Rewind - A brain-training quiz platform for people living with dementia.

A Smart TV application to ensure dementia patient’s independence and wellbeing as well as reduce caregiver burden.

This is the report for my Major project when I was studying Service design at London College of Communication, University of the Arts London during 2017–2018.

Acknowledgement

Big thanks to my grandmother Panju, mother Euisuk, father Hosun and my sister Roselina for generous support to completing this project. I hope we could happily manage this tough journey.

Thanks to all interviewees who were participated in my interview and survey. Especially ‘The Unforgettable Dementia Support Group’, caregivers from this group gave me insights, information and wish me luck with this project. Also thanks to Jack from ‘Dementia friends’ gave me the opportunity to join his community and gave amazing feedback about my project. Thanks to Alzheimer’s Society and Lambeth council to provide feedback and valuable information that helps with proceeding project.

Big thanks to all people who have participated in this project. MA Service experience design and innovation tutors, Hena Ali Naeem Khan, Silvia Grimaldi, Cordula Friedlander, Lara Salinas, Phillipa Rose and amazing students from MA SEDI for motivation and guidance.

Thank you all! :)

0 — Introduction / Summary

Assistive technology for inclusive design to improving dementia patient’s experience
This graduation project has suggested a possible future solution for people with dementia and Alzheimer’s disease in the United Kingdom. In the UK, the service around people with dementia is well organised and easy to access. However, as technology advances, which offers an easier way, society should come up with a new idea for dementia care.

The dementia care journey is tough for patients and families. Due to the ageing population, the number of dementia patients is increasing. Therefore, the living environment of dementia patients becomes more diverse. Ensuring patients’ independence has become a vital part of the caregiving journey. Along with this phenomenon, the importance of remote care has appeared.

Assistive technology could offer remote dementia care. To find a way of using technology pervasive into the patient’s life, co-design activity and iterative interviews were conducted. To create a dementia-friendly inclusive design, the design research process has been followed by the Double diamond process.

Societies and companies could create values from their relations from connecting local communities. Iterative desk research and interviews have driven this project into a value-centred design. Becoming a ‘dementia friend’ and joining a ‘dementia friend information session’ supported by the Alzheimer’s society offered me a new perspective from the social aspect.

1 — Project Background

1.1 — Contextual Research

This project started with observing users gain an empathic understanding of the problem this project will try to solve. Shadowing their experiences allows us to be immersed in the user’s feelings, thoughts, issues and challenges, and this became the starting point of the project.

1.1.1 — Observation & Shadowing

My Grandmother and Me

Dementia is one of the most common diseases among older adults. Also, my grandmother was diagnosed with dementia 4 years ago. My grandmother has lived in her home for decades; therefore, considering her situation and doctor’s advice, our family decided to keep her living environment as long as possible because the home environment will feel safer and more familiar to her. Every weekend, my mother takes her from her home to our house to have time with her.

Last Easter holiday, I was at my home, and I saw my grandmother could not recognise where the toothpaste and toothbrush were, even though they were just in front of her. So I thought, ‘How can she live alone by herself even she could not recognise several essential articles in daily use?’ So I did an observation about her daily life in our family’s house. Here are key findings from observations and shadowing.

My grandmother is looking for objects
  • She usually spends time watching TV. She loves watching the news and TV dramas. Also, she sometimes read newspapers. But, she didn’t remember the contents of what she has read or watch.
  • She can do most of the everyday tasks with some directions from our families. Such as there’s a towel in front of you, the pink one. After then, she could find them.
  • She spends 30mins for solving math quiz book which designed for elementary school students. Afterwards, my mother checks the answer. This activity is for training her brain to slow down memory loss.
  • She sometimes walks around the park with our families. Also, it’s dangerous because she has a risk to get lost.
  • She has to take pills every day at the same time. Mobile phone alarms help her to recognise pill times.

Visualising and categorising user’s behaviour and environment based on my observation helps me to gain a deeper insight into the user.

1.1.2 — An Initial Interview

The initial interview was conducted with my families to figuring out what she is doing during the weekdays while she stays in her home.

  • Every morning, she visits the dementia care centre around her home. She spends from 9 am to 6 pm. According to dementia progresses, she needs someone to wake her up and bring her to the care centre so that our family hired a social worker to help her while she is at her own home.
  • In the care centre, they organise several activities such as music, art, exercising and so on. We registered the care centre because we need someone to take care of her during the weekdays and provide many activities for slowing down memory loss.
  • When she comes back to her house from the care centre, she usually spends her time watching TV and solving math quiz book so that mother could check it later. However, my mother is always wondering what she is doing in her house alone.
  • Every Monday, my mother visited my grandmother’s home for cleaning. Because she is not able to clean up the room by herself.

Based on the observation, shadowing and initial interviews, the research area was focused on dementia patients who live alone. It is evident that they have to keep their living environment as long as possible, but they have difficulties with everyday life. However, there are opportunities to support their independent life.

1.2 — The Five Whys

The Five Whys is asking questions using the user experience to identify the underlying causes and motivations of external phenomena. I asked myself with ‘The five whys’ based on my observation in the empathise stage to define the next research stage.

  1. Why my grandmother who diagnosed with dementia lives alone?
    - Because she is attached to her home.
  2. Why it is important?
    - Because it is good for dementia patients to keep living in their home.
  3. Why it is good for them?
    - Usually, they have live decades before they diagnosed with dementia so they will feel safer and familiar in their home environment.
  4. Why they feel unsafe outside of their home?
    - Because of the dementia symptoms.
  5. Why dementia symptoms makes patients life more difficult?
    - Let’s find out in the next step.

