How can we

improve the
communication with
dementia people living
at home alone?

Understand

Envision

Improve the
Communication
for People with
Dementia

Design

Erik

HCI Project Work

Group 3
Laura

Discussion and
Recommendations
Mike

People with dementia may be healthy in body but fail to remember.

This leads to problems in their daily life and communication with
their relatives. These problems may occur over time as the dementia
progresses.

Researches show that people with dementia living at home alone

are more likely to feel lonely because dementia makes it harder for
them to maintain their social contacts and life. It also creates
stressful situations for relatives as they might receive several
intraday phone calls with the same question. Dementia hinders the
ability to make appropriate decisions about self-care and day-today needs. Nutrition is aected by the ability to go grocery
shopping, cook and eat. The risks for harm, falling, wandering and
getting lost create further challenges for managing personal hygiene
or household tasks, which can result in unsafe living conditions. In
order to provide adequate support family and caregivers need to
know
how much the dementia is aecting
the ability to manage daily
tasks and self-supply.

About one-third of
people with dementia live at
home. With the right support it is
possible for them to have an
independent life. Usually they want to
stay in their own home as long as
possible. A good quality care at
home can reduce hospital care
admissions.

The focus is not only on

direct communication
between people but
also on the exchange
of information that can
help families and
caregivers to better
calculate various
situations.

Phase 1
Understanding

What is
Dementia?

Research
Dementia describes a pattern of symptoms that occur when the
brain is damaged. It typically involves the loss of memory, mood
changes, problems with orientation, comprehension, language and
judgement.
Dementia is progressive - symptoms tend to develop slowly but
steadily over several years. There are over 100 different diseases
or conditions which can lead to dementia. The most common one is
the Alzheimer's disease.

What are
exiting
Solutions?

There a lot of assistive technologies

available to help people with dementia. One
of the technology are robots which improve
communication and help against loneliness.
Others are aids to remind things, to manage
medication, to orientate when lost, to
orientate daytime, to simplify communication
and to monitor electrical use.

Evaluation

Many products expect patients to

adapt to the technology. Solutions like
GPS tracking, Monitoring face many
ethical and privacy questions.
Robots can never replace human
contact and interaction.
1

To get a better understanding of what Dementia

means to patients, families and
caregivers.
What are the problems that exist in
the real life for people living with
Dementia?

Why?

Semi-structured

Interviews

What is currently done to help them with their daily

tasks and problematic situations?

Researchers who are working with dementia in

order to get a good background
knowledge.
Who?

Caregivers for people with dementia

in order to find out what are the biggest
challenges for people with dementia
living alone at home.
People who have experience with dementia in their
personal environment in order to understand what
dementia means for families, neighbors and friends.

Problems
Dementia

Eating
Forgetting appointments
Orientation
Taking Medicine
Emotion problems like
aggressive behavior
Getting lost
Asking the same question
several times
Falling (orientation)
Finding things again
Keeping clothes clean
Hygiene and cleaning
Paper work and bills
Transportation
Some dont want help

Existing
Solutions

Approximately 160.000 people

are affected in Sweden

Progressing disorder
Development is visible
Symptoms are totally based
on the affected person
Social skills can also differ
Often starts with loss of words
and communication
Losing awareness of own
situation
Most dont lose their sense of
humor

Other

Alarm at the door

Personal help (Nurses)
Tracking device in pocket
Night surveillance
Different kinds of robots
Oven guard
Special calendar, clock
Medication reminder, pillbox
Name pin for clothes
Panic button
Special phones

Individualized solution is

needed
Mild form of dementia in focus
Privacy, ethical and legal
issues
Medical aids are expensive
and complicated
2

The focus will be on older people in the

beginning and middle stage of any kind of
dementia. They can live alone at home
People
but they differ in memory, orientation and
Patients, Families,
emotions. They speak a different
Friends, Neighbors
language, apply different mental models
and Caregivers
and prefer things they know. Families,
friends, neighbors and caregivers differ in
age, physical abilities, distance, technology
usage and knowledge.
The selected solution should support regular
activities as well as situations that afford
immediate actions. Most activities are
Activities
performed at the patient's home and happen
Taking Medicine,
in a quiet environment. Several actions are
Daily Habits,
performed in a sequence. Due to Dementia
Eating
even simple activities can be complex.
Patients should not be forced to directly
interact with the solution.

Context

The main physical environment will be the living area

of the person. Homes can be different in size, number
of rooms, accessibility (e.g. stairs, bathroom),
location, social context and outside areas.

Technology

As dementia affects the ability to learn the

direct interaction with any kind of
technology should be limited and not
afford direct input of data. Communication
needs to happen in a familiar way and
therefore should be embedded into
existing daily-life objects of the patient.

