Aging in Place with ADRD

Product Design Case Study

A smart-home technology solution to support care partners and their care recipients having early stage Alzheimer's Disease & Related Dementia

Context

For the capstone project, we collaborated with IQ Solutions to understand aging in place for individuals having early-stage Alzheimer's Disease & Related Dementia, and their care partners.

Project Focus:

• Understand the needs and challenges of individuals with ADRD for in-home support and remote monitoring for their carepartners.
• Design solutions using off-the-shelf smart technologies to support both populations.

Client: IQ Solutions

Role: Lead Researcher

Team: Dawson Hoppes, Dhruvi Patel, Mishi Soni, Naishi Jain, Sravya Amancherla, Zora Moore

Methods & Tools: Contextual Design, Sketch

Duration: 8 Months (On-going)

Challenge

Currently, it is estimated that over 5 million people in the U.S. are afflicted with Alzheimer's disease & (or) related dementias (AD/ADRD), and this number is increasing. The extensive care needs of persons with AD/ADRD are variable, and care involves great demands on care partners. Family care partners may experience both adverse health consequences and economic hardship because of lost work and care expenditures.

Development of effective, technology-based interventions is needed to reduce the burden of caregiving and delay nursing home placement for persons with AD/ADRD.  A broad range of assistive technologies could help improve the lives of persons with AD/ADRD and their care partners.

Support in aging in place for individuals with early-stage ADRD and their care partners.

Research Process

Background Research

Literature Review

We surveyed 71 research papers and articles and identified key 6 themes to consider when designing technology solutions for individuals with ADRD & their care partners.

01 Safety v/s Autonomy

The two populations involved have clashing priorities. Caregiving is more challenging, when monitoring remotely. And activities that support independent living are linked to improved quality of life and empowerment. Hence, a right balance needs to be maintained between autonomy and safety.

02 Holistic Care

Lack of holistic support can lead to loneliness and boredom. Systems should focus on catering to the medical and social needs of the care recipient and care partner through social participation, and leisure. They should educate carepartners on how to provide care while looking out for their own well being. 

03 Personlization

Conditions, homes, and needs of people with ADRD are very specific. The needs and abilities of the care partners can also vary dramatically. Therefore systems should be flexible and should have the ability to be personalized, changed, and adapted over time as the condition grows. 

04 Care Partner Burden

Personizable systems put additional responsibility on the care partners as they now have to take extra time to set up the system as per their needs. Systems should be easily learnbale, and user friendly. Clinicians can be looped in, to the set up the system as per the individual's needs and abilities.

05 Integrated Care

Putting unfamiliar devices into a person’s living environment can cause them anxiety, and make them more aware that they are being monitored. Systems should be well integrated into the individual’s environment instead of being in focus.

06 Social over Medical Model

While we should acknowledge an individual's capabilities and limitations, we shouldn’t “dumb” down the system because of their limitations. Systems should move away from the illness narrative and should leverage their proficiencies, preferences, and passions.

Technology Environment Scan

We identified off-the-shelf smart technology devices that can be leveraged in our solution.

Wearables

• Oura Ring
• Token Ring
• Echo Loop
• Smart Watches

Smart Speakers

• Google Home
• Amazon Echo
• Facebook Portal

Activity Sensors

• Sensors for Motion
• Biomarkers 
• Temperature

Smart Home Systems

• Apple Homekit
• Google Nest

Competitor Analysis

We conducted a competitor analysis and identified 3 products that are targeting similar populations as IQS.

Presence Family Care Pack

It supports specific behaviors of people with ADRD such as falls and wandering  through their system of sensors.

Life Pod

It promotes virtual companionship between a remote caregiver and recipient by enabling proactive-voice check-ins.

HandsFree Health's WellBe

It provides a rich database of health-related information on its consumer health platform.

User Research

Retrospective Contextual Inquiries with 6 Care Partners.

Interview Focus

• Understand the care partner’s involvement in the daily life of the care recipient (Extent & Activities).
• Learn about the technologies currently used to support the care recipient and monitor their health and wellbeing.
• Understand the participant’s needs and challenges with in-person and remote caregiving.
• Understand their thoughts on adopting smart technologies to support caregiving

Selected Key Themes

01 External Assistace in Caregiving

Doctors, Clinicians, Healthcare Workers, Support Groups                To plan ahead to support the progression of the condition.

Family & Friends                                To make conversation and provide quick assistance when they are in contact with the CR.