1.3 — Research and Design Process

From identifying problems and desired outcome to develop the service

Design Process for Major Project

The design process follows the double diamond process. This project started with the observation of a personal situation. After that, it was divided into four phases, repeating divergent thinking and convergent thinking. Along with this, practical service design methods will move a project, such as personas, user journey map, stakeholders map, and so on.

2 — Discover

Discover the target user group, as well as their needs and pain points, and gain insight from them.

2.1 — Desk Research

Step back from the previous stage; the first desk research focuses on specific background context, understanding dementia diseases, patients’ and carers’ current situations for discovering pain points, with the need to explore new perspectives around dementia.

“Soaring rates of dementia and other neurodegenerative diseases constitute one of the most pressing public health challenges of the present era, and this will become even more challenging as the population ages” Robert Levenson, a psychology professor at UC Berkeley (Anwar, 2017)

2.1.1 — Dementia is a global issue.

Dementia is a global issue because of the ageing population. Almost 50 million people around the world have dementia, moreover, it will be 135.5 million in 2050. In the Age International website, Martin Prince said dementia has different types because brain functions are selectively affected. Moreover, as dementia progresses, all functions of the brain become more impaired, including memory, communication, learning, comprehension, and judgement. (Ageinternational.org.uk, 2018) These symptoms make patients’ everyday tasks more difficult.

There’s no cure for dementia; it just progresses. Therefore, caregivers have behavioural disturbances such as denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, and lack of concentration, as well as health problems, because of a high level of stress. (Alzheimer’s Disease and Dementia, n.d.)

However, being diagnosed with dementia doesn’t mean you have to give up your independece.

2.1.2 — Dementia patient’s independence

However, being diagnosed with dementia does not mean they have to give up their independence. About one-third of all people with dementia live on their own. Moreover, 85 per cent of people would want to continue living at home for as long as possible if diagnosed with dementia. (The Unforgettable Blog, 2018) In the early stages of dementia, most of them can continue living at home and enjoying life the same as before they were diagnosed with dementia.

85% want to stay at home, less than half believe it is possible — The Unforgettable website

However, as the illness progresses, they will need an increasing amount of help in day-to-day life. However, if patients and carers are eligible, there are many support services, including financial support from the local social services department and health and social care assessment. (The Unforgettable Blog, 2018) Also, there are many useful dementia products such as easy-to-use mobile phones or digital reminders that support patients’ independent life. However, in the end, they have to move to a care home or hospital for their safety.

2.1.3 — Assistive Technology and Dementia

Technology appeared as a new solution for dementia patients. Assistive technology for dementia patients is a broad term that describes objects, products, devices, and systems that assist in ensuring patients’ safe life and well-being at home or in a residential care environment. (Icarehealth.com.au, 2014) In this context, Alzheimer’s Society highlighted the importance of assistive technology. It can maintain patients’ independence and safety and keep them socially involved. Also, caregivers found it offers them support and reassurance. (Alzheimer’s Society, n.d.) On the Alzheimer’s Society website, we can see the advantages of assistive technology. It can promote patients’ independence and autonomy, improve confidence and quality of life, manage potential risks around the home, maintain patients’ abilities and independent living at home for as long as possible, help with memory and recall, and provide reassurance to carers, helping them feel less stressed. (Alzheimer’s Society, n.d.)

However, there are some barriers and concerns about using assistive technology. Some people are concerned that this technology might reduce human contact or make patients’ lives more difficult. Furthermore, most of the older adults are not familiar with digital devices. However, if we find the best way to apply it to technologies pervasive in their lives, assistive technology can be an effective way of combining high quality, consistent care and support. (Icarehealth.com.au, 2014)

“Assistive technology can give people with dementia help and support to remain independent, safe and socially involved.” - Alzheimer’s society

Some assistive technologies that help dementia patients’ everyday life

Impact

  • Help ease anxiety, establish a routine.
  • Improve the quality of life for everyone involved. Promote independence, autonomy.
  • Manage potential safety risks around home.
  • Reduce caregiver stress

“Assistive technology for the person with dementia can reduce caregiver burden” — Dementia care

2.1.4 — What Makes Dementia Patients’ Activities of Daily Living (ADLs) Difficult?

The patients’ brains are impacted by dementia, which makes patients’ activities of daily living (ADLs) difficult, including bathing, cleaning, grooming, dressing, eating, and toileting. There are some reasons for difficulties in daily living. On the Verywell Health website, Esther Heerema divided the reasons into six categories. Firstly, executive functioning makes sequencing, planning, and organising — multiple-step activities — difficult. Memory loss is the most common symptom of dementia, and it makes patients forget to do their tasks. Poor decision-making skills make them forget to wear a coat in winter. A lack of attention causes challenges in completing activities. Also, dementia affects their behaviours and personality. Visual-spatial changes jeopardise their perception so that patients become uncertain as to which container is the toilet. (Verywell Health, 2018)

“Patient’s memory loss makes their Activities of Daily Livings more difficult. They start forgetting things they knew before.”

2.1.5 — How Can We Slow Down Memory Loss?

There are some recommended activities for slowing down memory loss. For example, taking medicine every day at the same time is essential. Also, arts and crafts, music, and simple exercises can be helpful. Kate Carr from Unforgettable noticed that regular exercise improves memory, reasoning, judgement, and cognitive functions because it keeps blood flowing through the brain. For arts and crafts activities that can boost mood and slow memory loss, and in 2015, the Mayo Clinic proved that these activities can reduce the risk of developing mild cognitive impairment. (The Unforgettable Blog, 2015) Also, for other activities, dominos, puzzles, and games are being used now.

