Alterations in one's sense of self are often considered a significant psychological symptom of dementia. However, the self is not a unified construct; it consists of a set of closely connected, yet substantive, manifestations which might not be equally impacted by dementia. Recognising the multidimensional nature of the self, the current scoping review aimed to explore the nature and scope of the evidence demonstrating change in the psychological self in people living with dementia. Adopting a cognitive psychological framework, a hundred and five (105) quantitative and qualitative studies were reviewed, and findings were organised into three main types of self-manifestations: high-order manifestations, functional aspects of the self, and foundational manifestations. Overall, the results show that although there are alterations in some of these different manifestations of the self, these do not imply a global loss of selfhood. Despite notable cognitive changes during dementia, it seems that preserved aspects of self may be enough to compensate for potential weakening of some self-processes such as autobiographical recall. Better understanding alterations in selfhood is key to addressing psychological symptoms of people living with dementia, such as feelings of disconnection and reduced agency, and may inform new pathways for dementia care interventions.

Caregivers find it difficult to interact with people with dementia who have lost the capacity for speech. Adaptive Interaction is a simplified approach that uses the nonverbal fundamentals of communication to connect with people who can no longer speak. Here we present Adaptive Interaction as a method for equipping caregivers with these nonverbal skills to increase communication with the people they care for. Six caregivers were each paired with one individual with dementia and trained in Adaptive Interaction. After receiving training in Adaptive Interaction, caregivers identified more communicative behaviours in their interactions partners and engaged in more frequent positive social behaviours and meaningful actions during interactions. These findings suggest that it is possible to equip staff to use simplified communication based on nonverbal fundamentals to connect with people with dementia who can no longer speak.

Most individuals with advanced dementia lose the ability to communicate with the outside world through speech. This limits their ability to participate in social activities crucial to their well-being and quality of life. However, there is mounting evidence that individuals with advanced dementia can still communicate non-verbally and benefit greatly from these interactions. A major problem in facilitating the advancement of this research is of a practical and methodical nature: assessing the success of treatment is currently done by humans, prone to subjective bias and inconsistency, and it involves laborious and time consuming effort. The present work is the first attempt at exploring if automatic (artificial intelligence based) quantification of the degree of patient engagement in Adaptive Interaction sessions, a highly promising intervention developed to improve the quality of life of nonverbal individuals with advanced dementia. Hence we describe a framework which uses computer vision and machine learning as a potential first step towards answering this question. Using a real-world data set of videos of therapeutic sessions, not acquired specifically for the purposes of the present work, we demonstrate highly promising results.

Loss of verbal language production makes people with dementia appear unreachable. We previously presented a case study applying nonverbal communication techniques with a lady with dementia who could no longer speak, which we termed Adaptive Interaction. The current small-n study examines the applicability of Adaptive Interaction as a general tool for uncovering the communication repertoires of non-verbal individuals living with dementia. Communicative responses of 30 interaction sessions were coded and analysed in two conditions: Standard (Baseline) and Adaptive Interaction (Intervention). All participants retained the ability to interact plus a unique communication repertoire comprising a variety of nonverbal components, spanning eye gaze, emotion expression, and movement. In comparison to Baseline sessions, Intervention sessions were characterised by more smiling, looking at ME and imitation behaviour from the people with dementia. These findings allude to the potential of Adaptive Interaction as the basis for interacting with people living with dementia who can no longer speak.

IntroductionResearch into technology adoption has focused on older adults’ motivations, with less exploration of the perspective of healthcare providers, including occupational therapists, who are often described as the gatekeepers to assisted living technology. MethodThis qualitative study utilized semi-structured interviews and focus groups with 20 occupational therapists in England and Scotland. The goal was to identify those enabling factors necessary for occupational therapists to adopt assisted living technology. ResultsFive themes emerged regarding the enablers needed to support the adoption of assisted living technology by occupational therapists, including: (1) a positive client–therapist relationship; (2) affordability; (3) time; (4) increased awareness, education, and training; and (5) usability features of the assisted living technology. ConclusionWith an aging population and the increasing role that technology is playing globally in older adults’ lives, it has never been more important for occupational therapists to harness the potential of new, developing, and existing technologies to support people to live and age as well as possible. To accomplish this, however, requires that occupational therapists are equipped with the time, training, and education necessary to offer their clients assisted living technologies that are client-centered, usable, and affordable.

