Select Committee on Science and Technology Written Evidence

Memorandum by the Independent Consortium


  This submission addresses the application of research in technology and design to improve the quality of life of older people, with particular reference to people with dementia.


  Recent years have seen a rapid growth in research and development of new technologies to improve services and enhance the independence and quality of life of older people living at home. The actual and potential role of new technologies has been recognised in the National Service Framework for Older People (Dept of Health, 2001). A wide range of applications are being developed or are already in the marketplace, addressing both the direct and indirect support of frail and disabled people (Sixsmith 1998), for example: smart housing, client monitoring, teleconsultation, health and social care assessment, client records and care planning, client support (eg emergency response, counseling, information), health and social care information systems. However, the specific needs of older people with dementia have only been recently addressed and there remains considerable scope for research and development for this client group within a number of key areas (Judd et al, 1997; Sixsmith 2002; Orpwood 2002; Woolham and Frisby 2002a, 2002b; Bjoerneby et al, 1997):

    —  Supervision and surveillance. One of the major concerns in supporting cognitively impaired older people at home are the potential safety risks involved and the use of automatic alarms to highlight dangerous situations has received increasing attention from technologists and academics (cf Sixsmith 2000). For example, wandering behaviour may pose a significant risk for an individual as they may get lost or be unable to cope with the potential dangers of the outside world. However, restraint may be an undesirable or unethical option for people. Systems can be installed to determine whether a person has left a room or building and either use a prompt to discourage them from leaving or send a message to a carer or service provider if they do.

    —  Safety and security. The home environment can be a dangerous place for cognitively impaired people. For example, they may leave cookers and heaters unattended, while gas and electricity is potentially lethal if misused. "Smart housing" technologies may be particularly useful for people with dementia, automatically shutting off devices or allowing remote control by carers or service providers. Smart housing could also use sensors to control household appliances and devices, depending on movements and activities of person. Technologies that can provide such back-up whilst still empowering the person and not taking control away from them have been demonstrated (Orpwood 2002).

    —  Environmental control. Sensors for heating, cooling, ventilation, day and artificial lighting can automatically regulate comfort in the internal environment using systems that incorporate good energy management. In addition to passive controls it is recognised that it is important for autonomy and the sense of comfort for the individual to have the ability to actively control their environment, yet most available controls are not appropriate for older people with dementia. There is a need to develop better interfaces to enable people to regulate their own comfort.

    —  Carer support. Carer support is a key aspect of care in the community. Using telecommunications to carry out more routine tasks, such as shopping or going to the bank or post office, may provide them with more free time, relieving the "burden" of care. Access to information advice and counselling is also important. Smart house technology can also improve the quality of life of carers through ensuring careful monitoring of activities and alerting the carer only when necessary, eg allowing a carer to sleep secure in the knowledge that they will be woken if the person gets up and needs attention or reassurance.

    —  Reminder devices. New technology could also provide "reminder devices" to support independent living (European Commission, 1996; Woolham and Frisby, 2002a). These can provide cognitively impaired people with suitable decision support software to help in carrying out actions such as household activities, social participation, communication and vocational tasks.


  The development of technologies for people with dementia has generally focused on safety and security issues. However, there may be opportunities for more positive uses of technology to enhance quality of life. For example, Marshall (1997) suggests using technology to identify when a person is restless and bored and then initiate a familiar or enjoyable activity, such as playing familiar music or videos. Aromatherapy rooms could emit relaxing aromas to alleviate stress, while the use of telecommunications could help to reduce social isolation.

  Research and development within assistive technologies needs to reflect the specific needs of cognitively impaired people as well as those people with physical impairments (eg mobility, sensory, motor, control and manipulation). For physically impaired people, the underlying basis for technological development and design is to remove the environmental barriers that turn a person's impairment into a disability. In contrast, cognitively impaired people may have impaired abilities to understand their environment, formulate plans, carry out actions, communicate or remember what they have done or where they are. This has a number of implications for the development and implementation of telecare for this client group. For example, people with physical disabilities can directly interact with assistive technology. Someone with arthritic hands can benefit enormously from taps that are turned on by simply moving their hand in front of an infra-red sensor. For someone with dementia such devices are confusing and inappropriate. Design engineers need to develop assistive technologies in a way that the user's interaction is the same as they have always used in the past. For example the taps in the Gloucester smart house for people with dementia (Orpwood 2002) look like traditional taps but actually just operate sensors that can monitor how far the user has turned them. The house is then able to control water to flow at the rate desired, or it can shut the tap off if the user leaves it running.

  While it is accepted that technology can assist people with dementia there is also widespread concern about its potential misuse, and a fear that technologies designed for specific functions such as minimising risk can have a seriously negative impact on quality of life. It has been noted that there has been much greater take up of technologies that promote safety and the monitoring of health than those that support quality of life (Marshall 2001). Problems have been highlighted such as the potential erosion of privacy by the extension of telemedicine into the home environment, or the excessive restriction of the individual that can be concomitant with a safety and security culture. The potential for technologies to be a channel for ageism and the need for the user to be in control is recognised (Fisk 1999) and the challenge is to design technology interfaces that empower rather than restrict. There is a need for a better understanding of the dynamic between a range of technologies and their impact for good or ill on quality of life, to enable informed judgements to be made by specifiers and selectors of systems and devices for people with cognitive impairment.