2.1.6 — Can brain training activities help delay memory loss of dementia?

One web article named ‘Brain Exercises and Dementia’ from WebMD said one interesting study. This study focuses on the impact of brain training sessions among older adults, and it aims to aid memory, reasoning, and speed of processing information. As a result, participators’ skills and Activities of Daily Living (ADLs) were improved. In the case of dementia and Alzheimer’s, one study found that brain training delayed declines in thinking skills, so the symptoms did not show up until later. (WebMD, 2016) Based on this article, these activities for the active brain are not a sure way to prevent dementia or Alzheimer’s; however, they may contribute to delay symptoms or make one’s mind working better for longer.

2.1.7 —Caregiver Stress

Caring for people with dementia or Alzheimer’s is challenging and overwhelming. In an article from Alzheimer’s association, they categorised ten symptoms of caregiver stress: denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, lack of concentration, and health problems. (Alzheimer’s Disease and Dementia, n.d.) Therefore, there are many social organisations and services for dementia caregivers. Also, there are many Facebook groups for carers so that they can communicate their individual care journey, get some tips, or gain useful information, and they share their stories to stay strong.

Managing a caregiver’s stress is significant in the dementia care journey. Too much stress can be harmful to both carers and patients. According to the UC Berkeley study’s finding, published in the Proceedings of the National Academy of Sciences journal, dementia patients may die 14 months sooner (on average) if their family carers are mentally stressed. To sum up this study, the results showed that even factoring the patient’s gender, age, disease severity and mental health, the risk of mortality was greater for caregivers when they suffered from poor mental health. (Anwar, 2017)

Any caregivers suffering from severe stress?
- Some impressive answers from the Facebook community

326 comments from Alzheimer’s And Dementia Support Facebook group

These comments showed caregiver’s severe stress. All comments said yes about the above question. Even some people said they were about to explode.

Caring for people with dementia or Alzheimer’s is challenging and overwhelming. In an article from Alzheimer’s association, they categorised ten symptoms of caregiver stress: denial, anger, social withdrawal, anxiety, depression, exhaustion, sleeplessness, irritability, lack of concentration, and health problems. (Alzheimer’s Disease and Dementia, n.d.) Therefore, there are many social organisations and services for dementia caregivers. Also, there are many Facebook groups for carers so that they can communicate their individual care journey, get some tips, or gain useful information, and they share their stories to stay strong.

Managing a caregiver’s stress is significant in the dementia care journey. Too much stress can be harmful to both carers and patients. According to the UC Berkeley study’s finding, published in the Proceedings of the National Academy of Sciences journal, dementia patients may die 14 months sooner (on average) if their family carers are mentally stressed. To sum up this study, the results showed that even factoring the patient’s gender, age, disease severity and mental health, the risk of mortality was greater for caregivers when they suffered from poor mental health. (Anwar, 2017)

Dementia caregivers are 7x more likely to experience daily physical, emotional and mental exhaustion from caregiving than other caregivers. (Assistance, 2017)

Dementia caregivers are 3x more likely to feel extreme stress rom their caregiving responsibilities than other caregivers. (Assistance, 2017)

26% of dementia caregivers spend more than 25 hours a week caring for their loved one. (Assistance, 2017)

2.1.8 — Insights from Desk Research

User group: People with an early onset of dementia who live alone and their caregivers in the UK. There are 850,000 dementia patients across the UK.

Opportunities: Design the way of supporting dementia patients ADLs (Activities of Daily Living) to keep their independence and release caregivers’ stress.

User group-Progression of Alzheimer’s disease

2.2 — Field Research

Field research is driven to observe their point of view and understand the context. By seeing and meeting people in their environment, insights have been reframed, and new perspectives from user experience have been discovered.

2.2.1 — Unforgettable Caregiver Club Event

Unforgettable website (https://www.unforgettable.org/) and Caregiver’s club newsletter

‘Unforgettable’ is the company that aims to improve the lives of people who are affected by dementia and memory loss. ‘Unforgettable’ provides specialised products, practical advice for every step of dementia and a supportive community for caregivers. They sell products such as dementia patients’ activity materials for slowing down memory loss, clocks and watches for reminding time, support for eating and drinking, kits for health and well-being, products that help with mobility, trackers and object locators, and telephones and mobiles which are redesigned for easy use. The Unforgettable blog provides a wide range of articles explaining possible symptoms, treatments, and practical information on coping with dementia.

Unforgettable event

On 20th September, Unforgettable launched the Caregivers’ Club. It aims to find out how the caring community might be able to help carers find support and friendship. Also, they introduced products for caregivers to encourage them. For example, they used quotes that would encourage carers; thus, a cup they gave to people at the event read, ‘You can’t pour from an empty cup. Take care of yourself first.’

Guest speakers’ session

They also invited guest speakers to share information on their organisations, products, or services related to dementia. After the session, RemindMe Care was examined as an excellent example of senior digital care.

RemindMe Care

RemindMe Care (https://app.remindmecare.com/)
RemindMe Care: Features & Benefits (https://app.remindmecare.com/)

RemindMe care is digital software for the elderly with dementia or cognitive and learning disabilities. Simply put, this is a care SNS to reduce loneliness and improve well-being. It has many functions for patients and caregivers and can be used on a tablet or PC. RemindMe Care engages with families and builds personal profiles. Also, it provides readymade group activities, 1:1 therapy, and entertainment contents and can be integrated into Alexa, TVs, Touch Tables, built-in ReMe-Learn e-training, providing hospital connectivity and cross-generational and multi-cultural engagement.

