Designing a Mobile Intervention for Alzheimer's and Other Dementias

Introduction

The number of elderly (>= 65 years) experiencing dementia including Alzheimer’s has been increasing (Association, 2019). Although most elderly live in an independent or community living, about 1.4 million elderly currently live-in nursing homes in US (Howley, 2020). Some of the elderly experience cognitive challenges including dementia and Alzheimer’s. The elderly need cognitive stimulation, interaction with others, and emotional support. During COVID-19 pandemic closedown, quarantine and other restrictions (Rubin & Wessely, 2020; Zhang et al., 2020), elderly are vulnerable not only to the coronavirus, but also the social isolation with no family visits. They are increasingly depressed, leading to resisting care, medications refusal and agitation. This is even more than the general population during COVID-19 (Salari et al., 2020; Xiang et al., 2020). The behavioral symptoms and resulting dementia care process is shown in Figure 1 where both the intensity and frequency are further amplified by the pandemic. These behavioral disturbances are resulting in an excessive use of psychotropic medications and/or increased hospitalization. In addition to serious decline in the quality of life for the elderly and caregivers, this could create further strain on already overloaded healthcare systems.

Figure 1.

General Challenges in Alzheimer’s and Dementias for the Elderly

The current pandemic has created a significant trauma to the elderly who are not able to communicate and to the family members who are also experiencing other stresses. This situation is expected to continue beyond the current pandemic. Mobile interventions, under the general umbrella of non-pharmacological interventions, have the potential to improve the quality of healthcare and resulting outcomes (Iribarren et al., 2017; Singh & Varshney, 2019; Varshney, 2009; Yu, Beam, & Kohane, 2018). More specifically, communication tools have been used to connect with such a vulnerable population including Facetime and Skype for video conferencing (Siniscarco, Love-Williams, & Burnett-Wolle, 2017). Although these tools are useful and effective for connecting and communicating with general population, the use of communications tools has been quite difficult due to multiple barriers involving the elderly. These include the need for caregiver’s time to schedule phone call, difficulty in keeping all family members present at the time of phone call, and inability of the person with dementia in even remembering a phone call with the family members.

To address this dire situation, we focus on a mobile intervention, named AlzhaTV, for the elderly to stay in touch with their families and have pleasant recall of their past. The smart intervention includes a suite of mobile apps for the elderly, friends and family, nursing staff and administrators. The intervention, not requiring any technical interaction from the elderly, is available free-of-charge on both Android and iOS platforms and is being used by family and friends of the elderly. The intervention integrates videos from friends & family and caregivers and then displays the personalized videos in a loop matching their cognitive levels.