02 Pre-Post Diagnosis Relationship with CP

"I don’t want caregiving to be the main focus of our relationship"       

To keep things as they were before, they try to do fun activities with their CR, communicate like they used to before, and keep them distracted by not reminding them of their condition. They also try to keep the CR's mind active. 

03 Negative Perception of Tech

"I like writing things down as my CR remembers better this way"    

They are wary of using it as they suspect their devices being hacked. Considering the age bracket of the care recipients, care partners are not confident about adoption of technology by the CR. Some CPs think that technology makes people lazy.

Analysis & Synthesis

Affinity Diagram

We analysed the interviews to create an affinity diagram revealing the key themes and pattern in the data.

Affinity Diagram

Identity Elements of a Care Partner

In order to better design for our target audience, we identified 9 identity elements of the care partners. The elements can be categorized into 3 groups - 'I Am', 'I Want', 'I Do'. These groups help us understand different aspects of a care partner.

Identity Elements

A Day in Life of a Care Partner

The day of a carepartner is one that weaves between completing their daily tasks while monitoring and supporting their recipient.

Using our research insights, we built a model that shows the day in the life of a carepartner. The top of the model lays out the daily routine of a carepartner, and shows the personal responsibilities they have to manage. (I.e. work, shopping, social life, etc.) The bottom half of the models shows their caregiving responsibilities.

Key

Insights

Checking - In

“My care recipient manages their own medication, but I like to check to pill box later in the day to see if they took their meds.”

Caregiving is Part of My Life

“I manage my time and make sure my caregiving breaks don’t affect my workflow.”

Tech is Part of My Routine

"I use tech in my routine for checking-in, monitoring, planning, controlling house etc."

Tech Keeps Me in the Loop

“If my care recipient didn’t have Alzheimer's I wouldn’t be as connected to technology.”

Tech Makes Caregiving Easier

" I use technology for electronic Calendars, scheduling appointments, reminders etc."

Ideation & Product Concepts

Based on the insights gathered through research, we ideated two product concepts.

  Care+

A mobile application that leverages smart speakers to provide assistance with various caregiving activities and regular subtle check-ins. It can be integrated with any smart speaker device such as Amazon Echo or Google Home.

Features:

• Personalizable Routine Template: It provides specific templates for people with ADRD. These templates can be personalized based on the needs of the CR.
• Live Activity Updates: It allows the carepartner to view their care receiver’s daily activities. It also provides alerts/notification to the carepartner for specific incidents that might require the care partner’s attention.

Care Loop

A smart ring which can be integrated with any smart-home device

Features:

• It uses the framework of time-task-proximity
• The smart-home device detects the location of the care receiver using the smart ring  
• The care receiver will get alerts/notification about different tasks/activities based on their location

Next Steps

• Contextual Interviews with individuals having ADRD in order to learn their perspective on aging in place.
  
• Co-design with both populations to brainstorm and generate design ideas
  
• Design and evaluation of the final solution.
  

Learnings

Methods

• Foundational Research: I found the process of conducting foundational research quite daunting as the path was not as clear and straight forward. This experience taught me to trust the process.
• Literature Review: The process of segregating the resources into themes and then consolidating relevant data from across 71 research papers and articles into over-arching themes, was challenging.
• Competitive Analysis: Since the product catered to a niche population, it was important to identify the direct competitors and their unique selling points.

Domain Knowledge

• Alzheimer's disease & related dementia: To be able to understand the needs, motivations and challenges of our target population better, and to be able to have an intelligent conversation with our interviewees, it was essential to gain some knowledge about the condition.
  
• Smart Technology: Since the product we are designing needs to leverage off the shelf smart technology devices, it was important to get a sense of the current landscape of smart technology.
  
• Inclusive Vocabulary: I learnt the vocabulary essential for inclusive design. Eg. Usage of the term 'Individuals with ADRD' instead of 'Patients'

Skills

•  Empathy: Working for/with this particular population (Care partners in their mid 40s - 50s & Care recipients in their 80s) has improved my sense of empathy and inclusivity.
  
• Client Interaction: I learnt to effectively communicate expectations, requirements, challenges and deliverables, with the client, thus maximizing the productivity of every meeting and judiciously using their time.
  
• Time Management: Managing time through the IRB approval process - We were strategic in working through our IRB approval process by submitting an initial application with only care partners as the target population, as approval for sensitive populations can be time consuming. We utilized our wait-time efficiently by conducting an extensive literature review to supplement the user research.
  

Team from University of Maryland with the IQS Team

Let's Connect

I am available for full-time opportunities starting June 2020.

If you are interested in working together, I'd love to connect with you!

LinkedIn / About me / naishi.jain@gmail.com