  It is important that the implementation and application of new technologies and related services are grounded in a thorough understanding of the individual within their social and care networks (Kitwood, 1997; Pieper and Riederer, 1998). The needs and abilities of the person may vary considerably. People in the early stages of dementia may be able to cope reasonably well with only limited care, while others may be require considerable help and support. Important individual factors to consider are level and stage of cognitive impairment, ability to carry out activities of daily living, problematic and emotional factors such as anxiety and tendency to "wander". The informal and formal care networks will also determine the kinds of technological interventions that are needed. Again this will vary from individual to individual, depending on factors such as availability of informal carer, physical proximity, carer network and capacity to provide care. The application of new technology needs to be tailored in order to complement the person's abilities and capacities and to provide help and support to care providers.


  The independent project comprises researchers at three universities and representatives from industry, social care and the voluntary sector. We are confident that the expertise within the group is adequate to take on a very challenging project, both conceptually and technically. However, the interdisciplinary nature of the project requires collaboration between several institutions and it is unlikely that a single institution would have all the relevant expertise.


  It should be noted that both UK and European research funding is restricted to home nationalities, making it difficult for other countries (eg USA and Japan) to participate in collaborative work, even when this is desirable.


  The Independent project addresses an important health and social care user group, with a prevalence of dementia of around 4-5 per cent of the over 65 population. The current Government has set a clear agenda to improve level and quality of services to support independent living within the community and the development of technologies is recognised as an important part of this process (DoH 2001). The following recent statements are also noted:

    —  "By 2006 a further 100,000 people each year will be supported to live independently at home through extra intermediate and home care services" ("Delivering the NHS Plan—next steps on investment, next steps on reform" April 2002).

    —  "Improve the quality of life and independence of older people so that they can live at home wherever possible, by increasing by March 2006 the number of those supported intensively to live at home to 30 per cent of the total being supported by social services at home or in residential care." (Priorities and Planning Framework for 2003-06 "Improvement, expansion and reform: the next 3 years").

    —  "Service capacity increased in other key services which support people at home so that in 2006: 30,000 more people a year receive care packages involving five hours or more a week of home care; 500,000 more pieces of community equipment are provided; there are 6,900 more extra care housing places. An increase of 6,000 in the number of people in care homes supported by councils over the three years to 2006." (Priorities and Planning Framework for 2003-06 "Improvement, expansion and reform: the next 3 years").

  Current policy will require a change in the planning process, making it bottom up rather than top down and is implicitly looking for step change in achieving objectives. Plans are made locally but must meet these national targets that are "not negotiable". The implications of the policy and the demographics of increasingly older populations are that people with dementia will delay their entry into residential care and so methods of providing security, safety and support within the home for increased levels of dementia will be needed urgently. Equally, the eventual entry into residential care of patients with more severe dementia will affect the patient mix and the care needed in nursing and residential homes.

  Exploitation of the outputs of R&D has been relatively limited. The emergence of new technologies within telecommunications, sensoring, artificial intelligence, robotics etc offer tremendous opportunities and, potentially, new technology could play a significant role in the delivery and support of community care services. However, the care industry has shown only limited signs of utilising new technology to improve products and services. New business and service models are required to allow technologies to be integrated within existing structures. Attention also needs to be paid to ethical issues and practical aspects such as installation and maintenance


  Bjoerneby S (1997) The BESTA flats in Tonsberg. Using technology for people with dementia. Oslo, Human Factors Solutions.

  Cooper, R G (1988) "Winning at New Products" pub Kogan Page. ISBN1-85091-769-8.

  Department of Health (2001) National Service Framework for Older People.

  European Commission (1996) Telematics Applications Programme, Disabled and Elderly Sector: Project Summaries. DGXIII-C5, Brussels.

  Fisk, M (1999). Our Future Home: Housing and the Inclusion of Older People. London, Help the Aged.

  Judd, S., M. Marshall, et al (1997). Design for Dementia. London, Hawker Publications Ltd.

  Kitwood T, 1997 Dementia Reconsidered, Buckingham OU Press.

  Marshall, M. (2001). "Dementia and technology. Inclusive Housing in an Ageing Society". In S M Peace and C Holland (Eds). Bristol, The Policy Press.

  Orpwood, R (2002) "A `smart' house to support the person with dementia". In Dementia Topics for the Millennium and Beyond, Ed S. Benson. Hawker, London. pp 87-90.

  Pieper, R, Riederer, E (1998) Home care for the elderly with dementia. In Graafmans J, Taipale V, Charness N (eds) Gerontechnology: A Sustainable Investment in the Future. Amsterdam; IOS Press, 324-330.

  Poulson D, Ashby M and Richardson S (1996) Userfit: A practical handbook on user-centred design for assistive technology. Loughborough: HUSAT.

  Sixsmith, A J (1998) "Telecare at home". In Walker, A. (ed) European Home and Community Care 1998-99. London: Campden 141-142.

  Sixsmith A (2000) "An evaluation of an intelligent home monitoring system". Journal of Telemedicine and Telecare, 6, 63-72.

  Sixsmith A (2002) "New technology and the care of cognitively impaired older people". In Copeland J, Abou-Saleh M Blazer D (eds) Principles and Practice of Geriatric Psychiatry. Chichester: John Wiley and Sons.

  Woolham, J and Frisby, B Building a Local Infrastructure that Supports the use of Assistive technology in Dementia Care. Research Policy & Planning 2002 Vol 20 No 1.

  Woolham, J and Frisby B (2002) Using Technology in Dementia Care. In Dementia Topics for the Millenium and Beyond, ed S Benson. (Hawker: London p 91-94).

September 2004

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