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Loneliness, Isolation & Alzheimers in Long-term Care TouchStones Device & System

HAYLEE STRACHAN ID MAJOR DESIGN PROJECT LUIS ANGARITA & JULES GOSS


Thank you to Jules Goss and Luis Angarita for all your help and advisement. And thank you to all the people who were willing to share their input and time.


Loneliness, depression and social isolation are critical concerns in long-term care, especially to individuals with Alzheimer’s disease.


These individuals quality of life and emotional wellness suffers greatly due to limited mental stimulation and social interaction.


Progressive decline only exacerbating passivity and isolation.


How might we reduce passivity and isolation in Alzheimer ’s patients in long term care environments through meaningful social interactions?


RESEARCH METHODS

Literature Review

Mapping

Expert Interviews

Journey Mapping

Stakeholders Map

Personas

Benchmarking

Competitive Auditing

Value Proposition


Why Alzheimer ’s?


What is Alzheimer ’s? “Alzheimer ’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, e v e n t u a l l y, t h e a b i l i t y t o c a r r y o u t t h e simplest tasks.” ("What Is Alzheimer's Disease?”, National Institute on aging)

-

Is the most common type of Dementia

-

Effects the areas of the brain that control speed and motor skills

-

Many individuals with AD also suffer from behaviour changes and depression NIA. “What Is Alzheimer's Disease?” National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/what-alzheimers-disease.


1 10 in

people aged 65 and older has Alzheimer’s Dementia. Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


Roughly,

90% of those with dementia experience negative emotional symptoms such as agitation, agression and loneliness. Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


1

10 130 million people aged 65 and older in

By 2050, more than

people will have dementia globally.

has Alzheimer’s Dementia.

Alzheimer ’s Disease International. World Alzheimer Report 2015: The Global Impact of Dementia. Available at: http:// w w w. a l z . c o . u k / r e s e a r c h / W o r l d A l z h e i m e r R e p o r t 2 0 1 5 . p d f . L a s t a c c e s s e d M a y 2 0 1 6 . ”


Hundreds of millions of caregivers and family members will be affected along with them.

A l z h e i m e r ’ s D i s e a s e I n t e r n a t i o n a l . W o r l d A l z h e i m e r R e p o r t 2 0 1 5 : T h e G l o b a l I m p a c t o f D e m e n t i a . A v a i l a b l e a t : h t t p : / / w w w. a l z . c o . u k / research/WorldAlzheimerReport2015.pdf. Last accessed May 2016.�


Why long-term Care?


Loneliness, depression and social isolation continue to be critical concerns in longterm care, A l z h e i m e r ’ s D i s e a s e I n t e r n a t i o n a l . W o r l d A l z h e i m e r R e p o r t 2 0 1 5 : T h e G l o b a l I m p a c t o f D e m e n t i a . A v a i l a b l e a t : h t t p : / / w w w. a l z . c o . u k / research/WorldAlzheimerReport2015.pdf. Last accessed May 2016.�


Especially for those suffering from cognitive decline. A l z h e i m e r ’ s D i s e a s e I n t e r n a t i o n a l . W o r l d A l z h e i m e r R e p o r t 2 0 1 5 : T h e G l o b a l I m p a c t o f D e m e n t i a . A v a i l a b l e a t : h t t p : / / w w w. a l z . c o . u k / research/WorldAlzheimerReport2015.pdf. Last accessed May 2016.�


PROBLEM DEFINITION

Residents with Alzheimer ’s Disease i n L o n g - t e r m c a r e ( LT C ) , s p e n d considerable time not engaged in m e a n i n g f u l a c t i v i t y. A b s e n c e o f stimulation compounds loneliness, depression and isolation. Family members and friends often struggle to maintain the same sense of connection with their loved one.


Right now in Ontario most of the

78,000 people in long-term care live this way. Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


Long-term Care facilities face many barriers to providing better care.

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Underfunded

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Understaffed

-

Overwhelming work loads

-

Increasing demand

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Increase of complex needs

“Situation Critical: Barriers to Care Can Arise in Ontario's Nursing Homes.� DurhamRegion.com, DurhamRegion.com, 18 June 2010, www.durhamregion.com/news-story/3454120-situation-critical-barriers-to-care-can-arise-in-ontario-s-nursing-homes/.


Currently in Ontario due to rapidly increasing demand “[…] new residents to long-term care must have ‘high’ or ‘very high’ physical or

9 10 out of

residents have cognitive impairment (Canadian Institute for Health Information, 2017)

cognitive challenges in order to qualify for admission.” (Canadian Institute for Health Information, 2017)


Meaning, that majority of residents are being admitted with very complex care requirements, overwhelming already understaffed and overworked front line care workers. (Canadian Institute for Health ( L o n g - Te r m C a r e H o m e S y s t e m R e p o r t s , O n t a r i o M i n i s t r y o f H e a l t h a n d L o n g - Te r m C a r e , O c t o b e r 2 0 1 7 )

Information, 2017) “The waitlists for Ontario long-term care is growing rapidly by a p p r o x i m a t e l y 1 5 % a y e a r. � ( L o n g - Te r m C a r e H o m e S y s t e m R e p o r t s , O n t a r i o M i n i s t r y o f H e a l t h a n d L o n g - Te r m C a r e , O c t o b e r 2 0 1 7 )


K E Y S TA K E H O L D E R S Outlined are the critical stakeholders, the individuals we will be designing for, as well as individuals that will be pivotal in determining if a solution is adopted and used.

INDIVIDUAL

L O N G - T E R M C A R E FA C I L I T Y The facility the individual resides, providing care and residence.

INDIVIDUAL Individual suffering from Alzheimers disease, with a focus on those already in long term care facilities.

CAREGIVER

FRIENDS & FAMILY

CAREGIVER Informal and/or formal caregiver of person suffering from Alzheimer’s disease.

F A M I LY & F R I E N D S Family and friends of person suffering from Alzheimers disease, anyone in their support network.

LONG-TERM CARE FACILITY


INDIVIDUAL

E A R LY

STAGE 1

STAGE 2

MID

L AT E

STAGE 3

STAGE 4

STAGE 5

STAGE 6

STAGE 7

Up to 7 years

Up to 2 years

Up to 1.5 years

Up to 2.5 years

1-3 years

DEATH

Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


INDIVIDUAL

E A R LY

STAGE 1

STAGE 2

MID

L AT E

STAGE 3

STAGE 4

STAGE 5

STAGE 6

STAGE 7

Up to 7 years

Up to 2 years

Up to 1.5 years

Up to 2.5 years

1-3 years

DEATH

AREA OF FOCUS

Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


INDIVIDUAL

E N T E R S LT C Often triggered after incidents of self endangerment or injury

STAGE 5

STAGE 6

STAGE 7

DEATH

Moderate to severe impairment in memory, judgment and often language. May experience disorientation. May get lost or not recognize family members.

Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


INDIVIDUAL

E N T E R S LT C Often triggered after incidents of self endangerment or injury

STAGE 5

STAGE 6

STAGE 7

DEATH

Significant impairment in shortand long-term memory, and difficulties in basic daily tasks. Easily gets confused and frustrated. Says little unless directly addressed.

Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


INDIVIDUAL

E N T E R S LT C Often triggered after incidents of self endangerment or injury

STAGE 5

STAGE 6

DEATH

STAGE 7

Most severe and final stage of the disease. Individuals progressively lose speech, down to a few words until they are unable to speak. Can have a total loss of muscle control.

Alzheimer’s Association. 2017 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2017;13:325-373.


M e e t M a r y.


M e e t M a r y. Mary is 77 years old and has Alzheimers disease (stage 5).


M e e t M a r y. Mary is 77 years old and has Alzheimers disease (stage 5). She is a resident of a longt e r m c a r e f a c i l i t y i n To r o n t o Ontario.


M e e t M a r y. Mary is 77 years old and has Alzheimers disease (stage 5). She is a resident of long-term c a r e f a c i l i t y i n To r o n t o Ontario. Mary spends most of her day here, staring down the long hallway of the dementia unit.


M e e t M a r y. Mary is 77 years old and has Alzheimers disease (stage 5). She is a resident of long-term c a r e f a c i l i t y i n To r o n t o Ontario. Mary spends most of her day here, staring down the long hallway of the dementia unit. Face blank, eyes unfocused and bored. She sits watching.


MARY

A L Z H E I M E R ’ S A D VA N C E S TA G E

Age

77

Mary is a 77 year old woman in the more advanced stages of Alzheimer’s disease. She was diagnosed six and a half years ago. She lived with her daughter for about 2 years before things became overwhelming and her daughter insisted they begin

Occupation

Education

Retired Te a c h e r College

looking at long term care. She had begun to have problems carrying out daily activities like bathing, dressing and preparing meals. Mary would have much rather stayed at home with her daughter, but could see the burden she was placing on her. She was forgetting many things and Diane had to help her with most tasks. She was scared and very depressed when it finally came time to move into the LTC facility.

Diagnosis

Alzheimer’s Disease

She is in a wheelchair now, barely talks and spends most of her time in the day room watching TV or in her room. Her daughter tries her best to visit her every week, but

Stage

Moderately Severe Cognitive decline

Location

L o n g Te r m Care Facility

that doesn’t always happen. Mary spends most of her day bored and confused.

Needs: -

Children

One daughter

-

Provided Daily Cognitive Stimulation

Stimulation, to be present Structure to her days A g e n c y, t o b e h e a r d , t o h a v e s o m e c o n t r o l Personhood, to feel like people see her as a person A system of support (Caregivers & Family) and ways to interact with them

Wants: -

Daily Social interaction

-

More stimulation, something to do More control over what she does To b e m o r e c o n n e c t e d t o h e r l o v e d o n e s Her caregiver to treat her like a person not a task

Pain Points: Emotional Wellness

-

loneliness & social isolation Depression Boredom


BENCHMARKING INSIGHTS

Sense of self

Reliance

through objects

on tools &

& personal

aides

content

“The fact is that many people w i t h d e m e n t i a l i v i n g i n LT C homes will spend most of the day either in their rooms or in passive activities, such as sitting and watching others and/or

Loss of purpose & self

T V. � (Donovan et al., 2014)


NEEDS

INDIVIDUAL

To e s t a b l i s h &

Reminiscence and

Accessible mental

maintain meaningful

sense of self and

and sensory

social interactions

purpose

stimulation


Meet Susan.


Meet Susan. Susan spends her day caring for others.


Meet Susan. Susan spends her day caring for others. She faces impossible workloads, working just to meet the daily living needs of the majority of residents.


Meet Susan. Susan spends her day caring for others. She faces impossible workloads, working just to meet the daily living needs of the majority of residents. She is often overwhelmed, exhausted and burnt out.


Meet Susan. Susan spends her day caring for others. She faces impossible workloads, working just to meet the daily living needs of the majority of residents. She is often overwhelmed, exhausted and burnt out. She tries her best to engage with the residents, to talk to them as she works. She sees how isolated and starved for contact most of them are.


The staff-to-resident ratio in Canadian LTC environments is (Singer et al., 2015)

1: 9


“A survey published by CBC News revealed that some respondents claimed to be responsible for as many as 40 residents in one shift.” (Avtar 2018)


SUSAN

PERSONAL SUPPORT WORKER

Susan is a Personal Support Worker, working through a care agency. Most of her job

Age

41

is spent caring for people at a long term care facility, although occasionally she makes home visits. Everything is set up through the agency she works for. Susan loves some

Occupation

PSW

parts of her job but struggles constantly with the emotional weight that comes with this work. She often faces abuse from agitated and sometimes aggressive residents, and

Wage

15.50 per hour

feels constant guilt at the quality of life of many of the residents she cares for. She sees how starved for any kind of human connection most of them are, but can only

Education

College

manage so much. She sees other PSW’s burnout constantly, unable to deal with the emotional and physical toll of this job. Susan often questions how long she will be able to do this job. She has seen how other PSW’s have

Needs: -

Support in managing individuals QOL To o l s / a c t i v i t i e s t o s t i m u l a t e t h e i n d i v i d u a l Means to relate and connect to individuals unique interests and needs Better way to communicate with individuals family and loved ones (more efficiently)

Wants: -

“One of the biggest hurdles in working as a PSW is to gain the trust and cooperation of your residents.”

-

More Activ Help Help

active participants in care ities that don’t rely on her involvement in engaging individuals communicating and updating family

Pain Points: -

Feeling like the individuals daily quality of life and interactions rest solely on her shoulders Guilt and emotional distress at ability to do more due to impossible workloads Not knowing how to connect with certain residents

Location

L o n g Te r m Care Facility

“It’s also important to share your intimate knowledge of the person with dementia – personality, needs, interests, likes, dislikes, favourite activities and life history – with us as PSW’s, so we are better able to support and connect with that person as a unique individual.”


BENCHMARKING INSIGHTS “ E a c h r e s i d e n t h a s a p e r s o n a l i t y, feelings and needs that differ ‘Assembly Line’ culture due to chronic staff shortages

Emotional & mental burnout

f r o m o n e t o a n o t h e r. I t r y r e a l l y hard to get an “in” with each person I work with. If you developed that rapport, then you have a much easier time getting along, getting cooperation, getting your job

Pivotal in

Connection

adoption of

improves care

tools/aides

relationship

done sooner and more e f f e c t i v e l y. ” (Ontario Personal Support Worker Association, 2009)


NEEDS

INDIVIDUAL

Options/tools to

Understanding of

Support &

engage & stimulate

Individuals personal

understanding from

individual that don’t

interests & history

individuals

rely on assistance

for person-centred

family/friends

approach


Meet Diane.


Meet Diane. D i a n e i s M a r y ’ s D a u g h t e r.


Meet Diane. D i a n e i s M a r y ’ s D a u g h t e r. She has two children of her own and works a full time job but tries to visit her mother as often as possible.


Meet Diane. D i a n e i s M a r y ’ s D a u g h t e r. She has two children of her own and works a full time job but tries to visit her mother as often as possible. The visits are very hard on h e r. S h e o f t e n l e a v e s f e e l i n g overwhelming guilt and grief.


