Everyday Technology Improves East Bay Seniors’ Lives
CSUEB Professor explores low tech dementia interventions
BY FRED SANDSMARK ’83
Most of us love new appliances — witness the millions Americans spend on kitchen remodeling every year — but for 86-year-old Howard D., a new microwave at the Masonic Home in Union City caused nothing but distress.
Howard has dementia, and even though he knows housewares — he sold appliances during his working years — the new oven baffled him. Howard, whose family asked that his last name not be published to safeguard his privacy, simply wanted to warm his soup, but he couldn’t master the steps. Fortunately, the microwave’s arrival coincided with a visit by Nidhi Mahendra.
Mahendra, an assistant professor in the Department of Communicative Sciences and Disorders and director of the Aging and Cognition Research Clinic at CSUEB, was exploring whether everyday technology such as laptop computers and digital cameras could help people like Howard.
“There’s a myth that dementia patients can’t learn,” says Mahendra, who specializes in studying cognition and communication in seniors. “But the growing literature over the last decade shows that people with dementia are able to participate in interventions, maintain performance, and improve in some areas.” She won a three-year, $198,624 grant from the Alzheimer’s Association and Intel Corp. to test how technology might help.
With the help of student volunteers, she screened dozens of patients at East Bay senior residential facilities and enrolled 65 individuals with varying levels and causes of dementia. The first phase of the research, which began in 2005, explored whether seniors, some of whom had never used computers, could operate a mouse or touch screen and follow audio instructions on a laptop. Once they had established a level of comfort, she tested whether they could then play cognitively stimulating computer games. More than 80 percent of subjects succeeded. “They caught on to the computers very quickly,” Mahendra says. “They loved that there were different kinds of games and things they could choose.”
The second phase of her research project studied technology’s effectiveness as a teaching tool. “The way you teach somebody who has a healthy memory and (somebody with) a disorder of memory is very different,” Mahendra says. “We were hoping to show that certain strategies — a visual component to the learning, practicing a procedure over and over, and increasing the intervals between sessions — would help our patients be successful.”
Customized and personal
Traditionally, cognitive rehabilitation in dementia patients relies on static, generic stimuli such as word lists and pictures of strangers’ faces. Technology offers a chance to personalize and customize the training; instead of testing whether a subject could recall random words, Mahendra and her nine CSUEB research assistants, all graduate students, explored whether a person could learn practical tasks: navigate to the dining room, perform a specific safety routine, or — in Howard’s case — learn to use a new microwave.
Digital cameras captured still or moving images of tasks such as safely drinking water or locking the brakes on a wheelchair before standing up. Those tasks were then divided into steps, and those steps were assembled into computer-based lessons with voice-over instructions. Clinicians met one-on-one with patients twice a week for personalized lessons, and when it appeared that a patient had internalized the information — in an average of nine sessions — the clinicians began asking patients open-ended questions: “How do you drink water?” or “How do you stand up safely?”
After six weeks, 80 percent of subjects retained the information. “We showed that people with dementia do have the ability to benefit from interventions,” Mahendra says. “We tracked our patients out six or eight weeks after we’d stopped the training — which, in the world of dementia research, is pretty impressive.”
The emphasis on personal, practical tasks contributed to the study’s success, Mahendra believes. She also thinks the lessons extended beyond the clinic and into the patients’ daily lives. She tested this thesis by adding an element to the training: She taught each subject to associate a picture of someone at their facility with his or her name, and asked the staff to track the number of times a patient called them by name. “It wasn’t a perfect way to track it, but it definitely gave us incidental data that learning wasn’t restricted to the training session,” Mahendra says.
Riding two waves
Mahendra first became interested in cognition among older people as an undergraduate in India. She watched her grandfather’s decline into dementia; Mahendra recalls him as a literary man who wrote poetry and quoted scripture, but who lost those faculties as the disease progressed. She conceived of her computer-aided cognition training project in 2000 as her doctoral thesis but was advised that the research required a long-term situation. After receiving her PhD from the University of Arizona, Mahendra worked for several years in long-term care facilities, then joined CSUEB in 2005. Here, she saw the opportunity to revisit and expand the research she had started years earlier. The timing couldn’t be better.
“There’s an age wave coming our way,” Mahendra explains. Millions of baby boomers are retiring, and one in eight persons age 65 and older have Alzheimer’s disease. Indeed, dementia patients are the fastest-growing segment of speech pathologists’ caseloads, but there aren’t enough clinicians to work one-on-one with all of the people who will need help. “If you can combine the aging wave with today’s technology wave, you create opportunities where, as a senior, you could be doing things that allow you to keep your mind active without receiving cognitive treatment from a therapist,” she adds.
And that’s something seniors with dementia are eager to do. Mahendra says, “Howard always told us, ‘I’m not doing this for you. I’m doing this for me!’”