Over the last several years, increasing attention is being paid to the potential that smart technologies can have in helping people with dementia. ‘Technology enabled care services’, usually in the form of community alarms and ‘telecare’ – suites of movement sensors which can monitor a person’s activities - are a well-established part of social care services. Increasingly however, people are also turning to the ever growing range of consumer driven ‘smart technologies’ that are available. The range of such products increases on an almost daily basis, and include devices such as: smart phones, tablet computers, video or web based home cameras, GPS monitors, remote heating controls, smoke or carbon monoxide detectors, smart watches and fitness bands, doorbells, smart speakers or household goods such as washing machines or fridges.
As smart technologies become a ubiquitous feature of everyday life, more and more attention is being paid to how they can assist people with dementia. In addition, both the digital health markets and the so called ‘grey’ or ‘silver’ pound has been identified as a major potential market for smart technologies. For example Apple’s most recent watch contains both a fall detector and electro-cardiogram feature (turned off in the UK due to regulations relating to medical technologies), while major assistive technology companies see their futures as being driven by smart technologies specifically designed for care purposes.
Amazon’s Alexa voice recognition platform provides a powerful example of the potential of smart technologies in dementia care. Alexa is arguably the most successful of a growing range of voice controlled smart technologies called ‘virtual assistants’. This market is big money, really big money!
Since its release in 2014, sales of Alexa enabled devices, mainly manufactured by Amazon but increasingly being integrated into a range of other platforms, has reached over 100 million devices (Cnet 2019). One area which has seen much attention has been whether virtual assistants can assist with daily activities, and if they can provide a digital form of social companionship, what Amazon calls a ‘socialbot’ (Amazon 2019).
Voice enabled virtual assistants have been put forward as a means to combat loneliness for older people and people living with dementia who may spend long periods on their own. Alexa’s present capabilities enable people to ask it simple questions, such as ‘what time is it today’, as well as acting as a virtual diary and providing audible reminders – for example telling a person to take their medication. More advanced voice recognition activities are also in development, which seek to stimulate more natural conversations between a person and Alexa. Amazon itself organises an annual ‘Alexa prize’, a competition for Universities with the goal of creating a socialbot which can converse coherently and naturally with a person (Amazon 2019). Scotland has itself benefited from this fund, with a project called ‘Alana’ at Heriot Watt University which enables people to engage in conversation with a voice controlled robot, winning third prize and $50000 in the 2018 competition (Heriot Watt 2018; Cercas Curry et al 2018).
Using a series of programs known as ‘skills’, Alexa can give people access information about local events, as an electronic diary, to find and play music, to purchase goods, to control the heating or lighting within a person’s home (if connected to compatible devices), to call family or friends, or simply to ask questions such as what time it is. Importantly, it will never get angry or frustrated with a person repeatedly asking the same question. Such options are controlled by an app for a smart phone, but once set up can be used simply by using voice controls. Unsurprisingly then, Alexa’s potential has been highlighted not just by technology providers or academic researchers, but people with dementia themselves have talked and written about how they have made use of Alexa to help them, and the potential of virtual assistants to support people living with dementia (Medium 2017).
Given their relative newness, as researchers we do not yet know the extent to which such smart technologies are being used as a feature of dementia care. My own past research has suggested that while still relatively small, a number of carers of people with dementia are using smart technologies help them to provide care (Gibson et al 2016; 2018; 2019). In many cases these consumer technologies are preferred to telecare systems provided by local authorities, usually because the consumer products are easier to adapt to their individual circumstances, or may provide solutions to problems that telecare systems don’t deal with, or that are outside their remit. For example smart camera’s sold as a means to observe pets or to monitor for intruders can easily be repurposed to observe a person with dementia remotely, in most cases with no changes to the underlying technology needing to be made. Presently such cameras would be both impractical and unethical for use within telecare systems, but of course an informal carer would not necessarily be limited by such issues.
We therefore need consider the potential issues that may arise when making use of the increasingly wide range of consumer based smart technologies within dementia care. Indeed recent controversies regarding the use of currently available internet based technology platforms, such as the role of social media platforms in fomenting hate speech or fake news have demonstrated at we must apply a more critical eye to questions of technology, and its role in reshaping activities such as care. A first key question relates to what evidence exists that these technologies may be beneficial or harmful. While any carer can go out and buy an Amazon Echo speaker and use it as they will, questions arise about how these devices might be used to support people living with dementia. This is an important question – such evidence is required both to support their use within health and social care systems, and to protect people living with dementia from harm – harm in that these devices may not work properly, or simply to prevent people wasting money on devices which don’t and won’t actually help them.
A second question relates to what happens to the data about people collected by mainstream smart technologies, and what this might mean for the privacy of people using them. Most smart technologies collect large amounts of data about individuals, their activities and their preferences. This data is used to refine products, but can also be used to target individuals and populations, usually for ‘personalised’ advertising but also targeting people based on personal characteristics such as how they might vote, or what health needs they may have. It is not difficult to see how such data could be used inappropriately, and indeed there have been numerous examples where data has been misused for financial or political gain. Typically we consent to use devices in this way when we sign the user agreements that are part and parcel of most smart technologies. But in the case of a person with dementia, what if they do not or cannot consent for such data to be collected about them? There is also the question of what happens to this data? How is the data collected through such systems and used, and what might this mean for ‘care’ delivered by such smart technologies?