Meet Diane. D i a n e i s M a r y ’ s D a u g h t e r. She has two children of her own and works a full time job but tries to visit her mother as often as possible. The visits are very hard on h e r. S h e o f t e n l e a v e s f e e l i n g overwhelming guilt and grief. She tries to bring things she thinks her mom would like, hoping to get a glimpse of recognition.


DIANE

DAUGHTER & FORMER INFORMAL CAREGIVER

Diane is a 46 year old woman. She is the daughter of Mary, a 77 year old woman diagnosed with Alzheimer’s disease. She acted as her mothers caregiver after her father died and her mother was struggling to live independently. That worked for a while

Age

46

Occupation

Manager

but quickly became increasingly impossible for Diane to manage as Mary’s needs grew with the progression of her disease. Diane struggled with knowing when to move her

University

Education

mother into long term care, but after her third bad fall in a year, she started the process. Her mother is now in an advanced stage of the disease and living in long term care.

Medium

Income

Diane tries her best to visit once a week, but she works full time and has three children.

PWD

When she does visit she tries her best to always bring something, she wants to feel like she's doing something. She tries to bring photographs mom would like, she digs up old

77

AGE

cd’s and books mom might like to listen to. She likes bringing these familiar things, things mom liked, because sometimes she will get a reaction. Diane feels a lot of guilt

Diagnosis

that she is not able to be there more, and often feels emotionally drained after visits.

Stage Needs: -

Updates from caregiver on day to day basis Updates on her mom, knowing she's okay To f e e l l i k e s h e ' s n o t a l o n e

-

“I wish there was more I

-

c o u l d d o f o r h e r. I w i s h I

More stimulation for her mother To f e e l c o n n e c t e d t o h e r m o t h e r e v e n w h e n s h e can’t visit To r e m e m b e r h e r m o t h e r b e f o r e t h i s To k n o w h e r m o t h e r ’ s c a r e g i v e r s e e s h e r m o t h e r as a person To m a k e m o m f e e l m o r e c o m f o r t a b l e To f e e l l i k e s h e ’ s h e l p i n g i n s o m e w a y Helping to create more interactions between mom & friends and family

Pain Points:

could be there for her more.”

-

Communication with her mom is Visits are emotionally draining Maintaining a meaningful conne Constant guilt Feeling of grew and loss of her

Moderately Severe Cognitive decline

Location Year Diagnosed

Wants:

limited and difficult ction is difficult mother

Alzheimer’s Disease

L o n g Te r m Care Facility Late 2012

“I miss her…I know she’s still here, but I find myself grieving for her.”


BENCHMARKING INSIGHTS “It is in the late stage of Pivotal in adoption of tools/aides

Difficulty

dementia that family members

maintaining

experience true anticipatory

connection

grief. In this period, the person

i n LT C

with Alzheimer's can be severely limited in their communication, comprehension, and movement,

Pivotal in providing reminiscence & personhood content

Coping

and families report struggling

with grief &

to stay connected to their

ambiguous

loved one.”

loss

(Blandin "Dementia Grief – What Are The 3 Stages")


NEEDS

INDIVIDUAL

To e n g a g e &

Reassurance

Support through the

maintain meaningful

caregiver knows

grieving process

connection

loved one as an

and loss

‘individual’


Literature Review


KEY THEMES Key themes and insights that emerged from literature review.

Passive vs. Active Recipient of Care

Quality of Life

Va l u e o f Social identities

NonPharmacological approach

Va l u e o f Music

Sensory Interventions


JOURNEY MAP

CHANGING IDENTITY

AMBIGOUS LOSS

CHANGING R E L AT I O N SHIPS ENGAGING IN 
 MEANINGFUL ACTIVITY

L E AV I N G A LEGACY

BUILDING SUPPORT CIRCLES

KEY MOMENTS FOR INTERVENTION


‘Assembly Line’

Difficulty maintaining connection

Key insights from: Journey maps Empathy maps Personas

CHANGING R E L AT I O N SHIPS

i n LT C

Coping AMBIGOUS LOSS

with grief

CHANGING IDENTITY

BUILDING SUPPORT CIRCLES

culture due to chronic staff shortages ENGAGING IN 
 MEANINGFUL ACTIVITY

Stimulation Engagement Connection Purpose Agency Support

Connection improves care relationship

Sense of self through objects

THERAPIES

Loss of L E AV I N G A LEGACY

purpose &

Reliance

self

on tools & aides

& personal content


‘Assembly Line’

Difficulty maintaining connection

Key insights from: Journey maps Empathy maps Personas Lit Review

CHANGING R E L AT I O N SHIPS

i n LT C

Coping AMBIGOUS LOSS

with grief

CHANGING IDENTITY

BUILDING SUPPORT CIRCLES

culture due to chronic staff

Va l u e o f Social identities

shortages ENGAGING IN 
 MEANINGFUL ACTIVITY

Stimulation Engagement C oQnunaelci ttyi o n Pouf r L p iof see Agency Support

Connection improves care

Sense of place

relationship

Sense of self through objects

THERAPIES

& personal content

Loss of L E AV I N G A LEGACY

purpose &

R e Nl ioann- c e

self

Pharmaon tools & cological aa p pi d r oeasc h

Passive vs. Active


Expert Interviews


KEY INSIGHTS -

Sensory interventions are great if they are used mindfully be careful in method of application

-

C u l t u r e o f LT C & t a s k o r i e n t e d c a r e needs to be considered

-

Supporting family members in day to day worries/preoccupations without placing sole burden on formal caregiver

-

Continue to support individual’s existing strengths & identity

-

stored personal content/media can become a springboard for reminiscing

INTERVIEW WITH BIANCA STERN, EXECUTIVE DIRECTOR, H E A LT H & I N N O VAT I O N AT C A B H I


KEY QUESTIONS

“If the culture is open and sees strength in these people, not seeing them only as people with cognitive impediments that are socially isolated [‌] then they become human beings with individual strengths, abilities and preserved interests. So if you approach it that way, then you are going to discover and open lots of opportunities.â€? - Bianca Stern


KEY QUESTIONS

“How might we still engage a person like that in social interactions? Because if we don’t, these people become redundant, more socially isolated. If I don’t know how to communicate with somebody then I'm going to either stop communicating or I'm going to communicate over them.” - Bianca Stern


KEY QUESTIONS

“How do we bring these people into interactions that continue to give them a sense of living and purpose? Which is really important for anyone who’s identity is starting to get upset because they don't remember things and people don't acknowledge them.”” - Bianca Stern


Key Insights: -

Va l u e o f m u s i c t h a t c o n n e c t s t o individual is undeniable

-

Collection of personal media can encourage intergenerational connection

-

Personal media and content cannot be left to the PSW to source or provide

-

Families often struggle with adapting to non-verbal forms of connection, tool could be of great value, especially for visits

-

Being attached to a social circle is extremely important for QOL

INTERVIEW WITH CARE C O O R D I N AT O R S & MANAGER MUSIC P R O J E C T C O O R D I N AT O R


Interview Insights

“The social death that occurs w h e n t h e y e n t e r LT C i s w h a t i s really damaging. It makes them feel redundant, as if their not people anymore.� - Interview with Personal Support Worker


“It’s not that people don’t want to visit, it’s that they don’t know how…They don’t know how to communicate with someone they can’t carry a conversation with.” - Interview with Personal Support Worker


S o l u t i o n Ty p o l o g i e s


S o l u t i o n Ty p o l o g i e s In order to gain insights into the defined problem area, existing solution typologies were identified and explored for their proven benefits.