How is it different from the present project?
In the previous workshop in Age UK, most of the seniors were not comfortable with digital devices. Therefore, another delivery material was considered. RemindMe Care is not just for people with dementia. Therefore, it has many functions for entertainment for seniors. People with dementia are not able to learn new things. Therefore, while organising a suitable content for dementia patients, the company came up with a possible solution for supporting the patients’ activities of daily living.

2.3 — Target User Interviews

Target user interviews are the best way to extract information from real users to understand their current situations and problems and figure out opportunity areas.

2.3.1 —Facebook Group Interviews

Facebook groups are important communities for dementia carers or people who are interested in dementia and Alzheimer’s disease. Members share their personal stories and photos, get feedback from each other, and share important quotes that encourage carers. The interviews were conducted to gain insights from specific target user groups so that new opportunities were figured out.

Dementia & Alzheimer UK Carers Group
Dementia & Alzheimer UK Carers Group

‘Dementia & Alzheimer UK Carers Group’ has 2,874 people in the community. Some of them in the community were caring for a dementia patient who lives alone, and others live together with patients, but, they have to work full time. Thus, they have similar situations. Losing their memory makes patients forget how to manage daily life, and it causes a safety issue in their home. Moreover, interviewees highlighted the importance of keeping patients’ living environment. Patients may not be happy if they have to leave their space.

The Unforgettable Dementia Support Group

‘Unforgettable.org’ created a closed Facebook community group for family caregivers and people who are living with dementia. Exchanging questions and answers, sharing tips and advice, and posting individual stories and photos were conducted in this group.

The Unforgettable Dementia Support Group

In the second round interview, caregivers are conducting music and exercising activities to slow down memory loss. Some of them feel confident with using the internet, they are playing internet games, such as solitaire. Dominoes, Jigsaw puzzle, 100 piece puzzle of London, and adult colouring book. They also play table tennis and Hungry Hippos, They can be played together with families.

Dominoes and solitaire have rules for playing them. The scoring, the stimulation of playing, and the social side are beneficial for training the brain. Also, these activities and others give patients’ confidence in their abilities, helpful for their recall, and bring about childhood passion.

2.4 — Co-discovery

The co-discovery activity was conducted to gain a new perspective and explore opportunities about the way of slowing down dementia patient’s memory loss. This session is carried out with the caregiver of a dementia patient who was diagnosed with dementia four years ago.

Co-discovery session about the way of slowing down memory loss

Slowing memory loss is divided into two categories: activities in the home and activities in the hospital. Home activities are more focused on entertainment, socialisation, and daily living while hospital activities are more focused on assessing their condition. Co-design activities with users allow them to discover new ideas and suggest new perspectives. As a newly explored area, a cognitive assessment was recommended, which is carried out with the doctor as a tool for diagnosing dementia.

2.4.1 — How can we measure memory loss?

Cognitive Assessment
This assessment covers a broad range of activities to measure someone’s cognitive function. This tool is conducted during a time-limited office visit, and during the screening, a doctor can detect possible cognitive impairments so that patients could be referred for further evaluation. (Alzheimer’s Disease and Dementia, n.d.) This stage is important in the dementia care journey because we can detect the symptoms earlier, which means we can get support, information and medication earlier. (Dementia.org.au, n.d.)

There is no single implicit test for diagnosing dementia. Patients and their carers should choose the most suitable test version for the health setting within which we work. (Dementia.org.au, n.d.) An example of a cognitive assessment developed by Alzheimer’s Society and the Department of Health is given below.

“There’s no single test for diagnosing dementia. Detecting possible cognitive impairment is the aim of this test.”

2.5 — Insights

Key findings from desk & field research

  • Memory loss makes dementia patient’s everyday tasks difficult.
  • Dementia products, digital services and brain training & entertaining activities divide carer’s work with caregivers in the dementia care journey.
  • Digitalised memory active program can be a possible solution.

2.6 — HMW Question

Framing the problem and challenge to explore an opportunity for the innovative solution, How Might We Question, was set up. On reframing insight statements as How Might We Question, current challenges turn into opportunities for design. This question includes a possible solution and the potential impact for user groups. (Designkit.org, n.d.)

Workshop session_17th July

In this workshop session, the HMW question was divided into three summative questions, which are related to particular stakeholders. The possible solution is the digitalised memory active program, and the impact of this possible solution is to ensure dementia patients’ independence and caregivers’ personal life.

2.7 Possible Solution — Digitalised Brain Training Program

The digitalised brain training program could be combined with features of current activities, programs and services. Medication reminders and dementia products could be connected with this possible solution.

3 — Define

Exploring opportunity areas based on problem statements and applying them to real users’ lives led to narrowing down ideas.

3.1 — Persona Creation

Dementia caregiving stakeholder map

Personas are archetype profiles representing user groups, based on research and interviews. After defining the opportunity area, two personas were created to find out how this possible solution could be applied to users’ lives. In this case, the primary persona represents an actual user group, and the secondary persona represents a summative user group to gain the most benefit from the possible solution.

Symptom
Diagnosed with dementia 4 years ago.

Features
Forgetfulness / Repetitive behaviour / Memory loss

Goal
Keep reminding about essential information to reduce difficulties in activities in daily living.

