February 2, 1995: Vol26n15: Devices to help Alzheimer's patients don't keep pace with progress of 

By LOIS BAKER
News Bureau Staff
Ronald Reagan's position, prestige and economic resources can't
guarantee he'll have the devices necessary to maintain maximum
independence as his Alzheimer's disease progresses.
	The reason? Most existing devices for patients with dementia
aren't designed to remain useful as mental health deteriorates, a UB
study has shown. It is the first study to assess the use of assistive
devices by elderly persons with Alzheimer's disease and other
cognitive impairments.
	Results of the study, conducted by researchers in UB's
Rehabilitation Engineering Research Center on Aging, showed that
elderly persons with cognitive impairments living at home were using
fewer devices after a follow-up at one year than at the beginning of
the study, even though their need for helpful devices had increased
due to declining health and cognitive status. 
 	"Obviously we are not making devices that are as useful as
they should be," said William C. Mann, director of the center,
professor and chair of the UB Department of Occupational Therapy and
lead researcher on the study. "We need to develop more 'smart' devices
and devices that will remain useful longer, as cognitive health
declines."
	Results of the study were reported at a meeting of the
Gerontology Society of America.
	Baseline data for the study came from the center's Consumer
Assessments Study, an analysis of the types of assistive devices used
by the elderly, assembled from personal interviews with 90 people and
their caregivers. The study reported at the meeting was based on a
31-person subset of this group, all with cognitive impairments and
living in a home setting. Mann and colleagues will follow this group
for five years to provide direction for new device development and
improvement of existing devices.
	At baseline, this group was using an average of six devices
per person. More than half were physical rather than cognitive aids, a
not-surprising finding, Mann noted, because older people with dementia
typically have many diseases, and these afflictions can affect
physical abilities and sensory systems.
	The cognitive devices that were used, such as restraints,
doorknob covers, barricades, written schedules and reminder signs,
related mainly to safety and memory loss.
	Nineteen persons remained in the study at the end of the first
year. Most of the other 12 had moved into nursing homes. These 19 were
using 20 percent fewer devices at follow-up, Mann said. 
	"The use of assistive devices and home modifications offers
the potential for greater independence for older persons with
impairments, yet elders with dementia use fewer assistive devices and
have a higher rate of dissatisfaction than elders with other types of
impairments," he said.
	He asserted that much more can be done to adapt devices to
patients' declining mental status, advocating creation of more "smart
appliances," such as the microwave oven being developed by UB and
others that reads the bar code on a product, sets cooking time and
power level, starts when food is placed in the oven and has voice
capability to describe the food being prepared.
	The study results also showed that family caregivers need to
know more about using devices and adapting the home to make life
easier. 
	Interviews indicated that, collectively, caregivers had tried
a total of 18 interventions, mostly desperate attempts to keep the
person confined, such as removing doorknobs to prevent unsupervised
wandering.
	"To us, this reflects a lack of counseling," he said. "There
are creative ways to address these problems such as...camouflaging the
door." This could be done, he explained, by placing a poster over the
door or painting it to blend with the wall and camouflaging the
doorknob.