Home Residents with Dementia: Preliminary Inquiry.” American Journal Of Alzheimer's Disease And Other Dementias 19(2):111-116.

Robotic Cat NeCoRo

Robotic Pets: AIBO

The use of Sony’s computerized, or robotic, “pet” called AIBO, may be a means of stimulating social interaction in residents with dementia without the drawbacks associated with live animal visitation.

Kramer et al. (2009) study compared the effects of visitation by a person, a person accompanied by a live dog, and a person accompanied by an AIBO, on behavioral indicators of social interaction among female nursing home residents with dementia.

They found that the three types of visits stimulated residents to initiate conversation, touches, and looks at other individuals (human, dog, and AIBO). Both the live dog and AIBO stimulated resident social interaction beyond that stimulated by the visitor alone.

The AIBO induced longer looks and more resident-initiated conversation than the live dog and provided a positive source of social interaction.

Kramer, S., Friedmann, C. and P. Bernstein. 2009. “Comparison of the Effect of Human Interaction, Animal-Assisted Therapy, and AIBO-Assisted Therapy on Long-Term Care Residents with Dementia.” Anthrozoos, 22(1):43-57.

Robotic Pets: AIBO

The success of the robotic dog in stimulating social interaction by dementia residents, suggests that it may provide a viable alternative to live animal visitations.

Kramer, S., Friedmann, C. and P. Bernstein. 2009. “Comparison of the Effect of Human Interaction, Animal-Assisted Therapy, and AIBO-Assisted Therapy on Long-Term Care Residents with Dementia.” Anthrozoos, 22(1):43-57.

Wearable Video Monitoring

The IMMED Project, Megret et al. (2010) – France – Is a new application for multimedia indexing, using a system that monitors the instrumental activities of daily living to assess the cognitive decline caused by dementia.

Using this new device, researchers collect video data that can be analyzed to extract meaningful events occurring in everyday life.

This study evaluated the impact of the proposed system to the clinical diagnostic of dementia disease by medical experts is planned in the future of this work.

The feedback from medical researchers at the time of the study, encouraged the IMMED research team to continue to improve the automatic analysis and establish larger scale experiments.

Megret, R., V. Dovgalecs, H. Wannous, S. Karaman, J. Benois-Pineau, E. El Khoury, J. Pinquier, P. Joly, R. Andre-Obrecht, Y. Gaestel, and J. Dartigues. 2010. “The IMMED Project: Wearable Video Monitoring of People with Age Dementia.” ACM Multimedia Video Program Italy, Pg.1299-1302.

Wearable Video Monitoring

Megret, R., V. Dovgalecs, H. Wannous, S. Karaman, J. Benois-Pineau, E. El Khoury, J. Pinquier, P. Joly, R. Andre-Obrecht, Y. Gaestel, and J. Dartigues. 2010. “The IMMED Project: Wearable Video Monitoring of People with Age Dementia.” ACM Multimedia Video Program France, Pg.1299-1302.Also see: https://immed.labri.fr/docs/Slides_ICPR.pdf

Human daily activity indexing Range for image collecting

Camera and placement

SenSeCam is a wearable camera that can automatically take pictures to supplement memory. It can be combined with other devices that collect GPS data and audio (the software was still in developmental stages in 2012) that assigns context to image sets based on location, movement, and photograph contents (i.e. faces), allowing for the individual to use the software without caregiver intervention.

DejaView is a proposed design to integrate facial recognition technology with wearable sensors and context-assigning software.

MemExerciser system is also a self-guided system that has resulted in an increase in the percentage of details remembered over time.

Very little empirical research has been performed to gauge the effectiveness of various types of supplemental memory devises.

Future Technologies

Charness, N., R. Best, and D. Souders. 2012. “Memory Function and Supportive Technology.” Gerontechnology 11(1):22-34.

Microsoft’s SenSeCam

Questions?