Challenge
The way of using service.

User Story
Before diagnosed with dementia, she was such an active person. She enjoyed swimming, walking and travelling. And she has lived alone for decades since her husband passed away. After she diagnosed with dementia, she visits a senior care centre during every weekday, 9 am to 6 pm. When she comes back from the care centre, she always watches tv before she goes to bed. Also,

she sometimes solves math quiz book which Jenny left in her house for training brain. Every weekend, she visits Jenny’s house and spends time together. And once a month, she visits a doctor with Jenny for prescribing medication and check the dementia progress.

Needs
Supporting material to divide caregiver’s work, Remote care

Pain points
A high level of stress / Need personal time / Spend much time to take care of her mother, but she is busy because she works full time.

Family (Other carers)
Mother — Dementia patient, Live separately.
Husband — Businessman, Not able to help her.
One older brother — He is an office worker. Sometimes help her.
Two daughters — They support carer’s work sometimes during the weekends.

User Story
She is the primary carer of her mother. She lives with her family but every weekend. She brings her mother to her home and has time together. During the weekdays, she visits her mother’s house and cleans it. Other family members don’t have enough time to care Linda so that caring is almost her own work and this is the main reason for her high level of stress. Also, herself doesn’t have much time to care her all day so that she let her mother visit the care centre during the weekdays. However, she always worries about her, so they have a call every day to check Linda’s condition. For Linda’s memory active, she let her mother solve simple math quiz. But she always has to check answers. She is having a hard time because her mother asks the same questions again and again and starts to forget essential things such as reading time, feeling the weather.

3.2 —User Journey Map

Organising users’ daily activities with several touchpoints helped to find opportunities in the users’ lives and possible solutions that could be applied to certain touchpoints. Here are personas Linda and Jenny’s weekday and weekend journeys.

3.3 — Insights

  1. Applicable points
    What if use patient’s free time to remote care?
  2. Smart TV as a possible solution
    What if use smart TV as a delivery method?
  3. Digitalised
    What if digitalised dementia brain training activities?
  4. Reducing cost
    What if developing a personal cognitive assessment tool to reduce the cost of visit doctor?
  5. Inclusive
    Design service for both patient and caregiver

4 — Develop

Develop and iterate ideas that can be prototyped.

4.1 — Desk Research

As a possible solution, smart TVs could be used for dementia care. At this stage, this possible solution has been proved through desk research.

4.1.1 — TV Is an Important Component of Seniors’ Independent Life

The article ‘TV for Seniors’ highlighted some advantages of age-in-place without making any changes: 1. Is less expensive 2. Maintains freedom and dignity. 3. Enables them to remain in contact with friends, neighbours, and family members. As a result, they can improve their quality of life. (Independa, Inc., 2015)

Also, active participation in media consumption is an important part of the lives of the elderly. Recent studies showed that music, films, and TV are key components to their well-being, (Chotiner, 2016) and most of the senior citizens rely on television for entertainment, accessing the weather, staying on top of the news, and being alerted of any emergencies. (Waxman, 2017)

My grandmother is watching TV and it’s her favourite time.

“TV is an important window to the world and a basis for shared experience for seniors…We found that the primary gratifications the aging audience sought from media, including TV, were a sense of being more involved in the world, entertainment, acquiring information and passing time.” — Kathaleen Reid

4.1.2 —The digital generation is not just kids anymore

Slowly, but surely, digital consumers are taking over the coveted media demographics. This means that opportunities for adults (65+) are shifting to the digital generation. Which digital product is the most familiar among senior citizens? In the report, ‘Adults’ media use and attitudes,’ by Ofcom, it asked elderly people to say, out of all the devices they use, which device would they miss the most if it were taken away?

Mobile phones are the most-missed media device among all adults, particularly younger adults, but TV is still most missed among the over-55s.

https://www.ofcom.org.uk/__data/assets/pdf_file/0026/80828/2016-adults-media-use-and-attitudes.pdf

Currently, people who are 65+ years of age profoundly loved TV sets compared to other media devices. Then, how about Smart TVs? Based on the research, by 2019, more than 50% of TV households in Japan, the U.S., the UK, France, and Germany will have Smart TVs, according to IHS. (Correspondent, 2016)

https://www.broadbandtvnews.com/2016/02/02/strong-smart-tv-growth-in-japan-us-and-europe/

Also, the age group of Smart TV owners’ percentages is quite similar, and they take advantage of the internet capability of their TVs. In a nutshell, the penetration of Smart TV is increasing, and adults can use its features very well.

http://www.smartclip.com/sites/default/files/content/case-studies/case-study-pdf/smartclip_Smart%20TV%20Insights%202015_UK.pdf

4.1.3 — Smart TV as a Delivery Method

When we think about our common living room, the TV is always at its centre. The TV is a simple-to-use device and is a favourite among older adults; they do not need to be trained to use it. (Seniortv-aal.eu, n.d.)

The strengths of using Smart TV for home care are as follows:
1. It is easy to connect the Smart TV with other digital devices such as smartphones and tablets, as well as with other secondary peripherals like PlayStation, Wii and Kinect for certain services.

2. It can act as an easy way of keeping in touch with their friends, family, caregivers and other people around them (for non-smartphone users).

3. Caregivers or family members can remotely control the Smart TV.

4. Users do not need to buy a new product; they can install the system in the original TV.

4.2 — Co-creation

Co-creation was conducted with users as advisers to create a value-rich experience to organise the contents of the brain training Smart TV application. The involvement of direct users and other external stakeholders allows for the creation of differentiated contents and unique and personalised customer experiences.

