Developing an adaptive system for supporting personal activities and reinforcing cognition (SPARC)

Purpose Cognitive impairment is the single most important factor that threatens the function and quality of life of older adults [Stern & Carstensen, 2000]. The likelihood of developing a cognitive impairment increases with age; about 10% of those age 70-74 and 25% of those age 80-84 develop mild cognitive impairment (MCI), a heterogeneous state between normal aging and early dementia [Petersen et al., 2018]. Older adults with mild cognitive impairment (OAwMCI) experience difficulties performing a range of everyday activities and are at risk for social isolation. Technology-based interventions have the potential to improve the everyday functioning of OAwMCI. Most prior efforts have focused on the provision of cognitive training or rehabilitation and have not included other aspects of functioning such as everyday activities or social engagement. Our goal is to develop and evaluate an innovative intelligent adaptive software package aimed at providing cognitive and social support and engagement to OAwMCI. The system will be designed to adapt to the needs and abilities of the user, following the CREATE model of user-centered design [Boot et al., 2020; Czaja et al., 2019]. We will present the initial work from our user centered approach to design the system we are calling SPARC: Supporting Personal Activities and Reinforcing Cognition. Method We conducted a multi-faceted needs assessment to guide the design of the SPARC system. We interviewed five clinician subject matter experts (SMEs) who had experience working with OAwMCI to obtain their insights about the needs for cognitive and social support as well as potential facilitators and barriers to adoption of the SPARC system. We also conducted two focus groups with technical SMEs, to identify the technology currently available to support the design of SPARC, as well as potential challenges in the implementation of the proposed adaptive system. Results and Discussion The clinician interviews identified a range of social activities that could benefit from support including forgetting people's names, missing appointments, and withdrawal from social activities which could lead to feelings of isolation, embarrassment, and apathy. Healthcare activities needing support included medication management; understanding physicians; remembering and preparing for appointments; finding specialty providers; and scheduling appointments. Other daily activities mentioned for support needs were managing finances and understanding scams/fraud; getting lost; household upkeep; and mobility and transportation. The focus group discussions yielded valuable advice, including the reminder to not try to do everything in one system; to think about how to incorporate care partners; to understand a person's current level of functioning to guide support and adaptation needs; and to capitalize on existing software that could be integrated into SPARC. This multi-faceted needs assessment approach will guide the design of the system to support everyday activities, primarily in the home environment. Our SME insights provided important information on the feasibility of using technology-based approaches to support everyday activities and cognition for OAwMCI and insights on potential barriers to the implementation of technology-based interventions. Our findings also inform the design of other technologies and interventions to support OAwMCI.