Hello
I'm Corina Sas from Lancaster Univeristy
On behalf of my co-authors
i'm delighted to share our work
on how wall-sized displays were used in a dementia care home to support stimulation needs.
Our rationale is threefold
The concern for cognitive decline in dementia
has been addressed mostly through cognitive stimulation for reminiscing
and often on small screens.
Therefore
there is an unexplored design space
for supporting not just cognitive
but also sensory stimulation
through large displays
which allow for enjoyment, immersion, and arousal.
By sensory stimulation we mean
immediate, nonverbal engagement with the world through one's senses.
Our project also builds on the care home owner's interest in experimenting
and adopting new technologies to improve their provision of care.
To explore this opportunity, we focused on three research questions.
How do wall sized displays integrate into residential care homes?
What media content do they display?
or what informal psychosocial interventions do they inspire?
To address our objectives, we built the DementiaWall prototype,
consisting of 9 high quality displays
arranged in a 3x3, L shape grid.
Its height is 2m and length 2.4m
For the care staff
we provided a standard Google Chrome web browser
on a Windows 10 PC
with a stereo speaker system, and wireless keyboard.
The study took place over a year-long deployment
in a residential care home, where we made quarterly visits.
We ran 24 contextual interviews
with the care staff, family members
and 1 resident able to provide informed consent.
Through the interviews, we explored the use and experience of DementiaWall,
the psychosocial interventions it inspired,
their benefits, and ways in which the display has impacted the care home's practices.
Given that traditionally,
public displays have shown limited engagement and adoption,
with novelty lasting less than 6 months,
a key finding is the significant engagement and adoption of the DementiaWall.
Our log data
indicates that is was extensively used
for about 8 hours daily
usually from 9am to 5pm
and even more frequently after 8pm towards the end of the year,
benefiting resident's needs in the evening when they are tired or agitated.
This engagement led to increased use of the room
by residents and visiting families
as it became integrated in their routines
The led to a strong attachement to the DementiaWall
expressed by most participants
together with concerns for having it removed at the end of the project
DementiaWall also impacted on the residential care home
both the house itself, and the care practices.
We have found 5 domestication activities
Setting up and maintaining DementiaWall
plus 3 activities for co-designing informal interventions
Each involved configurations of social actors such as families, residents, and researchers
with the care staff driving this co-design stage.
Digital plumbing refers to the work we do to setup and maintain novel technologies in our homes
but has received limited consideration in sensitive settings.
Concerning the setup
We made careful choices together with the care home owners
regarding the placement, size, and shape of the display.
With respect to the maintenance
we provided remote support through desktop access and over-the-phone/email troubleshooting
A key finding is the underlying theme of personhood informing the overall approach to dementia care
both traditional interventions and novel ones inspired by the DementiaWall
An important outcome is that DementiaWall was open for exploration
as encouraged by the care home owners
like in this quote:
We have got a few carers that come up with ideas
prompted by the screen
I think that we have become more creative realising more things you could do
This democratic engagement included family members
who became curators of their loved one's photos
which were displayed by the care staff
either in family restricted settings, or with other residents.
This exploration was guided by the care staff's monitoring of resident's needs
in order to curate the most appropriate content
for their wellbeing, like in this quote:
It is experimental really
figuring out what works, what doesn't
we can change it day to day
if we see something works marvelously one time and then the next time
it doesn't work at all
because people change ... different moods on different days.
The media content was mostly videos from online sources such as YouTube
that can be grouped in 3 main categories:
Nature inspired such as: seaside, forests, countryside, flowers, foliage, birds
Entertainment such as: films, music, dance, and sports
Past lived lives
and inhabited places such as cities and buildings
DementiaWall has inspired four types of informal psychosocial interventions
supporting sensory, emotional, social, and cognitive stimulation.
An important outcome is the value of nature-based content
such as videos of seascapes and forest landscapes for mood regulation
Videos of sunny white beaches and waves breaking gently on the shore
were particularly useful helping residents in agitated states
to calm down and relax as shown in this quote:
with severe dementia
there is a lot of walking, so that
one resident almost exhausts herself
but
with the right image she would relax almost instantaneously
shoulders would drop and she would sit and look at the screen
Other interventions involved bringing to life
no longer accessible experiences
such as those of being in the cinema, resturant, or church
like in this quote:
She knows the church
and she was sort of sitting there
looking at it like there was a very familiar environment
she must have felt as if she was in the church
this one family member said.
The shown movies, in cinema-like experiences
provided enjoyment and reminiscing
but rather than involving conversations
these experiences support sensory and social stimulation
or what one family member called "comfortable silence"
Is a bit liberating when you can actually sit
and just watch in a relaxed atmosphere
now, she's more relaxing, she enjoys the visits better
Our findings led to 4 key insights
DementiaWall supported personhood by providing residents with choices for interaction
These were both explicit through: choosing to be in the room to
watch the display or request specific content;
as well as tacit
as their interests and moods informed the care staff's choice of tailored content.
These outcomes are significant. given that having one's personal interests accounted for
may be more important for personhood in dementia than the decision making itself.
DementiaWall was used for group reminiscing
generic content was also collectively relevant
showing shared generational experiences and identities
of housewives in post World War II, as most of the residents were.
This, what we called collectively relevant content,
sits between generic and personal content, challenging their distinction.
In contrast to generic content
personal one was much less used
due to its confidentiality issues regarding its consumption in a public room
However,
we have seen instances of novel uses of private photos
viewed only by the resident and her family in a restricted public context.
This indicates the need for more nuanced understandings of sharing practices for vulnerable users.
We highlight the importance of participatory design and research approach.
This allowed for co-created naturalistic interventions,
led by the care staff
and outside our influence as researchers and our academic privilege.
Ownership,
as a key aspect of participatory research
also surfaced as DementiaWall became part of the fabric of the care home.
Its cost is beyond the reach of most care facilities,
raising challenges for sustainable use.
Therefore,
we made a commitment to extend its use
until we provide alternative cost-effective solutions
to ensure sustained capacity for our collaboration
as a key aspect of participatory research.
We define 'infrastructure-based prototype'
as a "blank canvas"
on which users, as curators of content, can draw on.
They are in fact large-scale infrastructures deployed for continuous long-term use,
in real settings,
to support a generic functionality
whose content can be creatively explored for different social practices.
Our findings, challenge the dichotomy between
traditional prototypes as implemented tools for evaluation,
and generative ones for playful exploration of the design space.
Indeed,
the DementiaWall was used for both evaluation and generative purposes,
leading to strong attachment, and creative appropriation
for novel uses such as psychosocial interventions.
We can think of other scenarios decoupling function from content generation,
that could be used to explore the value for future research of what we called:
infrastructure-based prototypes.
To conclude,
our exploration suggests the value of large displays
for personhood in dementia
which has been supported by specific interventions
addressing distinct stimulation needs.
Thank you