4.2.1 — In-depth interview: Involvement of caregiver

Interviewee
Caregiver (Age. 53) who is caring an early onset dementia patient.

Purpose
Gather ideas as many as possible and categorised based on their aims.

Main question
What kind of contents could be suitable and useful for you and your loved one?

Summarised In-depth Interview 28/09/18

Insights
Mainly, the contents aim to recall memories from daily life. Also, her advice divided into two categories which are from cognitive assessment and entertaining activities that other patients and caregivers are doing currently.

  1. Contents from Cognitive Assessment
    The former one is based on cognitive assessment paper which is normally conducted in the doctor’s office. This assessment paper asks about reading time, calculation, simple thing and name of animals. Also, apart from the assessment, she hopes her loved one to handle the sense of weather and remember their family and herself.
  2. Entertaining Activity
    Reading news and simple exercise are recommended as an entertaining activity for brain training and the patient’s health.

“Repetitive learning about supportive information on daily living could be helpful to keep the patient’s independence.” — Dementia caregiver (53)

4.2.2 —Co-Design Activity: Involvement of caregiver

Co-design activity Sheet 10/10/18

For further ideation, co-design activity was conducted with caregivers. This sheet provided closed to final output and let participators create a question by themselves. This activity allowed narrow down their idea based on their experience into actual form clearly.

Co-design activity with family members

4.2.3 — Online survey: Involvement of community

To gather ideas apart from previous activities this online survey aimed gain insights about caregiver’s emotional opinion about what do they hope their loved one does not forget and what do they want to keep reminding to the dementia patient.

Online survey Screenshot 10/27/2018–11/2/2018
Online Survey Result

As a result, caregivers hope their loved one does not forget the people around them, for instance, their family members. Also, they hope they do not forget how to manage everyday tasks such as how to eat, hospital appointment, home address, the layout of the bathroom and don’t go outside in the dark. Also, they wanted to keep reminding about the emotions to them. Likewise, all family member love them always and remind about happy memories.

“I hope she doesn’t forget that she has a family who loves her very much.” — One response from the survey

“I know they have very little ability to remember new information and this won’t get.” — One response from the survey

4.2.4 — Desk Research: Involvement of doctor

Based on the different type of Cognitive Assessment Toolkit, the contents were divided into four categories.

  1. Time > Time, Year, Weather
    - Date of birth? / Time? (to the nearest hour)
    - Last year of second world war?
    - What year is it? / What month is it?
    - Say the months of the year in reverse
    - Clock drawing
  2. Math > Calculation, Purchasing
    - Count backwards 20 to 1
    - Could you take 7 away from 100?
    - Serial 7 subtraction starting at 100
  3. Things > Recognise objects, Match name and photo
    -
    Can you tell me something that happened in the news recently?
    - Now can you name as many animals as possible? It can begin with any letter.
    - Place the paper on top of the pencil
    - Pick up the pencil but not the paper
    - Ask the subject to copy this diagram
    - Ask the subject to count the dots without pointing to them
    - Ask the subject to identify the letters
    - The similarity between eg banana — orange = fruit
  4. Memory Recall > Read & Repeat
    - Read the script / Repeat the script
    - Name of the current Prime Minister
    - Name of the USA president
    - Name of the USA president who was assassinated in the 1960s
    - Name of the woman who was Prime Minister
    - Address recall correct?

https://www.alzheimers.org.uk/sites/default/files/migrate/downloads/alzheimers_society_cognitive_assessment_toolkit.pdf

4.3 — Case Study — Digitalised brain training program

GameChanger

Game Changer is the UK-based scientific study which is supported by the University of Oxford and Alzheimer’s Society. This is the smartphone application for the people who have not diagnosed with dementia and anyone over the age of 18. The aim of this study is understanding the very earliest stages of Alzheimer’s disease and find a way to prevent slow down and treat the condition. Based on the research data, future research aims to figure out the baseline for detecting an individual’s risk of developing dementia and check cognitive changes. (Joingamechanger.org, 2018)

GameChanger app screenshots

The content of this app is about short-term memory. Remember the photo and direction after that repeat this routine. After the first stage, the number of photo is increasing, and directions become more diverse as the stage progresses.

How can it be different from the present project?
This study provides a program which aims to train short-term memory. However, the contents of the program do not present other values. Organised meaningful information that could support the patient’s daily life and everyday tasks could be the differentiation with this study.

Insights
This brain training program is organised by the University of Oxford and supported Alzheimer’s Society and provides a well-designed program and they use the result as research data. It creates another value from connection with Alzheimer’s Society. This could be applied to my project as well.

4.4 — Prototyping

The flow of the screens was sketched out to narrow down ideas into the paper sketch. This session allowed the first inspiration for the layout of each screen and the flow of the functions. Paper prototyping screens lead to organised the main structure of the interfaces.

Paper Prototypes

4.5—Testing

To gain feedback from experts, the testing session with paper prototypes helped to gather valuable insights and allowed more user-centred design.

Dementia Friends information session 31/10/18

‘Dementia Friends’ is the programme supported by Alzheimer’s Society to change people’s perceptions of dementia. The aim of the programme is transforming the way of public’s thinks, acts and talks about the condition. As a student who is doing a project for the dementia patient’s well being, I became a part of the programme.

Participated in the Dementia Friends information session allowed to meet dementia expert. Jack who is the organiser of the Dementia Friends information session at St Joseph’s Hospital gave valuable feedbacks from his experience.