Multi Sensory Environments

Te c h n o l o g i c a l Companions

Wearable Devices

S e n s o r y To o l s

Dementia Friendly Communities

Engagement Therapies


S o l u t i o n Ty p o l o g i e s While many cognitive

MUSIC THERAPY

functions decline rapidly during the disease progression, receptivity

There is unequivocal evidence for the use of music in the care

to music can remain until

and treatment of those with Alzheimers. Research has shown

the late phases of

that music based interventions result in a signified decrease in

dementia. (Adridge 1996)

typical symptoms such as agitation (Ragneskog, 2001). It has

Example of a resident iPod from the iPod project

shown to increase interaction between individual patients, subsequently decreasing sense of isolation and perhaps most importantly it helps to foster a heightened sense of identity (Ragneskog, 2001).

Music shown to enhance verbal communication and assist in recall & eliciting of memories associated with positive feelings. Scene from ‘Alive Inside’ documentary exploring music benefits Ragneskog, Hans, et al. “Individualized Music Played for Agitated Patients with Dementia: Analysis of Video-Recorded Sessions.” International Journal of Nursing Practice, vol. 7, no. 3, 2001, pp. 146–155., doi:10.1046/j.1440-172x.2001.00254.x.


Music shown to enhance verbal communication and assist in recall & eliciting of memories associated with positive f e e l i n g s . (Ragneskog, 2001)


S o l u t i o n Ty p o l o g i e s

SNOEZELEN THERAPY A Snoezelen room is a therapeutic environment created ‘for the express purpose of delivering high levels of stimuli to patients with Dementia.’ It is usually a room utilizing tactile elements, interactive: lights, sound and visuals, sometimes with scent incorporated. These multi-sensory environments (MSE) have proven to be very beneficial in improving moods and behavioural issues of individuals with Alzheimers. They help to stimulate and engage individuals, while also providing an environment for bonding with caregivers. (Letts, et al. 2011)

Increases mental stimulation and verbal communication. Shown to improve mood and aggressive b e h a v i o u r s . ( L e t t s , e t a l . 2 0 11 ) Examples of types of elements used within these MSE and caregiver interaction.


Increases mental stimulation and verbal communication. Shown to improve mood and aggressive behaviours. ( L e t t s , e t a l . 2 0 11 )


S o l u t i o n Ty p o l o g i e s Tools such as

REMINISCENCE THERAPY Reminiscence therapy (RT) “involves the discussion of past activities, events and experiences with another person or group of people, usually with the aid of tangible prompts such as photographs, household and other familiar items from the past, music and archives sound recordings” (Lopes 2017). Reminiscence therapy is one of the most popular psychosocial interventions in Dementia care. RT uses artifacts, images and influence from a person’s past to encourage short-term memories by stimulating the often more accessible long-term ones.

Effective in evoking memories, s t i m u l a t i n g m e n t a l a c t i v i t y, encouraging social interaction and emotional connection.(Lopes 2017)

Lopes, Teresa Silveira. “Reminiscence Therapy Effects In Older Persons With Mild Dementia.” Alzheimers & Dementia, vol. 13, no. 7, 2017, doi:10.1016/j.jalz.2017.06.2191.

memory boxes, memoirs, photographs, objects, recordings and personal memorabilia are often used.


Effective in evoking memories, stimulating m e n t a l a c t i v i t y, encouraging social interaction and emotional connection. (Lopes 2017)


S o l u t i o n Ty p o l o g i e s

FIDGET TOOLS Occupational therapists, family members and caregivers often turn to fidget ‘tools’ to help engage and distract individuals with Alzheimers. They may help to alleviate stress and restlessness, individuals with mid-late Alzheimer’s often find comfort in repetitive sensory stimulation. Studies have shown that restless hands can lead to other more serious issues such as wandering

Fiddle ‘tools’ have been shown to be an effective way to reduce anxiety and provide comfort to those with AD. ( Ly k k e s l e t , G j e n g e d a l , S k r o n d a l , & S t o r j o r d 2 0 1 4 )

or dermatillomania (skin-picking). Sensory tools are often made in a range of different tactile materials. (Lykkeslet, Gjengedal, Skrondal, & Storjord 2014)

Lykkeslet, Else, et al. “Sensory Stimulation—A Way of Creating Mutual Relations in Dementia Care.” International Journal of Qualitative Studies on Health and Well-Being, vol. 9, no. 1, 2014, p. 23888., doi:10.3402/qhw.v9.23888.


Fiddle ‘tools’ have been shown to be an effective way to reduce anxiety and provide comfort to those with AD. ( Ly k k e s l e t , G j e n g e d a l , S k r o n d a l , & Storjord 2014)


S o l u t i o n Ty p o l o g i e s Toronto’s Blue Umbrella Pilot Program provides businesses opportunities to

D E M E N T I A F R I E N D LY COMMUNITIES

receive training on how to provide dementia friendly services and environments and identifies these dementia-friendly areas with

Dementia friendly communities can be understood as a ‘city,

the blue umbrella symbol.

town or village where people with Dementia are understood, respected and supported.’ These communities began first in Japan as a means to support the growing aging population suffering from Dementia. This model has since inspired many other countries to adopt similar initiatives.

These approaches acknowledge people living with Dementia and puts the burden of inclusion on the community instead of the individual.

Hogeway, a small village just outside of Amsterdam dubbed ‘Dementia Village’.

https://alzheimer.ca/en/bc/About-dementia/Dementia-friendly%20communities/What%20is%20a%20dementia-friendly%20community


These approaches acknowledge people living with Dementia and puts the burden of inclusion on the community instead of the individual.


Analogous Activity

GreyMatters is an interactive life storybook app for the tablet that aims to improve quality of life for people with dementia and their caregivers, through shared reminiscence.


Analogous Activity

The ’Simple Music Player’ has been designed for individuals with Dementia, requiring a simple action of lifting the top to play music. Uses the benefits of music therapy.


Analogous Activity

Printed Memories is digital postcard tool launched by RIOCH that’s designed to help bring individuals with Alzheimer’s and their family’s closer together. Staying connected through personal images and raising funds for research.


Analogous Activity

Tovertafel is a playful interactive light projection system designed for individuals suffering from cognitive decline. It helps to stimulate and engage users in social interaction.