A final issue which emerges is how do people make sure such smart devices are being used in ways appropriate to a person – i.e. that they will work and work for them? My own research has indicated that smart home technologies can be preferred to ‘telecare’ because the person has greater choice over the range of products available, and are more able to tailor them to areas that will help them (Gibson et al 2018). For example a carer who lives far from the person they care for may want a means to observe and communicate with the person. This could be achieved through a tablet computer and video conferencing, such as skype or FaceTime. But it could also be achieved via a smart webcam installed in the home of the person with dementia. These two arrangements fulfil similar functions, but there are subtle and not so subtle differences which may determine how appropriate they are. In this case, the first case involves some form of consent on the part of the person – namely they have to accept any video call. In the second case, the system can operate without a person’s consent or even without their knowledge, but may be acceptable to a carer even if this is against the wishes or without the knowledge of the person being cared for. There is the potential for technologies to be used to enable more person centred forms of care, for example by freeing carers to spend more time on meaningful activities as more instrumental parts of caring are automated, such as medications management. But these technologies retain the potential to be misused, to replace rather than augment carers, which will only serve to further isolate people living with dementia.
To conclude then, smart technologies are having a growing role in assisting with dementia care, and this will only grow as more technologies are introduced, and as older people and people with dementia are identified as a growing market for these products. Indeed such technologies have great potential, from assisting people with their everyday activities, to automating basic acts of care to enable carers to spend more quality time with people with dementia. But it is also important that, as we develop such technologies, we also ask questions about how these might be used. In a final issue, we also need to consider how we support people with dementia and their carers to navigate this increasingly technologized landscape.
Here are some resources about technologies, including smart technologies that may be used in dementia care:
Dementia Circle - A resource provided by Alzheimer Scotland which provides information about everyday technologies and their use in dementia care. Examples of smart technologies include virtual assistants, smart lighting and smart communication devices.
Unforgettable - An online store which sells a range of assistive and everyday products which can support people with dementia with a range of everyday and care based activities.
AT Dementia - An information resource about Assistive Technology products, including some smart technologies.
Alzheimers Society Assistive Technology pages - The UK Alzheimers Society provides information on a range of assistive technology products and how to access them.
Day 2 of the DSDC's International Masterclass is focused on person centrered technology and design and includes presentations from Una Lynch, Sonsira Solutions Northern Ireland on 'Robotics, technology and protecting the dignity of people with dementia' and Dr Mauro Dragone, Heriot Watt University UK on 'Internet of robitic things and the techno-care relationship'. See the full programme and book your tickets now.
Alexa for Dementia (2018) In brief. How to use Alexa to help people with dementia Alexa for Dementia https://www.alexadementia.com (last accessed 17/03/2019)
Amazon (2019) The Alexa Prize https://developer.amazon.com/alexaprize (last accessed 05/03/2019)
Cercas Curry, A., Papaionannou, I.Suglia, A., Agarwal, S., Shalyminov, I., Xu, X.,Dusek, O., Eshghi, A>, Konstas, I., Rieser, V., Lemon Alana, O. Open-domain Social Dialogue using Ontologies and Entity Linking. 1st Proceedings of the Alexa prize. https://m.media-amazon.com/images/G/01/mobile-apps/dex/alexa/alexaprize/assets/pdf/2018/Alana.pdf (last accessed 05/03/2019).
Cnet (2019) Amazon has sold more than 100 million Alexa devices. Available at https://www.cnet.com/news/amazon-has-sold-more-than-100-million-alexa-devices/ (last accessed 05/03/2019)
Gibson, G., Dickinson, C., Brittain, K. Robinson, L. (2018) Personalisation, customisation and bricolage: how people with dementia and their families make assistive technology work for them Ageing and Society. In press
Gibson, G., Newton, L., Pritchard, G., Finch, T., Brittain, K., Robinson, L (2016) The provision of assistive technology products and services for people with dementia in the United Kingdom Dementia. 15: 4 681-701
Gibson, G. Brittain, K., Robinson, L. (2019) Working with assistive technologies and people living with dementia. In Neves, B., Vetere, F. (2019) Ageing and Digital Technology: designing and evaluating emerging technologies for older adults London: Springer.
Heriot Watt University (2018) Heriot-Watt world leading in robotics and AI https://www.hw.ac.uk/about/news/2018/heriot-watt-world-leading-in-robotics-and-ai.htm (last accessed 05/03/2019).
Medium (2017) Using the Amazon Echo to improve the lives of Alzheimer’s patients Medium.com https://medium.com/@JaysThoughts/using-the-amazon-echo-to-improve-the-lives-of-alzheimers-patients-f5727560a5eb (last accessed 17/03/2019)