Feedback session with Jack Dementia friends information session organiser

Key insights
1. Make it easier
- Designing questions easier makes them give confidence.

2. Use old photos
- Dementia patients start to forget with recent memories. Using old photos can help patients to recall their old memories

3. Use photos and illustrations
- Use coin illustration in the math section. This will be helpful with the situation patients want to purchase products.

4. Use 1950s pop star’s photo and music
- Music helps them to recall their old memories.

4.6 — Insights

Final quiz contents were organised after the co-design session. They divided into five categories. The quiz will be organised along with the category and useful information to support user’s daily living.

5 — Deliver

Implementation of ideas based on the previous research stages. Refine and design service delivery method.

5.1— Service Concept

Rewind is a digital platform that provides brain training quizzes for dementia patients. Five quiz sets are provided in one day, divided into five categories: time, math, things, mood, and love. The result of the quiz is sent to the carer’s smartphone through an application, and this result can be shared with the doctor via email. Due to the advantage of TV, external services can be connected with this platform with the use of a GPS tracker and Wii.

Service Key Values

  1. Ensure patient’s independence
    - Organised quiz contents related to daily life & Make their free time more meaningful.
  2. Release caregiver burden
    - Slow down memory loss & Prevent repetitive behaviour
  3. Store patient’s data
    - Utilise data for further dementia research.

The five categories of the quiz

Mapping insights and gathering information

5.2 — Stakeholder Map

Stakeholder map is the map which is visualised all groups of cooperators related to the particular service. This method allows users, companies, partner organisations & charities, and other stakeholders to be shown and the relationships between different groups to be schematically analysed.

5.3 — Value Proposition Canvas

To create more value, this service designed on the assumption that the Alzheimer’s Society provided the service. Due to Alzheimer’s Society’s participation, the service system could be circular and created more value.

5.4 — Rewind System Map

Rewind has a circular system. Alzheimer’s Society provides the service and the data gathered to the Society again. Through the circular system, the service will be improved and provide a better user experience.

5.5 — Rewind Features Map

Rewind has key seven features. This chart below presents the contents of the feature and the purpose of the contents.

Graphic Ideation Moodboard

5.6 — Graphic Design Guidelines

These sheets provide the guideline heuristics for designing accessible digital interfaces, services, and contents for people with dementia. Dementia and Alzheimer’s disease symptoms are diverse. Thus, it is important to consider different levels of digital literacy. This list can be used for evaluating digital interfaces. (Rik Williams, UX Architect, 2017) Rewind interface considered this accessibility. Therefore, Rewind can provide comfortable interfaces for the dementia patient’s digital experience.

5.6 .1- Service Elements

In order to deliver user-centred experience, logo, colour, visual system and font were built.

Visual Metaphor System
The name of the service proceeds from reminds your memory like rewind the videotape.

Logo metaphor
The visual metaphor of the logo is from a pile of videotapes’ shape. Each tape presents the user’s memories and histories. Therefore, this logo contains the meaning of rewind each memory a day.

Graphic metaphor
A circle and a boundary line also be used for the visual metaphor to screen design. The circle is used to concentrate the user’s attention to the photo. And the line is used for divide question and answer screen. This layout design came up with when we took the video out of the cover.

5.6.2 — Logo System

This logo’s centre is transparency to avoiding the user’s attention to the logo. It is pervasive to the background image. Therefore, when the user enters the screen, they can focus on the main content.

5.6.3 — Colour System

Vivid colour and high contrast
Rewind has five categories, so it has five highlight colours. Each colour represents the meaning of emotion to the dementia patient. Especially, violet is the colour which represents Alzheimer’s disease. Thus, this colour used in ‘Rewind your love’ category which is the question about the patient’s family members and their emotions.

5.6.4 — Typography

Source Sans Pro is google open san-serif font which has a simple shape and free from decoration. The simplicity of the shape is more visible and readable, digitally.

5.7 — Rewind

The following paragraph showed final design output of Rewind.

5.7.1— First touchpoint: Promotion

The early sign of dementia can be detected earlier. However, they usually think they will be fine, thus, they don’t visit GP. This behaviour pattern makes the proper treatment delayed. As the first touchpoint of the service. this poster can be a simple screening tool for elderly people.

Reading broken typeface can be the first assessment for detecting dementia. Because sometimes identifying broken letter is used to assess cognitive impairment. Behind the broken sentence, the quote ‘Dementia is not a natural part of ageing’ located with a hand-script font. It is not clearly visualised for older adults, however, it delivers the message to the public.

Rewind Website
When the user accessed to ‘www.rewind.com’ they can be referred to this website. The information about how to use service, how others use the service, detailed information about each application, data protection and submit enquires and get some support.

5.7.3 — Rewind for Dementia Patient: Smart TV Application

Wireframing

Flowchart

Concept-Image

Smart TV screen design

Page 1. Rewind your time
Divide the quiz section and the answer section clearly apply different background colours so that the user can recognise where they are.

Page 2. Rewind your math / Page 3. Rewind your things
Using a different colour for a different section, users may not be confused about the quiz. Divided question area and the list of answer area offers users to recognise contents clearly.

Page 4. Rewind your mood / Page 5. Rewind your love
Using coloured circles as a background graphic, users can concentrate on the image even it is black and white. Users may not distinguish contents if all the elements are in the same colour tone. Music will be played in this section for better recall memory. Reflected caregiver’s opinion, remind them about their family love you.

