Cover Story

Imagine living in a home for 50 years or more, then suddenly having to leave it behind, along with many of your friends, neighbors, possessions and creature comforts--moving not just to a new neighborhood but perhaps a new city or state. Many older adults don't have to imagine it--they've lived it.

Seriously ill or just in need of a little daily assistance, they've had to move to assisted living or a long-term care facility. But what if they didn't have to move? What if a few technological tools could assist them with daily tasks and help maintain their independence?

Finding and testing such tools is the goal of psychologists equipping people with medical technology that allows them to stay in their homes. And, because assisted living is sometimes the only option, other psychologists are working to make assisted living more home-like and helpful: One effort involves a community centered on wellness; another involves applying the Montessori method with dementia patients.

More than a smart house

For example, in the "Aware Home" on the Georgia Institute of Technology campus, psychologist Wendy A. Rogers, PhD, and her colleagues are testing new technologies to bolster seniors' comfort and safety. The home is part of the National Institute on Aging's Center for Research and Education on Aging and Technology Enhancement (CREATE), a project exploring technology and human interaction.

Traditional smart-home technology allows users to program and control the house's security, temperature, lighting and other electrical appliances through a central system, which is often remotely accessible. The CREATE team takes a more personal approach.

"The idea behind Aware Home is to build computer intelligence into the home environment and go beyond the traditional smart home by being aware of people's needs and supporting them," says Rogers. His team tests tools such as the "Technology Coach" to teach older adults to use home medical devices such as glucose meters. The tool tracks their use of a given device--through video, for example--and gives ongoing feedback. The "Memory Mirror" uses radio frequency identification to log when a person uses medication, car keys and the like. The user can locate lost objects by consulting the log.

CREATE technologies also involve relatives of the main user: Reminiscent of those magical moving paintings from "Harry Potter," the "Digital Family Portrait" is a family picture that changes from day to day. Relatives place their older loved one's picture in a digital frame that will display information about that person's general movements, activity level and even the weather outside. Research trials on several hundred people over the last five years reveal the technologies effectively aid users, and that users like them. The Rogers team also uses the data to create new designs and make changes to existing devices.

"I have been surprised at how open older adults are to new technology--contrary to the stereotype," she says. "The key is that they need to know, 'Why is this useful to me?'" And although the technology may seem slightly intrusive, Rogers says that the older adults she's talked to are willing to make the tradeoff for greater peace of mind and staving off assisted living.

Some products are currently being tested by companies and might be available in the next few years, says Rogers. Other products are longer-term projects, and it may be five to 10 years before they come to fruition, she adds.

A different kind of retirement community

"What if we think of housing as not just a box, but something that can promote meaning, wellness, physical self-care and connection?" That question, posed by Sara Honn Qualls, PhD, has prompted her collaboration with a retirement community developer.

Qualls, a psychology professor and director of the gerontology center at the University of Colorado at Colorado Springs, is working with a local developer to see if a little technology and a lot of human interaction can promote well-being among independent and assisted-living clients.

The development will not have a long-term care facility, but will be part independent living units and part assisted living. The goal is to focus on wellness by working directly with patients and matching them with resources or services they need, says Qualls. The community will provide some assisted-living services, as needed, to independent living clients, so that they can stay in one place as long as possible. The staff will give all clients a health and wellness exam on arriving, and every six months thereafter, to determine their general health, strength, stamina, mobility and cognitive function. Staff incorporate the evaluations into online health records accessible from residents' living quarters. Local health-care providers and the community's acute care center can input information. Residents can use these records when they meet with a staff coordinator functioning as a lifestyle coach aiding them with health and wellness. The development will also feature an onsite medical center for preventive care and fitness programs for strength building and maintenance.

The development will also offer mentally stimulating activities like book clubs, film discussion groups and community volunteering.

In addition, rooms will be equipped with big Web TV screens through which residents can access their medical records, entertainment and perhaps short streaming-video exercise programs, or announcements of group dinners or other social events, says Qualls.

Designers hope these and other amenities such as spa services, a pub and a coffee shop bolster residents' quality of life. "We hope that the living environment can actually promote well-being and not just be a place to provide services when people deteriorate," says Qualls.

Better care for all

Another psychologist has created a program for seniors who need more than wellness programs and technological assistance. Cameron Camp, PhD, director and senior research scientist at the Myers Institute for Research in Cleveland, has done extensive research engaging people with dementia by applying the Montessori method.

"We basically use Maria Montessori's principles as our principles--they're good rehabilitation principles," Camp says. Montessori learning tasks are tailored to level of ability, broken into stages from simplest to most complex, and very structured. The method also emphasizes engagement of all the senses and the use of external cues to prompt learning. Camp used these principles to create activities for patients with dementia that provide social, sensory and cognitive stimulation. In numerous research studies conducted during the last 10 years, he has found that these techniques improve verbal and motor activity in dementia patients. In addition, because the activities involve familiar materials and provide sensory input, they can often stimulate patients' memories. For more information on Camp's research, see the "Further Reading" section below.

"We want to be able to create meaningful social roles and focus on the strengths that remain," he says.

Camp has designed numerous training manuals and says the method can be applied in long-term care, assisted living and adult day care. For instance, rehabilitation staff might teach patients simple tasks like sorting pictures or objects according to color or category to stimulate motor skills. Or, to encourage patient interaction and bolster their self-esteem, staff might involve them in an activity such as a food drive. Myers Institute staff also design large-print books or other reading materials for patients with dementia and train them to discuss what they've read.

"It cues their memory, recall and curiosity," says Camp.

Staff adapt activities for different levels of difficulty and stages of dementia, he adds. Performing such tasks on their own gives them a sense of accomplishment, and, by engaging them, helps reduce problem behavior

"A person with dementia lives in the moment; we need to provide as many good moments as possible," Camp stresses.

Further Reading

  • Camp, C.J., & Skrainer, M.J. (2004). Resident-assisted Montessori programming (RAMP): Training persons with dementia to serve as group activity leaders. Gerontologist, 4, 426-431.

  • Camp, C.J., & Schneider, N.M. (2002). Use of Montessori-based activities by visitors of nursing home residents with dementia. Clinical Gerontology, 26, 71-84.

  • Judge, K.S., Camp, C.J., & Orsulic-Jeras, S. (2000). Use of Montessori-based activities for clients with dementia in adult day care: Effects on engagement. American Journal of Alzheimer's Disease, 15, 42-46.

  • Kleespies, P.M. (2003). Life and death decisions: Psychological and ethical considerations in end-of-life care. Washington, DC: American Psychological Association.

  • Orsulic-Jeras, S., Schneider, N.M., Camp, C.J., Nicholson, P., & Helbig, M. (2001). Montessori-based dementia activities in long-term care: Training and implementation. Activities, Adaptation & Aging, 25, 107-120.

  • Orsulic-Jeras, S., Judge, K.S. & Camp, C.J. (2000). Montessori-based activities for long-term care residents with advanced dementia: Effects on engagement and affect. Gerontologist, 40, 107-111.

  • Werth, J.L., Jr., & Blevins, D. (Eds.). (2005). Psychosocial issues near the end of life: A resource for professional care providers. Washington, DC: American Psychological Association.