Conversation Design: Can Amazon Echo Plus replace home health aides in care for US seniors in early stages of dementia?
Majority of elderly people prefer to age at home, and healthcare organizations and policy makers are challenged to better support long term care at elderly’s. [1]
Aging at home is especially important for the 4.7 million US dementia seniors [2], as they benefit from aging in their familiar home environment. [3]
They can fall into the early, middle and late stages of the disease. [4] In the early stages they can be discharged home after a hospital check, and home health aide can be offered as a caregiver [8]. A problem with human home caregivers, however, is that they will be insufficient in coming years and the ratio of caregivers to the elderly is decreasing. [9] Currently, technology is already used as a caregiver. [10] Robotic devices are capable of providing caregiving. [11] [12] With its current skills and functionalities, Amazon Echo Plus, powered by Amazon’s cloud-based voice service called Alexa should be considered a substitute to human caregiver in the early stages of dementia. [13]
I present arguments that favor the use of technological caregiver in the face of Echo Plus in the early stages of dementia.
Firstly, dementia seniors in the early stages of the disease can usually still take care of themselves but may forget things like taking pills and scheduled appointments, prompting the need for reminders. [14] [15]
Early dementia symptoms usually include memory and organizational difficulties. These problems result in omission of daily medicine intake and missed doctor appointments. Having reminder functionalities, Echo Plus can remind about health appointments and important events in senior’s calendar. Other reminders include various types of medicine intake reminders at certain times of the day. Echo is better than a human caregiver as health care aides are prone to mistakes, such as dose omission, incorrect drug, incorrect time drug is given, and wrong resident it is given to. [16] Even though this error occurs in nursing homes where they take care of 7 to 10 patients [17], home health aides also visit substantial number of patients per day — 5 to 6 [18].This increases the chances of mixing medicaments between patients, or forgetting to give the right ones at the right time. As for Echo Plus, Alexa saves reminders offline [19] meaning it is fully reliable and will never skip a daily dose reminder despite internet disruptions. Seniors have also created their unique profile in Alexa’s cloud.
Secondly, dementia seniors are concerned about the safety of their home environment and these concerns affect their peace and comfort at home [5]. They tend to forget to turn off appliances in their homes like stoves, as well as lights. [20] Luckily, smart homes powered by technology provide a safe environment and thus can alleviate the concerns. Alexa’s latest functionality, Hunches, offers increased home safety. Hunches will remind users to switch off lights or items when they are not in their usual state, or before going to sleep. [21] Echo Plus, powered by Alexa and being a smart home hub [22] can thus ensure safety by connecting to other home devices such as lights, in-wall switches, plugs, outlets and locks and remind of their state. [23] Additionally, Echo can connect to various thermostats [24] and small and large cooking appliances to remind of their state. Users can manipulate smart objects with their Echo even when the internet is down. [25] [26]
Thirdly, older adults with cognitive impairment are more likely to fall than their peers without cognitive impairment [6] Fortunately, Amazon Alexa has a market of apps called skills. In this market, users can download communication skills such as Ask my Buddy. With it, elderly can contact their close circle like family members to ask for help in the case of a fall or emergency. To do so, elders have to simply say Alexa, followed by the skill name and name of person who should be contacted [27] The skill is particularly useful, as health aides in early stages of dementia are available only for a few hours [28], whereas patients can ask Echo for help at any hour of the day.
Next, I present the arguments that favor the use of human caregiver in the early stages of dementia.
Firstly, even though Alexa can work offline and remind about medicine intake regularly and accurately, the technology is still prone to system issues. [28] Improper medicine intake is prevalent in 60 per cent of the elderly. Some middle stages of dementia appear to decline reading comprehension. [29] [30] Unlike Echo, human aides who are legally in charge of supervising and giving medicine to elderly [31] will be there at all of the above mentioned scenarios to remind seniors to take their pill or go to the doctor. They will also stop seniors from taking the wrong medication or help them find it.
Secondly, despite keeping the home environment safe in terms of technology and appliances use, smart homes cannot keep the environment safe from difficulties arising from motor disabilities. The progression of Alzheimer’s disease varies from patient to patient [7]. Seniors in moderate stages of dementia will require more assistance to safely carry out activities such as hygiene [32] including bathing, dressing, grooming, toileting, and subsequently with waking and eating [37]. Home health aides are qualified to see symptoms early and can judge when increased motor assistance is required. [33] Contrary to that, Amazon Alexa currently doesn’t have motion sensors or functionalities to measure the difficulty with which motor activities are carried out and thus judge that the safety concerns regarding home self-habituation have to be raised.
Thirdly, Alexa doesn’t have a fall or motion sensor. It relies on seniors saying certain words to initialize the “Ask my Buddy” skill. That is a big burden we put on dementia seniors. The risk of institutialisation after fall is increased 5 times among dementia patients [4] and might result in death, as it can lead to major fall-related injuries. A fall can also lead to language and communication disorder. It can also lead to the inability to carry out a motor act despite intact motor and sensory pathways [34]. Broca’s aphasia, the most common type of traumatic brain injury (TBI) [34] results in difficulty to produce senstences. [35] As Alexa accepts sentence-structured input only, she might not be able to understand senior’s long request required to use the skill. Memory loss increases the chances that the Alexa wake word or skill name will be forgotten. Despite the few hours they are present in the home, Home health aides will be there to prevent falls, call an ambulance right away and cover first aid courses [36].
To sum it up
Despite the ability of Amazon echo to cover all memory loss related issues for elderly in early stages of dementia, dementia is bound to progress to moderate stages at different speed for different individuals. Once it progresses, help with basic daily activities supplied by health aide might come earlier for some than others. A health aide is needed to observe the day-to-day changes and to start offering more assistance to the senior.
Falls remain frequent and dangerous for dementia seniors as they can lead to death. The current Alexa skills cannot replace a human who can report regardless of person’s condition after the fall and even offer first aid. Despite the 24 hour availability of Echo Plus, given the current capabilities of Amazon Echo the two reasons above mentioned come to show that despite promising in the first stage of dementia, Echo cannot be the sole caregiver and replace hourly health aide for conditions such as dementia that is bound to progress at unexpected rate.
I am fully optimistic that Amazon’s solution to meeting the needs of dementia patients is just around the corner. My belief is based on the fact that Amazon is supposedly building a ‘health & wellness’ team as it aims to upend health care for new mothers and people with diabetes. Now, more than ever, we can and should focus on upending dementia patients’ care next :) Dear Amazon, I volunteer my time to make this happen!
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References
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