Problems found in interviews and research

were grouped and possible solutions
selected. The challenges living at home
alone with dementia were narrowed
Brainstorming
down into three main areas: medicine;
organization and orientation; eating.
Existing challenges and solutions were
collected for all categories. With the help of
these categories several ideas were created.
We agreed to select those ideas which dont require a direct
interaction from the person with dementia with any technology. All
possible ideas were discussed and analyzed which problems they
could solve and which additional challenges may occur.

Some solutions were either too expensive (as smart plates or

fridges), had ethical issues (navigation devices in clothes, cameras
on table), were hard to control (smart cupboard) or too distracting
(video while eating).
The most promising ideas were the following:
Monitoring with sensors in clothes or at home Scenario 1
Connecting people for eating and helping Scenario 2
Help to remember with printers or digital frames Scenario 3

Phase 2
Envisionment

Requirements
MoSCoW

Based on the results a

list of non-functional
requirements was created. These were used as a
basis for choosing ideas and creating scenarios.
The technology selected for the solution must be
invisible for the person living with dementia. It must
be integrated into the daily life without changing
habits and a solution needs to be affordable.
It should not afford direct interaction or data input.
Communication between the system and the family
should be in focus. For the family it should be easy to
use and quickly to understand.
Accessing and controlling the solution could be done
remotely by the family or the caregivers. A solution
could also be used to connect different people.
There are many problems we want cover with the
selected solution. It is important that we focus on one
specific problem that we want to solve and not to
come up with a Swiss Army Knife" solution.

Based on the ideas, the non-functional requirements

and the personas we developed three individual
scenarios - each solving a different problem.

Gunn Jonsson
72 years
Lives in a small house in Stabby, Uppsala
Gunn gets up every day at 7am and prepares
breakfast. After that she goes to the bathroom to take
a shower and to brush her teeth. She regularly visits her
best friend Kersti and her doctor. Her family is visiting her
at least once a week. She cleans her house and does most
of the shopping herself. In the evening she watches TV and goes
to
bed around 10pm. Gun has a stationary phone in her living room that she uses
regularly. She is not used to smartphones or any other new technology.
Gunn has recently been diagnosed with Alzheimer. She regularly forgets about
appointments. Sometimes she loses her sense of orientation for places and of what
day and time of day it is. She often feels lonely at home and tries to call her family as
often as possible.

Frederik Jonsson
48 years
Lives in Stockholm with his family
Gunns son
He works full time as a bank manager and has to travel a
lot. His wife Annika works full time as a teacher. Their
daughter Anna (20) goes to university in Malm. Their son
Andre (17) goes to school in Stockholm. They all have
smartphones. Frederik worries about Gunn living by herself in her small house in
Uppsala.
4

Scenario 1
StatusGuard

This first scenario

focuses on the home
Description
sensors. The goal is
to develop an idea that
helps families to get
feedback on the patients
status and receive
notifications about unusual situations.
Gunn has an electrical monitoring tool
(e.g. Watty) installed at her home and her
family can check if everything is OK on the
StatusGuard App.
The app notifies the family if something
might be wrong with Gunn and offers them
to contact Gunn or other persons for
immediate help. Gunn herself does not
interact with the StatusGuard system and
does not enter any data
herself.
Over time the system
learns about the daily
Concept
habits and can react
faster on problems.

Gunns
normal day

Gunn
has a
problem

Gunn wakes up at
7am and has
breakfast in the
kitchen. In the
evening she watches
TV.

There is no activity
in the morning. The
system tries to call
Gunn. She doesnt
react. Frederik gets
a message.

The language
used for the
colors should
help to instantly
identify the
persons status.
Green indicates that the
system is receiving information about
activities that match the daily habits.
Orange indicates that the person's last
activity was a long time ago or that the
person currently cant be tracked. It doesnt
necessarily mean that there is a problem.
Red indicates a higher probability of a
dangerous situation and requires direct
attention.
The system can never assure a 100%
accuracy of the situation which makes the
chosen wording for the
description very important.
In order to keep
the app simple
the design
pattern cards
has been
chosen.
5

In the second scenario we

concentrated on the problems of
loneliness and eating by using the
Description
idea of connecting people for
regular get togethers. The
transportation is organized and the
meetings are supervised by a caregiver.
Dementia patients often have one caregiver
coming for each meal to their home - bringing
people together could reduce the caregivers
workload. This supports also the fact that
many older people are used to eat with their
family and not alone.

