title: The COACH prompting system to assist older adults with dementia through handwashing: an efficacy study.
abstract: BACKGROUND
  Many older adults with dementia require constant assistance from a caregiver when completing activities of daily living (ADL). This study examines the efficacy of a computerized device intended to assist people with dementia through ADL, while reducing caregiver burden. The device, called COACH, uses artificial intelligence to autonomously guide an older adult with dementia through the ADL using audio and/or audio-video prompts.
  
  
  METHODS
  Six older adults with moderate-to-severe dementia participated in this study. Handwashing was chosen as the target ADL. A single subject research design was used with two alternating baseline (COACH not used) and intervention (COACH used) phases. The data were analyzed to investigate the impact of COACH on the participants' independence and caregiver burden as well as COACH's overall performance for the activity of handwashing.
  
  
  RESULTS
  Participants with moderate-level dementia were able to complete an average of 11% more handwashing steps independently and required 60% fewer interactions with a human caregiver when COACH was in use. Four of the participants achieved complete or very close to complete independence. Interestingly, participants' MMSE scores did not appear to robustly coincide with handwashing performance and/or responsiveness to COACH; other idiosyncrasies of each individual seem to play a stronger role. While the majority (78%) of COACH's actions were considered clinically correct, areas for improvement were identified.
  
  
  CONCLUSIONS
  The COACH system shows promise as a tool to help support older adults with moderate-levels of dementia and their caregivers. These findings reinforce the need for flexibility and dynamic personalization in devices designed to assist older adults with dementia. After addressing identified improvements, the authors plan to run clinical trials with a sample of community-dwelling older adults and caregivers.
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada. alex.mihailidis@utoronto.ca
authors.forename: Alex
authors.initials: A
authors.lastname: Mihailidis
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Boger
authors.forename: Tammy
authors.initials: T
authors.lastname: Craig
authors.forename: Jesse
authors.initials: J
authors.lastname: Hoey
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001185:Artificial Intelligence; D017028:Caregivers; D003071:Cognition; D003704:Dementia / Q000523:psychology*; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D008297:Male; D017010:Reminder Systems; D012656:Self-Help Devices; D014741:Video Recording