Page 6. Result page / Page 7. Popup quiz
When they enter the wrong answer, the quiz continues to appear until they enter the correct answer.

Page 8. Object tracker page / Page 9 Activity page

5.7.4 — Rewind for Caregiver: Smartphone Application

Flowchart

App screen design
Carers can assess the result of the quiz which is divided by date and categories. Also, they can check the history of the quiz and the following result of them.

5.7.5- Rewind for Doctor: Image file

The result of the quiz classified and exported to the image. The doctor can receive the result via email. In this image file, the doctor can access the history of quiz content, time duration for each section, the number of correct answer & category, the number of incorrect answer & category and the change of total result compared to the previous office meeting.

Introducing Rewind

5.8— About Data protection

Rewind data protection
‘Remindme Care(2.2.1)’ was used as examples to assume Rewind’s data protection. Rewind encounters a variety of stakeholders. Users input their data, service provider and external medical service provider received the data. User’s valuable and sensitive personal and medical information will be responsibly managed and used with our data protection system.
The list below was referenced to the ‘Remindme Care’ website ‘Data protection & GDPR’ section. (Remindmecare.com, n.d.)

Data Collection — Service provider and external medical service provider can assess a patient’s name, age, symptom, the result of the quiz and time duration of using service. Family members’ photo and information will be encrypted and stored in the system for creating quizzes, will not be shared with anyone.

Data Hosting — The UK’s NHS G Cloud compliance requirements and Ico will host data on secure servers.

Data Portability — User’s data will be made available to care facilities such as GP, hospital, memory clinic and dementia care home in a compliant and secure manner.

5.9— Service blueprint

5.10 —Business model canvas

5.11 — Impact

Related to the insights, Rewind create value for users, community and the world. The contents of Rewind provide the better living to users, the system of rewind offers community’s engagement, and the impact of Rewind can contribute to reducing the cost of caring and researching dementia and Alzheimer’s disease.

1. Ensure patients and carers well being
The contents of the quiz organised with the information related to the everyday task. Keep reminding them about the sense of weather and way of purchasing items can be helpful to improve their thinking skills, reduce the difficulties in doing everyday tasks and use spare time more meaningful. Caregivers can divide their carer’s work with this service such as keep answering to repetitive behaviour and reduce worries about the patient who lives separately with family. Due to training brain with quiz activity, rewind can contribute to slowing down memory loss.

2. The circulating system for creating value in the community
The service provider is Alzheimer’s society, and they also collect data and feedback at the end of the service for further dementia research and improve the service. Unforgettable which is the company sells dementia product is in the system for suggesting to the user about the specific product which can be connected with rewind. The blog and caregiver club they have can be the platform to promote the service and gather new users. The result of the quiz will be shared with the doctor, GP, hospital, dementia care home and senior care centre as supporting material to check the patient’s condition. Therefore, they can reduce office meeting time and make the registration process more manageable.

3. Reduce the cost of caring and researching dementia
Alzheimer’s society has conducted care research to improve the care and services available to people living with dementia. (Alzheimer’s Society, n.d.) However, the amount of dementia research has been neglected by the government because of the budget. Operating rewind as a research tool as well as provide the service can reduce the cost of caring and researching dementia compared to the case they provide them separately.

6 — Evolvement

Expanding to the Smart Home service
When the Internet of Things is commercialised then now, Rewind, the smart tv application, can be a hub that connected with IoTs to provide a better experience for patient’s independence and safety.

7 — Conclusion

The potential of technology assists people with dementia’s wellbeing. To create the value-centred solution, the involvement of various stakeholders in the design process is needed.

Related to the insights, a new, innovative service should be needed for the increasing number of dementia patients and their caregivers, even the seniors who do not feel familiar with the technology. Developing the service to support the care journey is one of the most necessary areas for people living with dementia. Rewind is a brain-training quiz platform that, with the help of technology, is organised with useful information about everyday tasks. For the user-centred approach, the quiz contents were designed to reflect caregiver, volunteer, and expert ideas.

As there are various types of dementia and diseases worldwide, the quiz content should be designed based on more specific data and medical grounds. However, this service is seen as a small step to ensure patients’ independence and relieve caregivers’ burdens. TV as a method of service delivery provides patients with a possible solution that can permeate their lives in a useful and friendly way.

When an app is connected with the community, it becomes a service, and Alzheimer’s disease has various stakeholders in caring and researching areas, which means that the app also offers the opportunity to create more value from their relationships. Therefore, during the research process, it was important to collect feedback from the stakeholders’ different perspectives. By assuming that Alzheimer’s Society is a service provider, Rewind creates value that contributes to further dementia research. Furthermore, connecting with medical stakeholders creates value that supports the assessment of cognitive impairment and checks dementia’s progress.

Furthermore, if patients have their data, it could lead to a reduction in visiting time at doctors’ offices so that one of the impacts we can expect is a reduction in the cost of caring, as well. To ensure this value, certification with the community and doctor should be taken a step further. The involvement of various stakeholders provides better user experience and creates higher value.

Some types of technology may not be needed immediately, but it can be helpful to know what is available and what may be able to help in the future.- (Alzheimer’s Society, n.d.)

7.5 Service Design Symposium on Dec.2018

Can service design positively affect the future of health and biotech?’

8 — Bibliography

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I’m a service experience designer who loves innovative technology, human-centred goodness and collaborative work. Currently based in Seoul, South Korea.

I’m a service experience designer who loves innovative technology, human-centred goodness and collaborative work. Currently based in Seoul, South Korea.