Research & Publications

Evaluation of a Digital Companion for Older Adults with Mild Cognitive Impairment

Jan 1, 2016

Abstract

Study Objective: The purpose of this study was to examine the feasibility of a digital companion system used by older adults with mild cognitive impairment (MCI). We utilized a commercially available system that is comprehensive in its functionalities (including conversation ability, use of pictures and other media, and reminders) to explore the system’s impact on older adults ‘ social interactions, anxiety, depressive symptoms, and acceptance of the system.


Study Design: We conducted a three-month mixed methods evaluation study of the digital companion.


Results: Ten female community-dwelling older adults (average age 78.3 years) participated in the study. Overall, participants utilized the tool regularly and appreciated its presence and their interactions. Participants scored higher at the end of the study in cognition and social support scales, and lower in presence of depressive symptoms.


Conclusion: Findings indicate the feasibility of a digital companion for people with MCI and inform the need for additional research.


 

Introduction


In recent years, various information and communication technology (ICT) applications have been developed in order to engage older adults with cognitive impairments in entertainment or reminiscence therapy or to simply provide a forum for interactive and tailored engagement. The types of applications available can be grouped into those that mitigate specific impairments of their target users, such as motor impairments or memory deficits, and those that take advantage of and aim to maximize continuing abilities. Technology has been used accommodate motor impairments and aid interaction through commercially available gaming devices, touch screens, and prototype devices. The MINWii videogame employed a Wii remote as an input device to accommodate motor impairments of users who might not otherwise be able to play the game.1, 2 Shik, Yue, and Tang (2009) used headphones and amplifiers to accommodate hearing impairments and projectors to magnify photographs to accommodate vision impairments.3 Other systems may gather, for example, materials from the users’ daily activities using technology, such as GPS, cameras, and audio recorders, to compensate for memory deficits).4-6 Tools have been designed to alleviate caregiver strain originating from the need to repeatedly provide details to help someone with dementia recall facts about events during casual reminiscence.6 Yamagami and colleagues used a video at the beginning of a session with the ICT to remind participants how to use tools. The participants then showed staff how to use these tools, reversing the roles of staff as helper to resident as helper. By using a video instead of having staff instruct the residents, this role reversal was possible.7


Certain skills, such as sensory awareness, musical responsiveness, and emotional memory, have been labeled “continuing abilities” in dementia, as they are thought to persist after others have been compromised by the disease.8 Sensory awareness is the response to various forms of stimuli (e.g., visual, audio, tactile). Musical responsiveness refers to the strong responses people with dementia can have to music. Emotional memory refers to the ability to experience rich emotions. Technology is commonly used to encourage and draw out these continuing abilities. Such as through the display of movies, photographs, and audio that elicit sensory or emotional responses. Many systems that promote reminiscence with people with dementia use technology solely for this purpose.9 Media are used as triggers to prompt a positive response in the form of interactions or improved mood. Reminiscence systems that focus on emotional memory appeal to something personally relevant to the individual user. This ranges from materials that are personal only in that they are from the general era in which one grew up to artifacts related to individual interests10 or even objects that belonged to the individual.11


ICT tools that integrate one or more of the functionalities described above can provide an integrated system that is meant to not only engage older adults in specific activities and tasks but also create an opportunity to address social isolation and loneliness. The effects of loneliness and social isolation are well documented for older adults; a recent meta-analysis of 148 longitudinal studies reported a 50% reduction in the likelihood of mortality over a period of 7.5 years for individuals with strong social relationships.12 Social isolation is negatively associated with health status and health-related quality of life of older people with effects magnified among older adults with dementia.13 ICT applications that address loneliness and social isolation often have anthropomorphic or animal features in order to generate a likeness to a friend or pet, and are referred to as digital companions. An older adult can interact with such a digital companion both at pre-programmed times (for example, when reminders or other messages are sent) as well as at the discretion of the user. Conversations can range from simple exchange of messages to sophisticated discussions depending on the system’s features and the level of machine learning algorithms, artificial intelligence or human response involved at the other end.


Digital companion tools are also referred to as Embodied Conversational Agents (ECAs). ECAs interact with users through verbal and non-verbal behavior cues such as prosody (pacing and intonation) and hand movements.14 A small number of studies have emerged examining the use of digital companions or ECAs. Bickmore et al. (2013) created a virtual laboratory to study users’ reactions. Elderly participants interacted with an ECA acting as an exercise coach. Results showed that users who interacted with an ECA that used variable dialogue exercised significantly more than those interacting with an ECA with non-variable dialogue.15 Vardoulakis et al. also investigated the use of an agent to provide social support and wellness counseling for older adults.16 A system was constructed that allowed research assistants to control an ECA placed in an older adult’s home in real time. Qualitative analysis of the interactions identified multiple topics that older adults liked discussing with the agent and general design principles towards building future companion agents for older adults.16


While these studies have introduced insight into the potential of digital companion tools, the vast majority of them have been tested within laboratory settings, where older adults were unable to interact with the system over a long period in a naturalistic setting, or only tested with one user only. Furthermore, these studies are not longitudinal and for the most part rely on assessment of the system when it is used once or for a limited number of times. Finally, most of these digital companions either provided simply opportunity for conversation, or focused on one aspect of interaction by showing pictures or other media or served a single purpose (for example, exercise coaching or reminding of upcoming events and medication).


The purpose of this study is to examine the feasibility of digital companion systems in real world settings used by older adults with mild cognitive impairment in their natural environment and for a longer period of time. For this purpose we utilized a system that is comprehensive in its functionalities (including conversation ability, use of pictures and other media, and reminders) to explore the system’s impact on older adults’ social interactions, anxiety and depressive symptoms, and participants’ acceptance of the system.