TOOLS

Research Synthesis -

Sensory stimulation shown to benefit mood, and aggressive behaviours Music increases brain activity & memory recall. Promising in heightening sense of identity & positive feelings

SUPPORT

-

‘Fidget’ tools reduce anxiety

Crucial to maintain social connections Support networks struggle to adapt to changing relationship dynamics

Individuals often lose a lot of their social networks a f t e r e n t e r i n g LT C ’ s LT C ’ s a r e u n a b l e t o support regular individual engagement

Need Stimulation Engagement Connection Purpose Agency Support

SOCIAL

-

Social engagement is crucial in overal QOL Isolation, lowered self esteem, depression and feeling of lacking purpose

isolation and lack of engagement speeds progression of the disease Reminiscence encourages social interaction and emotional connection


Stakeholder Needs


Individual

Family & Friends

Caregiver

To e s t a b l i s h & m a i n t a i n

To e n g a g e & m a i n t a i n

To o l s t o e n g a g e &

meaningful social

meaningful connection

stimulate individual that

interactions

to individual

don’t rely on assistance

Reminiscence and

Support through the

Understanding of

sense of self and

grieving process and

individuals personal

purpose

loss

interests & history

Accessible mental and

Reassurance caregiver

Support from

sensory stimulation

knows loved one as an

individuals family/

‘individual’

friends


Individual

Family & Friends

Caregiver

To e s t a b l i s h & m a i n t a i n

To e n g a g e & m a i n t a i n

To o l s t o e n g a g e &

meaningful social

meaningful connection

stimulate individual that

interactions

to individual

don’t rely on assistance

Reminiscence and

Support through the

Understanding of

sense of self and

grieving process and

individuals personal

purpose

loss

interests & history

Accessible mental and

Reassurance caregiver

Support from

sensory stimulation

knows loved one as an

individuals family/

‘individual’

friends


Individual

Family & Friends

Caregiver

To e s t a b l i s h & m a i n t a i n

To e n g a g e & m a i n t a i n

To o l s t o e n g a g e &

meaningful social

meaningful connection

stimulate individual that

interactions

to individual

don’t rely on assistance

Reminiscence and

Support through the

Understanding of

sense of self and

grieving process and

individuals personal

purpose

loss

interests & history

Accessible mental and

Reassurance caregiver

Support from

sensory stimulation

knows loved one as an

individuals family/

‘individual’

friends


Market


Drivers

Rising Geriatric population R i s e i n p e r v a s i v e n e s s o f A l z h e i m e r ’s D i s e a s e Increasing number of manufacturers & distributors Increasing Healthcare expenditure Government investment in research & development

FutureMarketInsights, Dementia Care Products Market: Global Industry Analysis 2012 – 2016 and Opportunity Assessment; 2017 – 2027.


Key Players

“ G e o g r a p h i c a l l y, N o r t h A m e r i c a is the leading consumer driven market for Dementia Care products because of the large number of product suppliers and product affordability in the region.” (FutureMarketInsights, Dementia Care Products Market: Global Industry Analysis 2012 – 2016 and Opportunity Assessment; 2017 – 2027.)

FutureMarketInsights, Dementia Care Products Market: Global Industry Analysis 2012 – 2016 and Opportunity Assessment; 2017 – 2027.


Market

Gap Shift towards Non-Pharmacological approaches & interventions based on benefits of current therapies

For individuals in mid-late stages

Products that enable benefits of therapies on a day-to-day basis in a manner that the user can operate without the need for assistance, while meeting established needs.


ENGAGE

SUPPORT

CONNECT

STIMULATE

Opportunity


Concept Directions


SUPPORT

Digital Therapeutics Optimizing benefits of current therapies at an individual level to promote social interactions and sense of self. Utilizing digital technologies to facilitate therapeutic benefits of:

-

Reminiscence therapy Music therapy Multi-Sensory Environments

ENGAGE


Ta c t i l e I n t e r f a c e ‘Active’ tactile elements that create an intuitive and engaged interface. Employing established benefits of ‘fiddle toys’ engage user and reduce stress, while encouraging ‘active’ participation with an accessible interface.


“Stored personal data can become a springboard for reminiscing.” - Bianca Stern

Ta n g i b l e R e m i n i s c e n c e Ta n g i b l e ‘ m e m o r y b a n k s ’ that house and release personal media/memories to user through ‘active’ tactile elements.


Opportunity COGNITIVE

SOCIAL

- Digital Therapeutics - Ta n g i b l e R e m i n i s c e n c e - Ta c t i l e I n t u i t i v e I n t e r f a c e - Support care platforms Optimizing benefits of current therapies at an individual level to promote social interactions and sense of self. Engaging user in reminiscence through mental and sensory stimuli, while connecting meaningfully to others.

TOOLS


Objectives

To c r e a t e a p r o d u c t o r system to increase the quality of life for those w i t h A l z h e i m e r ’s through social engagement and stimulus.

To a s s i s t l o v e d o n e s i n maintaining meaningful connections and social contact with those in the later stages of the disease.

To p r o v i d e LT C facilities and staff with a tool/database for accumulated personal content for therapies and individual care.


Solution


Designed for residents in long-term care a n d t h e i r f a m i l i e s , To u c h S t o n e s i s a personal device and application that prompts daily social engagement and r e m i n i s c e n c e . To u c h S t o n e s p r o v i d e s maintained and accessible social interaction for residents with declining cognitive and motor functions, while offering families points of connection.


Concept

What?

TouchStones

Tactile digital engagement aid, that encourage personal reminiscence and social interaction through shared personal media and maintained communication. Engaging support circles in care and maintained

Application

To u c h S t o n e

To u c h S t o n e s

emotional connectivity.

Stimulates interaction between individuals, caregivers and loved ones. Facilitates meaningful connection & reminiscence.


How?

Connects individual to their loved ones, promoting reminiscence through maintained social connection. Engages user in sensory stimulus and encourages engagement in immediate environment.

TouchStones

Pressure points on the TouchStone ‘activate’ When individual interacts with tactile surface elements on

Family members, loved ones and

Connected TouchStones prompts

TouchStone the sender receives a

caregivers use TouchStones app to

engagement with new shared

notification of engagement with

upload upload voice messages,

personal media through light and

shared media/message.

audio and music.

light vibration.

media/message, playing audio for the individual.


Concept

SYSTEM ARCHITECTURE SUPPORT CIRCLE

Who?

TouchStones

LT C

The TouchStone device is used by the individual in long-term care with mid-later stage Alzheimer’s disease. Their friends and family interact with the TouchStone application, using it to upload content to the device. The long-term care facility encourages formal caregivers and PSW’s to use content relayed through the device to better connect to their residents.

INDIVIDUAL


Individual

Family & Friends

Caregiver

To e s t a b l i s h & m a i n t a i n

To e n g a g e & m a i n t a i n

To o l s t o e n g a g e &

meaningful social

meaningful connection

stimulate individual that

interactions

to individual

don’t rely on assistance

Reminiscence and

Support through the

Understanding of

sense of self and

grieving process and

individuals personal

purpose

loss

interests & history

Accessible mental and

Reassurance caregiver

Support from

sensory stimulation

knows loved one as an

individuals family/

‘individual’

friends


+

-

interactive engagement -

Encourages interaction

aid + reminiscence platform

-

Benefits of music & -

reminiscence therapy -

Helps maintain

connection

on input from friends

h u g e i m p a c t o n t h e f a m i l y,

& family

providing a lot of comfort for

Creates support platform

S W -

For use in therapies Point of interaction in

O

T -

Facilitating ‘active’ recipient of care

-

Information for personentered approach

them. It could be a great outlet for their grief. […] will help ease their daily worries and

If individual does not

concerns if they can feel

engage

visits -

“I could also see this having a

from content relies

meaningful social

-

Individuals benefit

-

Potential for theft in

connected and useful.”

