Current Devices to Help Alzheimer's Patients Don't Keep Pace With Disease, Study Shows

BUFFALO, N.Y. -- Ronald Reagan's position, prestige and economic resources can't guarantee he'll have the devices necessary to maintain maximum independence as his Alzheimer's disease progresses.

The reason? Most existing devices for patients with dementia aren't designed to remain useful as mental health deteriorates, a University at Buffalo study has shown. It is the first study to assess the use of assistive devices by elderly persons with Alzheimer's disease and other cognitive impairments.

Results of the study, conducted by researchers in UB's Rehabilitation Engineering Research Center on Aging, showed that elderly persons with cognitive impairments living at home were using fewer devices after a follow-up at one year than at the beginning of the study, even though their need for helpful devices had increased due to declining health and cognitive status.

"Obviously we are not making devices that are as useful as they should be," said William C. Mann, Ph.D., director of the center, professor and chair of the UB Department of Occupational Therapy and lead researcher on the study. "We need to develop more 'smart' devices and devices that will remain useful longer, as cognitive health declines."

Results of the study were reported at a recent meeting of the Gerontology Society of America.

Baseline data for the study came from the center's Consumer Assessments Study, an analysis of the types of assistive devices used by the elderly, assembled from personal interviews with 90 people and their caregivers.

The study reported at the meeting was based on a 31-person subset of this group, all with cognitive impairments and living in a home setting. Mann and colleagues will follow this group for five years to provide direction for new device development and improvement of existing devices.

Twenty-five members of the 31 were diagnosed with Alzheimer's disease; the remainder were cognitively impaired, but had no specific diagnosis. Participants ranged in age from 65-92 years.

At baseline, this group was using an average of six devices per person. More than half were physical rather than cognitive aids, a not surprising finding, Mann noted, because older people with dementia typically have many diseases, and these afflictions can affect physical abilities and sensory systems.

The cognitive devices that were used -- such as restraints, doorknob covers, barricades, written schedules and reminder signs -- related mainly to safety and memory loss.

Nineteen persons remained in the study at the end of the first year. Most of the other 12 had moved into nursing homes. These 19 were using 20 percent fewer devices at follow-up than at the start, Mann said.

"The use of assistive devices and home modifications offers the potential for greater independence for older persons with impairments, yet elders with dementia use fewer assistive devices and have a higher rate of dissatisfaction than elders with other types of impairments," Mann said.

He acknowledged that this may be due to a rapid decline in mental status, the difficulty of remembering directions or the lack of necessary judgment to select and use devices. But Mann asserted that much more can be done to adapt devices to the declining mental status of Alzheimer's patients and other cognitively impaired elders.

He advocated creation of more "smart appliances," such as the microwave oven being developed by UB and others that reads the bar code on a product, sets the cooking time and power level, starts when the food is placed in the oven and possesses voice capability to describe the food being prepared.

The study results also showed that family caregivers need to know more about using devices and adapting the home to make life easier for themselves and their loved ones.

Interviews with caregivers indicated that, collectively, they had tried a total of 18 interventions in the home, mostly desperate attempts to keep the person confined, Mann said, such as removing doorknobs to prevent unsupervised wandering.

"To us, this reflects a lack of counseling," he said. "There are creative ways to address these problems such as, in this case, camouflaging the door." This could be done, he explained, by placing a poster or mural over the door or painting it to blend in with the wall and camouflaging the doorknob.

On the positive side, the study revealed that while caregivers were spending more time tending to their loved ones at the one-year follow-up, their perception of their burden had decreased and their use of social resources had increased.

Mann said these findings indicate that caregivers adjust to their task and find other resources -- social agencies and family members -- to help share their responsibilities.