As part of the Challenging Obstacles and Barriers to Assisted Living Technologies (COBALT) project, we developed the COBALT Tools for Engagement (TM), a number of innovative techniques to engage older people in all stages of the technology development process. In the present study we used Technology Tours of the homes of eight older adults to look at their daily usage and examine the ways in which technology influences well-being. All of the participants use multiple technologies every day both inside the home and out. The data highlighted how technology contributes to well-being in a number of ways, including enabling them to maintain current activities; providing a means of staying in touch with families and friends; being easy to access and learn to use; and enhancing their lives. These can be divided into two types of factors: ones that relate to the direct outcomes of technology use and how these contribute to feelings of wellbeing and factors that relate to meeting an individual's needs, which if met contribute to their well-being. The findings indicate that well-being is a multi-faceted construct that includes autonomy, i.e. remaining independent, competence both in continuing to complete activities and learning new ones, and communication with other people. The study also indicates that Technology Tours provide an easily applicable and accessible means for enabling older adults to speak as `experts' on technology.

Digital video games offer opportunities for older adults with cognitive impairment to engage in meaningful activities. However, to achieve this benefit digital video games are needed that take account of the players' cognitive impairment. This paper reports work with older adults with cognitive impairment due to dementia to find out how they can best be prompted to initiate and play games independently, what sorts of digital video activities they like to play, and if playing digital video games is engaging. The results demonstrate that older adults with cognitive impairment can learn to play new digital video activities and can be prompted to play independently through visual and auditory cues. Their behaviour indicates features of Flow similar to that reported in other gaming studies.

Purpose– The purpose of this paper is to present the self-described “journey” of a person with dementia (Brian; author 3) in his re-learning of old technologies and learning of new ones and the impact this had on his life.Design/methodology/approach– This is a single case study detailing the participant's experiences collaborating with a researcher to co-create methods of facilitating this learning process, which he documented in the form of an online blog and diary entries. These were analysed using NVivo to reveal the key themes.Findings– Brian was able to relearn previously used technologies and learn two new ones. This lead to an overarching theme of positive outlook on life supported by person-centredness, identity and technology, which challenged negative perceptions about dementia.Research limitations/implications– The paper provides an example of how learning and technology improved the life of one person with dementia. By sharing the approach the authors hope to encourage others to embrace the challenge of designing and developing innovative solutions for people with a dementia diagnosis by leveraging both current mainstream technology and creating novel bespoke interventions for dementia.Originality/value– The personal perspective of a person with dementia and his experiences of (re-) learning provide a unique insight into the impact of technology on his life.

The principle of introducing a third element to a stressful communicational encounter, to which both participants can direct their attention, and which can provide prompts for communication, has a wide potential applicability. We have developed a system to support the communication of older people with dementia, which uses this principle. The approach has uses in many settings in which there is a cognitive or emotional blockage to communicational flow, several of which are described.

Evaluation of staff training in psychosocial approaches to dementia typically reveals good knowledge at the end of the training but poor adoption and translation into practice after training ends. Here we describe our experiences piloting a training package designed to equip nursing home staff with the skills to communicate with residents with very advanced dementia who can no longer speak. We have previously described in this publication (PSIGE Newsletter 105, 2008) our first tentative attempt to use this approach to communication, which we call Adaptive Interaction, with a lady with very advanced dementia. Adaptive Interaction is based on Intensive Interaction, which uses the nonverbal fundamentals of communication as the basis for non-speech based interaction. We consider the challenges of enabling and supporting care home staff to adopt this approach and use it confidently and the lessons learnt for delivering similar psychosocial interventions in care settings.