LTC

- F a m i l y m e m b e r o f i n d i v i d u a l w i t h A D ( Wa l k f o r M e m o r i e s I n t e r v i e w )


Business Model Canvas Key Partners Alzheimer’s Society

Key Activities Marketing & production

Value Propositions

Customer Relationships

Prompted daily communication

24/7 24/7Chatbot Chatbotsupport support

tool for individuals in long term

Platform Maintenance

Email Support

and motor functions. Social Media

Facilitating maintained social

Philips

Family members of loved one in long-term care

care with declining cognitive Residential Care

Customer Segments

Residential Care Facilities

connections and personal Spotify

Key Resources

Community

Channels

reminiscence. Promoting proven therapeutic

Dementia Care Product

Mobile application

Suppliers

methods

Dropbox

Website Brand

Providing family comfort and Residential Care Facilities

tools

Cost Structure

Manufacturing R&D

Revenue Streams

Marketing

Platform design development & maintenance

TouchStone

Annual

Extended

Device Sales

Subscription to

warranty and

pro account (app)

support


Key Partnerships


Ideation


Form Inspiration


Ideation Sketches


3 D I d e a t i o n & Te s t i n g

Ta k i n g i n s p i r a t i o n f r o m s m o o t h pebbles and beach stones, I quickly moved into 3D modelling. Creating many variations of a pebble like form out of foam.

I then tested the feel of the differing forms and sizes, this helped me narrow down my direction.


Prototyping Device


Form Development Once I had a better idea of the form I began 3D modelling it as a hollow shell. 3D printing these shell models allowed me to test the form and functional requirements.


M a t e r i a l Te s t i n g

SUPPORT

I tried many different materials when printing the forms. I also tested each of the different material finishes with consideration for light affordance.

ENGAGE


Te s t i n g L i g h t

ENGAGE

SLA Clear Resin, white latex coat finishing

SLA Clear Resin, white Plasti-dip finishing

white ABS Filament Sanded


Code development

SUPPORT

Breaking down the main functions of the device and platform I was able to begin coding a way of simulating these interactions. Simplifying each interaction and finding analogous existing code to help frame the portions of the code, I was able to sequence the main interactions into a loop. *With ALOT of advice and help from those far more proficient.

ENGAGE


Circuit Development

Then I began constructing the circuit and testing the code. Followed by endless troubleshooting and debugging.


Components C O S T E S T I M AT E Parts cost - $ 24-33 To t a l C o s t - $ 6 9 - 7 9

COMPONENTS Wifi module Pressure Sensor Inductive Charging pad NeoPixel Ring Speaker


W i z a r d o f O z Te s t i n g

Using the prototyped circuit, form and pre-recorded platform ‘content’, participants were able to interact with what felt like a fully functioning prototype. Allowing for evaluation of core functionality and perceived value.

*Force sensors were secretly triggered by facilitator not participant, to give illusion of touch activation feature


Key Feedback

“I wouldn’t limit this to people just in later stages, I could see this as being extremely useful for pacifying anxiety when individuals first move into care. It could also be great for reminders in earlier stages.” - F i r s t L i n k C a r e N a v i g a t o r, A l z h e i m e r S o c i e t y o f To r o n t o

“I would make sure you have an explanation or instruction card visible, something that could be posted near it…so new PSW’s can facilitate using it.” - Personal Support Worker

“I would allow the messages or music to stay there […] not disappear until there’s something new…in case they didn’t hear it or want to hear it again.” - F i r s t L i n k C a r e N a v i g a t o r, A l z h e i m e r S o c i e t y o f To r o n t o


Key Feedback

“I think the light will help to build up an instinct to touch, the repetition if they are doing it daily and rewarded for it [with the content] might help create a muscle memory.”

“Even if the resident able to follow [the meaning of the light colour] it would still be helpful for the family or PSW to come in and see ‘Oh you have a message!’ or ‘a song.”

- Personal Support Worker

- Personal Support Worker

“I can see this being great when younger family visits too. Younger people often have a hard time knowing what to do when visiting, it can be uncomfortable if verbal communication is limited…this would be great for alleviating some of that and encouraging them to get past that.” - F i r s t L i n k C a r e N a v i g a t o r, A l z h e i m e r S o c i e t y o f To r o n t o


Prototyping Platform


Wireframing

In order to begin working through the functions and features of the platform I began wireframing. This simplification, allowed for a clearer hierarchy of the information.

*Initial sketches of screens and structure.


User Flow Mapping

With this hierarchy of information, I was able to begin m a p p i n g t h e u s e r f l o w. W i t h this structure I could begin creating interaction scenarios, to better understand my stakeholders needs.


P a p e r P r o t o t y p e Te s t i n g

A testing session was held to test paper prototypes of main user flow scenarios of the platform in order to gain feedback . Participants were given low fidelity paper prototypes and each tasked with different actions to complete.

*Colour coded tasks & prototypes


*Observing participants going through tasks highlighted key problems with hierarchy of information.

Feedback from these testing sessions allowed for a much more in depth understanding of user flow and helped to further define the information architecture and features.


Interactive Prototype

The testing sessions were repeated with interactive lowfidelity digital prototypes. This allowed participants a better feel for the platform experience.

Key Feedback -

Clarify content upload sequence Notification of sent content ‘played’ feature Share with ‘both’ or just device option clarification/feature


Identification Label

Device Identification The vinyl labels provide the option for Ma ry Thomas

users and or caregivers to identify the devices owner and contact information.

RM 141 B e l m o nt H o u s e LT C

Branding

416-786-5296

3 Label Options

Label Placement

Included in the TouchStone

The stickers have been made to fit

packaging are 3 different device

the bottom of the TouchStone

identification stickers.

device. This ensures easy device identification.


Primary Logo

T h e To u c h S t o n e l o g o i s r e f e r e n t i a l of both its name and it’s device. It’s purpose is to help convey the product value by imbue the narrative of a ‘touchstone’, of the souvenir you keep to remind you of cherished memories.


Secondary Logo

The alternate blue logo is for use when a dark contrasting colour is required, ensuring brand flexibility in all instances.


Social Media Icons

Across all social platforms the To u c h S t o n e b r a n d i n g i s consistent, using the primary logo. The blue background allows the icon to be more recognizable and to contrast against most white social media feeds.

Instagram

Facebook

Twitter

110px x 110px

360px x 360px

110px x 110px


Product Packaging


Standard Parcel C5 Post Size Box 235mm x 165mm x 70mm Five Panel Folder, made to Parcel C5 specifications Heavy duty, recyclable


Product Packaging


Identification Label

Device Identification The vinyl labels provide the option for Ma ry Thomas

users and or caregivers to identify the devices owner and contact information.