HealthCare

HomeCare

CareGuide

My Profile

Gunn Jonssonn
04.08.1943
72 years

Stabby backe 1
752 30 Uppsala

Medical Report

Family Information

Gunns Home Loation

GetTogether

Breakfast

Lunch
Lunch

Fika

Dinner

Location:
Stiftelsen Andreas
Monday
Weekdays: 8:30am - 10am
Weekend: 9am -11am
Group Size: 20-50
Special Diets: Possible

Monday, Wednesday, Friday

Group: Uppsala Stabby2
Transportation arrives: 11:30am
Reminder: 9am
No Special Diet needed

Location: Various Nursing Homes

Weekdays: 3pm - 4pm
Weekend: 3pm - 5pm
Group Size: 20-50
Special Diets: Not at all Places

Location: Various Homes

Weekdays: 6:30pm - 8pm
Weekend: 6pm - 8pm
Group Size: 3-5
Special Diets: Possible

Update

Configure

Configure

Configure

Scenario 2

GetTogether

Gunn has a profile on the Telia healthcare

platform. Her family can edit and update this for
her. They can sign her up for regular breakfast,
lunch, fika or dinner groups in Uppsala. A
caregiver will organize the groups and
the transportation. On the selected
days Gunn is reminded by a phone
call about the pick up time.
Concept

Mockup
A mockup has been chosen as
design representation for the
profile on the Telia healthcare page.
Although the profile is not used by Gunn
herself it should still be simple and only
show the main information. The top part
shows basic background information.
The bottom part contains the
configuration and details about the
individual GetTogethers. This is placed
on a grid that contains all events
together. In order to allow a better
scanning of the page the title are all
placed in the same sections.
The color is mostly based on the existing
Telia icon. For GetTogether the different
colors should indicate which meals are
booked already without loosing too much
contrast.
6

Description

Scenario 3
FrameControl

The third scenario has a focus on communicating with people who have dementia through a
digital frame connected to a stationary phone. That display of the frame is remotely controlled
by a mobile application. The goal is to improve the communication between people with
dementia and their family. It makes them to feel closer and reduces stressful movements.

Concept

Storyboards
Prototype

After talking to Gunn Frederik creates an

note on his app and sends it to her frame.
The next time she wants to call him for
the same reason she will be reminded by
the frame.

Next to Gunns stationary phone Frederik has installed a digital frame that can be
controlled by the FrameControl app on his phone. It can show different kinds of
information depending on the current settings. Notes can be added to help Gunn
remember calls, pictures can be shown and the frame can be used for video calls
within the family. It also shows pictures of the calling person.

This concept is represented in a prototype showing the possible

interactions with the application and the digital frame.
In the user interface several design patterns have been used.
For example clear entry points and grid of equals for the
main functional buttons Note, Video Call and Pictures to
show that they are equally important and easily
accessible.
The app always shows the current state of
the digital frame so that the family can see
what Gunn sees. The colors should not
distract from the preview and the main
actions.
The layout for the digital frame is kept
simple and only shows the main
information. This should help Gunn to
focus on the given note, picture or video
without distraction.

Recommendations

StatusGuard
Evaluation
All the concept have to be
evaluated in order to find out if they
are valid and if they can be used in real
life. This could happen with the help of
focus groups and pilot programs (for
example with the GetTogether idea). The
applications need to be tested by users
and a heuristic evaluation can be used
to get feedback on the usability and
the user experience of each
idea.

One part that has not been covered is the configuration of the settings area. How can the
communication of the app be customized to the individual needs of a user? A second idea is to
record messages for the test calls. The next step would be to see the status of multiple people
within the app. This could add hospitals or nursing homes as potential target users. By using the
design pattern cards we have already created the foundation for that idea. StatusGuard should
also provide add ons for the integration of further technologies such as surveillance systems,
electrical door locks, GPS sensors and so on.
Especially with the mentioned recommendations this concept would not only be interesting for
people with dementia but also for other groups of people who want to live an independent life
but need some kind of supervision from caregivers and families.

GetTogether

In order to test if the concept of bringing people together for meals is working it is important to start
with a smaller version (e.g. only small groups for lunch). If the concept is working and accepted by
older people it can be extended. One idea is to allow a further connection amongst (older) people
especially for those ones who are more used technology. It can also be extended from just meeting for
meals
to meeting for other social activities such as playing games together or going to the theater. The idea of
connecting people is not only interesting for patients with dementia but also for others who don't want to eat alone or feel lonely.

FrameControl
One possible extension for the concept with the digital frame can be a reminder functionality that uses sound or voice output. The FrameControl
could be useful to connect with other ideas and applications for example the GetTogether concept as mentioned in our video - other people such
as caregivers could also get the right to add notes or picture to the frame. This opens the discussion about who is controlling and monitoring the
shown content.

