LTC Resources - Interview with Marcia J. Scherer

From wheelchairs to hearing aids, assistive technology has long been a staple of caring for older adults with disabilities; however, for elders with cognitive impairment, including those with Alzheimer’s disease and brain injury, there are numerous barriers to successful implementation of an assistive technology. In Assistive Technologies and Other Supports for People With Brain Impairments, Marcia J. Scherer, PhD, MPH, FACRM, professor of physical medicine and rehabilitation, University of Rochester Medical Center, NY, discusses an array of assistive and cognitive support technologies, advises methods of implementation using real-life situations, and provides other resources for long-term care providers, caregivers, and families of elders with cognitive disabilities. Annals of Long-Term Care^® (ALTC) had the opportunity to interview Scherer about the importance and challenges of providing assistive technology to elders with cognitive impairment.

ALTC: What are some examples of assistive technologies that are available to elders with cognitive impairment?

Scherer: Depending on individual needs and preferences, elderly individuals with dementia, traumatic or acquired brain injury, or those who have survived a stroke can potentially benefit from everyday technologies that provide personal assistance (ie, wristwatch, SmartPhone), and from specialized technologies (ie, e-pill alarm watch). Which one, or combination, is most appropriate for an individual requires an early and comprehensive assessment. For example, an Apple iPhone has many helpful features for individuals with cognitive disability and specialized applications can be obtained, but the phone has a small screen, small keys, and the complexity may make it less useful for some individuals with cognitive disability, those who have poor motor control, and those with poor eyesight. An alternative is the Jitterbug^® phone (www.greatcall.com), which has a simpler interface, large keypad with yes/no action buttons (ie, no confusing icons), and a speaker with an ear pad that is also compatible with hearing aids. Many other examples of products are given in the book.

What are the advantages and disadvantages of using everyday technologies versus specialized technologies?

In general, everyday technologies tend to be more affordable and look like products everyone else uses, thus avoiding the stigma of using support from a device. However, they most likely will not be paid for by health insurance and, because they are made for the “average user,” they may not be as useful for those with particular needs. The advantages of specialized technologies are that they are likely to be paid for by health insurance, the products tend to be very durable (can withstand being dropped, having moisture get inside, etc), and they have strong support services and warranties. They tend to work better for persons with complex needs. But because they are specialized, they look different from everyday technologies and their cost may be high.

How can integration of an assistive technology create a higher quality of life for elders?

Successful integration is the key phrase. When older adults are provided with the support that best matches their needs and priorities, doesn’t interfere too much with their daily routine, and helps them realize benefit from use, then their functioning, confidence, and sense of control tend to increase. This is fundamental to subjective quality of life. The most effective support may be personal assistance, strategies, or technologies—most commonly, a combination of these. Too often we see non-use, abandonment, or frustration with support devices. When this occurs, it usually arises from a poor match of person and technology or other form of support. This can easily be prevented by getting to know the individual and using a systematic process for support selection. The book describes a complete process for accomplishing this (with accompanying questions to ask) as well as following up to determine realization of benefit from use of the support.

“Assistive Technologies and Other Supports for People With Brain Impairment” was published by Springer Publishing Company, New York, NY, in December 2011. Scherer is also president and director, Institute for Matching Person & Technology, Webster, NY. Learn more about Scherer’s work with the Institute at https://matchingpersonandtechnology.com.