RM 141 B e l m o nt H o u s e LT C

Final Design

416-786-5296

3 Label Options

Label Placement

Included in the TouchStone

The stickers have been made to fit

packaging are 3 different device

the bottom of the TouchStone

identification stickers.

device. This ensures easy device identification.


To u c h S t o n e S y s t e m

To u c h S t o n e Device

To u c h S t o n e Platform


To u c h S t o n e S y s t e m

Personal Device for Resident

Social Portal

Accessible Interface

Sensory Stimulation

Light Prompt

Reminiscence aid

Device Use Notification

Platform for f a m i l y, f r i e n d s & caregivers

Support Network Platform

Shared ‘Memory bank’

Share Music

Share Vo i c e Messages


Device Features


Materials & Manufacturing

Silicone On the top piece, there is a silicone rubber injection insert, over a clear injected moulded plastic shell.

Injection moulded plastic shell

Tw o To n e F i n i s h

On the top piece, there is a silicone

Matte Silicone rubber top finish, and

rubber injection insert, over a clear

a smooth gloss plastic finish on the

injected moulded plastic shell.

bottom piece.

Designed to minimize parts and assembly of outer shell, with easy allowance for separation of speaker enclosure.


Sound

Speaker Enclosure Custom speaker enclosure, providing omnidirectional sound form form fitted shell.


To u c h C o n t r o l Capacitive Sensing Two floating sheet metal pieces act as the touch sensors. They are placed on the inner rim of the plastic shell, connected to the main PCB using metal contacts.

FSR When FSR sensors detect pressure coming from the top shell, they release the content shared with the TouchStone. Touch being the only action required to release shared content.


Light Indication

Light Light indicates new content has been shared with the stone.

Colour Indication Colour of light indicates type of content awaiting release. Warm - Voice message Cool - Music


Identification Labels

Ma ry Tho mas Room 126

Vinyl ID Labels The TouchStone packaging comes with 3 label options for device identification. The labels fit on the bottom of the base and allow for easy personalization.

B e l m o nt H o use 416 983 7456


Platform Features


Build your Community!

Download To u c h S t o n e s t o create your loved one’s circle.

Register the To u c h s t o n e d e v i c e to your loved one’s new circle!

Invite contacts to join circle, now synced to To u c h S t o n e d e v i c e .

Contacts will receive an email or text invite to join.


Join a Community!

Email invite instructs contacts to download the To u c h S t o n e s a p p .

Each email invite contains a unique activation code.

The code syncs users to correct To u c h s t o n e community and device.


S h aRr e m Miensi s ca eg e&s D&i sMceom v eorr!i e s !

Upload your own family photos, memories.

Add your voice to a s t o r y, b u i l d a n d d e v e lR op e my ionui sr cl o eved ones ‘memory bank’.

Record and share voice messages, stories and reminders.

Receive notifications when your loved one plays your content.


Reem miinniissccee & & D Diissccoovveerr!! R

Create and add to collections. Collate new content and personal memories.

Explore memories of your loved one’s life.

Browse shared memories and stories.

Save your favourite moments and memories.


In Context


In Context


In Context

Soft, smooth surface

Comforting form


Experience Mapping


Record memories & stories

Accessible contact

Create voice message

Share with device

Share with device

Share with platform


Light

Visual prompt

New shared content

Colour indication

Wa r m = Message


To u c h interface

Engagement prompt

Capacitive sensing

To u c h Sensing


Engagement sensed

Content released

Message played


Notification

Message played


Content last shared, still available to replay

No new content


T h a n k Yo u !


BIBLOGRAPHY Alzheimer’s Disease International. World Alzheimer Report 2015: The Global Impact of Dementia. Available at: http://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf. Last accessed Jan 2019.”

Singer, J., Negrello, T., Rondeau, A., Glussich, A., & Boyes, C. (2015). Understanding Staff-to-Patient Ratios. Canadian Institute for Health Information. Retrieved from http://www.nhlc-cnls.ca/assets/2016%20Ottawa/Singer%20Poster%20FSI%20Staff%20to%20Patient%20Ratio.pdf Canadian Institute for Health Information (2017). Continuing Care Reporting System: Profile of Residents in Continuing Care Facilities 2016-2017. Ottawa: CIHI.

Donovan, C., Stewart, C., McCloskey, R., & Donovan, A. (2014). How residents spend their time in nursing homes. Canadian Nursing Home, 25, 13-17.

NIA. “What Is Alzheimer's Disease?” National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/what-alzheimers-disease.

Avtar. “Five PSW Problems Faced by PSWs in Ontario.” Personal Support Worker HQ, 22 Aug. 2018, personalsupportworkerhq.com/psw-problems/.

Ontario Personal Support Worker Association, A Real PSW. “True Story from a REAL PSW ~ Part 7.” OPSWA's Blog, 21 Aug. 2009, opswa.wordpress.com/2009/08/21/true-story-from-a-real-psw-part-7/.

“Dementia and Personhood.” Bayshore HealthCare, 4 Apr. 2018, www.bayshore.ca/2018/02/14/dementia-and-personhood/.

Blandin, Kesstan. “Dementia Grief – What Are The 3 Stages.” Dementia.org, www.dementia.org/dementia-grief-3-stages.

Letts, L., et al. “Effectiveness of Interventions Designed to Modify and Maintain Perceptual Abilities in People With Alzheimers Disease and Related Dementias.” American Journal of Occupational Therapy, vol. 65, no. 5, 2011, pp. 505–513., doi:10.5014/ajot.2011.002592.

Ragneskog, Hans, et al. “Individualized Music Played for Agitated Patients with Dementia: Analysis of Video-Recorded Sessions.” International Journal of Nursing Practice, vol. 7, no. 3, 2001, pp. 146–155., doi:10.1046/j.1440-172x. 2001.00254.x.

Lopes, Teresa Silveira. “Reminiscence Therapy Effects In Older Persons With Mild Dementia.” Alzheimers & Dementia, vol. 13, no. 7, 2017, doi:10.1016/j.jalz.2017.06.2191.

Lykkeslet, Else, et al. “Sensory Stimulation—A Way of Creating Mutual Relations in Dementia Care.” International Journal of Qualitative Studies on Health and Well-Being, vol. 9, no. 1, 2014, p. 23888., doi:10.3402/qhw.v9.23888.


