Research article

The COACH prompting system to assist older adults with dementia through handwashing: An efficacy study

Alex Mihailidis^1,2* , Jennifer N Boger^1,2* , Tammy Craig¹ and Jesse Hoey³

¹  Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada

²  Toronto Rehabilitation Institute, Toronto, ON, Canada

³  School of Computing, University of Dundee, Dundee, UK

author email corresponding author email* Contributed equally

BMC Geriatrics 2008, 8:28doi:10.1186/1471-2318-8-28

Published:	7 November 2008

Abstract

Background

Many older adults with dementia require constant assistance from a caregiver when completing activities of daily living (ADL). This study examines the efficacy of a computerized device intended to assist people with dementia through ADL, while reducing caregiver burden. The device, called COACH, uses artificial intelligence to autonomously guide an older adult with dementia through the ADL using audio and/or audio-video prompts.

Methods

Six older adults with moderate-to-severe dementia participated in this study. Handwashing was chosen as the target ADL. A single subject research design was used with two alternating baseline (COACH not used) and intervention (COACH used) phases. The data were analyzed to investigate the impact of COACH on the participants' independence and caregiver burden as well as COACH's overall performance for the activity of handwashing.

Results

Participants with moderate-level dementia were able to complete an average of 11% more handwashing steps independently and required 60% fewer interactions with a human caregiver when COACH was in use. Four of the participants achieved complete or very close to complete independence. Interestingly, participants' MMSE scores did not appear to robustly coincide with handwashing performance and/or responsiveness to COACH; other idiosyncrasies of each individual seem to play a stronger role. While the majority (78%) of COACH's actions were considered clinically correct, areas for improvement were identified.

Conclusion

The COACH system shows promise as a tool to help support older adults with moderate-levels of dementia and their caregivers. These findings reinforce the need for flexibility and dynamic personalization in devices designed to assist older adults with dementia. After addressing identified improvements, the authors plan to run clinical trials with a sample of community-dwelling older adults and caregivers.