Discussion

Limiting the design space for this research question was very difficult. During brainstorming we came up with
many valuable ideas that we had to leave out due to the given frame of our project. Interviews and research
helped a lot to understand the topic and to come up with solutions. We focused on ideas that are easy to
integrate into the daily life and are not too expensive. Creating scenarios, wireframes and prototypes
worked well for the project. Fully following the user centered design process would require more user
interaction what would also help to better evaluate the concepts directly from the beginning. Feedback from
current caregivers or researchers would have been a very valuable asset to the feedback we received
from people who have experience with dementia patients.
In the following we want to reflect the strong and weak sides of each of our scenarios.

Status Guard
We started with the idea of using sensors in the home. Especially the idea of a carpet measuring the weight, door
sensors, electrical monitoring and sensors attached to clothes seemed promising to us. With StatusGuard we limited the
focus to the monitoring of electric activity. The main constraint we faced by choosing a technology like Watty was that the systems accuracy is
a factor that is hard to measure. There are many variables that we cant predict and that will only appear once the system is in (test-)use. The
biggest advantage of this solution is that it does not require any input from the person with dementia. It learns habits and keeps family and
caregivers informed without bothering the patient. Even if the system is extended with further sensors it will still not require constant data input.

GetTogether
We wanted to see Gunn as a human being with social needs rather then as a patient locked in at home. Connection people for meals could not
only help them feel less lonely but also solves eating difficulties. The success of the idea relies on the acceptance of the people. It needs the be
researched if sitting together with unknown people is medically advisable or if it is too distracting and perhaps even stressful.

FrameControl
The main idea for this concept is not to change the usual way of calling. CommunicationFrame will serve as an additional feature to a stationary
phone and doesnt require any direct interaction from the person with dementia. We thought about applying the design pattern card to the frame
in order to offer the possibility to add multiple notes or to show a calendar with time and weather. But an evaluation has to be done first in order
to find out if it makes sense or if it is confusing for the person. In our approach we focused on the main elements without any distraction.

Method Appendix

Understand

Envision

Design

Research - Interviews - PACT - Brainstorming

Requirements - Personas - Scenarios

Conceptual Design - Wireframes

Prototypes & Mockups

Research: To get a common understanding of

dementia and connected problems for people
living at home as well as existing medical aids
we read articles, websites from dementia
research groups and forums for relatives.
Interviews: In order to verify our information we
prepared, executed and evaluated seven semistructured interviews with a prepared introduction
and a basic set of questions. Goal was to have
an open discussion and not a fixed interview. We
talked to a researcher, caregivers and people
who have experience with dementia.
PACT: A general PACT analysis helped us to
narrow down the people, activities, contexts and
technologies.
Brainstorming: Finally we needed to get an
overview of the collected data. We created
different categories for the problems and
brainstormed ideas that would help solving them.

Requirements: The PACT and the

brainstorming helped to create a clear picture
of what a solution needs to be like. We
collected these points into non-functional
requirements that should be fulfilled by every
selected solution.
Personas: In order to get a better view on the
brainstormed ideas we created two personas.
We put ourselves in Gunns and Frederiks
shoes to find out which solutions are good and
still fulfill the given requirements.
Scenarios: Based on our personas and the
three most promising ideas we developed
three different scenarios. How would a
selected idea look like in the everyday life of
Gunn and Frederik? How would it react if
something is wrong with Gunn?

Conceptual Design: At the beginning the

scenarios contained several use cases. We
created a conceptual design by collecting all
objects and activities that belong to one scenario.
This helped us to better structure each concept.
Wireframes: In oder to get a first idea of how the
scenarios can look like physically we created a
first set of wireframes. This helped us to identify
possible challenges and weak points. In several
iterations we created a set of wireframes per
scenario that we decided to proceed with.
Prototypes: For the first and the last scenario we
created interactive prototypes that helped to test
and communicate the concept and the related
interactions.
Mockups: As interaction is not a main part of the
second scenario we decided to do a mockup to
illustrate the main functionality and the design
pattern we have chosen for this concept.
10

Appendix - Our Process

Interviews

Planning

Brainstorming

Design
Iterations

Appendix - StatusGuard

One challenge with the electrical monitoring is that it can

not measure if and when Gunn has left the house and when
she returns. We solved this by adding additional
movements sensors inside and outside the main door. This
leaves us with the problem that we can not identify if Gunn
entered the house or someone else (what happens if
burglar break into the house?).

Appendix - GetTogether

2
Another idea was to create some kind of history for the
GetTogether events in order to have another source of
information about Gunns status for the family.

Appendix - FrameControl