IMAGES Page 4 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_19. Page 5 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_4. Page 6 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_9. Page 11 - missing Page 12 - missing Page 13 - Mark. “Ronnie Looking Much Thinner, Lying in Bed at Oak House with His Wife, Winnie Just a Month before He Passed Away.” The Agony of Alzheimer's, Daily Mail, www.dailymail.co.uk/health/article-3119923/Living-lifeAlzheimer-s-Photographer-s-touching-images-document-father-s-four-year-struggle-active-grandfather-man-no-longer-remember-son-s-name.html. Page 14 - missing Page 16 - Mark. “The Agony of Alzheimer's.” The Agony of Alzheimer's: Photographer's Harrowing Images Document His Father's Struggle , Daily Mail, www.dailymail.co.uk/health/article-3119923/Living-life-Alzheimer-sPhotographer-s-touching-images-document-father-s-four-year-struggle-active-grandfather-man-no-longer-remember-son-s-name.html. Page 17 - Mark. “The Agony of Alzheimer's.” The Agony of Alzheimer's: Photographer's Harrowing Images Document His Father's Struggle , Daily Mail, www.dailymail.co.uk/health/article-3119923/Living-life-Alzheimer-sPhotographer-s-touching-images-document-father-s-four-year-struggle-active-grandfather-man-no-longer-remember-son-s-name.html. Page 18 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 19 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 30 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 31 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 32 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 33 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 34 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 35 - Maja. Into Oblivion. 2012, majadaniels.com/projects/into-oblivion/#PHOTO_34. Page 38 - Personal Support Worker Feeding Resident with Alzheimer's in Long-Term Care. 2017, healthydebate.ca/2018/09/topic/ontario-long-term-care-beds. Page 39 - Personal Support Worker Feeding Resident with Alzheimer's in Long-Term Care. 2017, healthydebate.ca/2018/09/topic/ontario-long-term-care-beds.


IMAGES Page 40 - Personal Support Worker Feeding Resident with Alzheimer's in Long-Term Care. 2017, healthydebate.ca/2018/09/topic/ontario-long-term-care-beds. Page 41 - Personal Support Worker Feeding Resident with Alzheimer's in Long-Term Care. 2017, healthydebate.ca/2018/09/topic/ontario-long-term-care-beds. Page 42 - Personal Support Worker Feeding Resident with Alzheimer's in Long-Term Care. 2017, healthydebate.ca/2018/09/topic/ontario-long-term-care-beds. Page 45 - Personal Support Worker Feeding Resident with Alzheimer's in Long-Term Care. 2017, healthydebate.ca/2018/09/topic/ontario-long-term-care-beds. Page 48 - Ursula. “An Alzheimer's Patient with Her Daughter in Zurich, Switzerland.” The New Offensive on Alzheimer’s Disease: Stop It Before It Starts, Newsweek, www.newsweek.com/2017/02/24/stopping-alzheimers-disease-itstarts-557221.html. Page 49 - Ursula. “An Alzheimer's Patient with Her Daughter in Zurich, Switzerland.” The New Offensive on Alzheimer’s Disease: Stop It Before It Starts, Newsweek, www.newsweek.com/2017/02/24/stopping-alzheimers-disease-itstarts-557221.html. Page 50 - Ursula. “An Alzheimer's Patient with Her Daughter in Zurich, Switzerland.” The New Offensive on Alzheimer’s Disease: Stop It Before It Starts, Newsweek, www.newsweek.com/2017/02/24/stopping-alzheimers-disease-itstarts-557221.html. Page 51 - Ursula. “An Alzheimer's Patient with Her Daughter in Zurich, Switzerland.” The New Offensive on Alzheimer’s Disease: Stop It Before It Starts, Newsweek, www.newsweek.com/2017/02/24/stopping-alzheimers-disease-itstarts-557221.html. Page 52 - Ursula. “An Alzheimer's Patient with Her Daughter in Zurich, Switzerland.” The New Offensive on Alzheimer’s Disease: Stop It Before It Starts, Newsweek, www.newsweek.com/2017/02/24/stopping-alzheimers-disease-itstarts-557221.html. Page 53 - Ursula. “An Alzheimer's Patient with Her Daughter in Zurich, Switzerland.” The New Offensive on Alzheimer’s Disease: Stop It Before It Starts, Newsweek, www.newsweek.com/2017/02/24/stopping-alzheimers-disease-itstarts-557221.html. Page 67 - “Patients with Dementia Deserve Better Diagnosis and Treatment.” Nursing Times, 2010, www.nursingtimes.net/roles/mental-health-nurses/patients-with-dementia-deserve-better-diagnosis-and-treatment/5021421.article. Page 68 - “Patients with Dementia Deserve Better Diagnosis and Treatment.” Nursing Times, 2010, www.nursingtimes.net/roles/mental-health-nurses/patients-with-dementia-deserve-better-diagnosis-and-treatment/5021421.article. Page 71 - Hallie. Resident Holding IPod Shuffle. CBC/Radio Canada, www.cbc.ca/news/canada/ottawa/arnprior-nursing-home-ipods-treats-dementia-1.3826707. Page 71 - “Michael Rossato-Bennett Putting a Pair of Headphones on a Resident.” Vox, 2014, www.vox.com/2014/7/19/11628964/alive-inside-film-documents-power-of-music-to-restore-memory-ipods. Page 73 - “Caregiver Assisting Resident with Led String Lights over Her Shoulder.” HollyCreek Community, www.hollycreekcommunity.com/senior-living/co/centennial/memory-support. Page 73 - “Close up of Elderly Hand Grabbing Fabric and LED String.” Residences Senior Living, residencesseniorliving.com/multi-sensory-dementia-therapy/. Page 75 - “Elderly hands holding photos.” Vox, 2014, www.vox.com/2014/7/19/11628964/alive-inside-film-documents-power-of-music-to-restore-memory-ipods.


IMAGES Page 75 - “Woman Looking at Photos of Herself on a Screen, with Caregiver Pointing.” Alzheimer’s Disease: Causes, Symptoms, Treatment, 2014, alzheimers-review.blogspot.com/2014/02/Digital-Reminiscence-TherapySoftware.html. Page 76 - “Elderly hands holding photos.” Vox, 2014, www.vox.com/2014/7/19/11628964/alive-inside-film-documents-power-of-music-to-restore-memory-ipods. Page 77 - “Product Photos.” The Alzheimer's Store, www.alzstore.com/twiddle-muff-p/0209.htm. Page 79 - Krista. “Stores in Hogewey Village.” BrainTest, braintest.com/story-dementia-village/. Page 91 - “Resident Staff Boundaries Nursing Homes.” Cell Code, cellcode.us/quotes/resident-staff-boundaries-nursing-homes.html. Page 96 - “Woman Holding up IPad with Photograph of Her Self.” Book of You, www.bookofyou.co.uk. Page 97 - Eun hee. “Interactive Tactile Light, Hand Reaching to Touch.” Designboom, www.designboom.com/technology/surface-matters-tactile-audio-lighting-exhibition-by-eun-hee-jo/. Page 98 - Alice. “Box of Therapy Tools.” Dezeen, Nov. 2016, www.dezeen.com/2016/11/04/tools-for-therapy-nicolette-bodewes-tactile-object-psychotherapy-dutch-design-week-2016/.

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Loneliness, Isolation & Alzheimer's in Long-Term Care: TouchStones Device & System  

Designed for residents in long-term care and their families, TouchStones is a personal device and application that prompts daily social enga...

Loneliness, Isolation & Alzheimer's in Long-Term Care: TouchStones Device & System  

Designed for residents in long-term care and their families, TouchStones is a personal device and application that prompts daily social enga...

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