Creation and validation of a daily task reminder clock for people with dementia in a Pune dementia center

Abstract

BACKGROUND:

This mixed-method study aimed to develop and validate an activity reminder clock for dementia through user testing and feedback. The increasing prevalence of dementia worldwide presents significant challenges for both patients and caregivers. Dementia impairs cognitive functions, complicating daily routines and management of everyday tasks. As the disease progresses, patients often struggle with time management and maintaining a structured routine, which can lead to increased confusion and reduced quality of life. Assistive technologies, such as activity reminder clocks, have emerged as potential solutions to help address these challenges. These devices are designed to aid individuals with dementia by providing reminders for daily activities, which can help them maintain a sense of normalcy and independence.

MATERIALS AND METHODS:

The study was done in three main stages: the qualitative phase (phase 1), the device development phase (phase 2), and the quantitative phase (phase 3). The study’s two sections consist of demographic and semi-structured interview questions. The semi-structured survey instrument was created for Interviews with medical professionals and caregivers and included expectations for this kind of technology, as well as opinions on the necessity of an activity reminder clock and the difficulties involved in caring for dementia patients. During the qualitative phase, interviews with physicians and caregivers revealed themes such as the advantages of assistive technology and difficulties with implementation. Thematic analysis influenced the development of the user-friendly activity reminder clock. In the subsequent quantitative study, which had thirty participants, a Likert scale was used to assess effectiveness.

RESULTS:

The results revealed a resounding yes (86.67%), with 93.33% of participants thinking the reminder clock was essential for dementia care. A whopping 93% of the participants expressed satisfaction with its usability, affordability, and convenience of use. Fisher’s exact tests revealed a significant correlation between age and recommending the device to others (P = 0.03).

CONCLUSION:

The study highlights the reminder clock’s effectiveness and utility in enhancing daily tasks. Everyone agrees that it is necessary, logical, and beneficial. The findings indicate that age affects suggestions for device adoption and Favors tailored technology interventions to improve the quality of life for dementia patients.

Introduction

The condition known as dementia causes cognitive abnormalities that impair one’s capacity to carry out routine duties and activities. Global cognitive impairment, a hallmark of dementia, can show up as challenges with Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs). In 2015, there were 47 million cases of dementia worldwide. As the world’s population ages and life expectancy rises, dementia rates are expected to rise further, reaching 75 million cases in 2030 and 132 million cases in 2050.[1] The proportion of older persons with cognitive impairment will rise in tandem with the world’s population’s increasing aging. The current global dementia rate is close to 47 million, and by 2050, this figure is expected to triple.[2] Novel technologies have the potential to benefit those suffering from dementia and their informal caregivers, who are typically close friends or family members rather than medical professionals like nurses. The use of assistive technology can lessen the load of caregiving[3] boost the independence of those with medical conditions and enhance the wellbeing of both patients and those who provide care for them. The range of assistive technology available for those with dementia has been further broadened by the development of cutting-edge mobile technology created for those with dementia, their caregivers, and even the surrounding environment.[4]

This study builds upon recent research emphasizing the positive impact of assistive devices on daily activities for dementia patients.[5] The exploration of these devices involves a multidimensional approach, considering not only the perspectives of healthcare professionals but also the practical experiences and opinions of caregivers and individuals with dementia. Drawing from the insights gained in recent studies.[6] Our research adopts a mixed-methods design, incorporating both qualitative and quantitative approaches. Through interviews with healthcare professionals and the development of an innovative activity reminder clock, this study aims to contribute valuable insights into the potential benefits and challenges associated with integrating technology into dementia care. This introduction sets the stage for the current study, positioning it within the context of recent research while highlighting the need for a comprehensive understanding of assistive devices’ impact on individuals with dementia [Figure 1].

Figure 1.

Conceptual framework of study

In addition to exploring the efficacy of specific technologies, recent longitudinal studies have delved into the sustained impact of reminder systems in dementia care and provided valuable insights into the long-term benefits and challenges associated with reminder systems.[7] work extended this perspective, considering the dynamic nature of caregiver-patient interactions in the context of reminder system utilization[5]

Complementing these perspectives, the present study adopts a mixed-methods design, aligning with the broader trend in research methodologies within this domain offers a qualitative exploration, capturing the perspectives of caregivers on various assistive devices provided a methodological framework, contributing to the ongoing discourse on best practices in the development and evaluation of assistive technologies for dementia. As the field continues to evolve, this study contributes to the existing body of knowledge by integrating insights from recent research, employing a mixed-methods approach, and developing an innovative activity reminder clock tailored to the specific needs of individuals with dementia.[8]

Examining the usefulness of the reminder clock in the context of a particular region and population might provide insightful information, particularly if there are social, cultural, or infrastructure elements that affect its uptake and efficacy. Tailored Design for Dementia Patients: You may set your study apart by creating a reminder clock that is specially tailored to the requirements and preferences of dementia patients. Novelty can be increased by incorporating customizable reminder settings, intuitive user interfaces, and audible and visual indicators that are obvious. Combination of Human Factors and Technology: By fusing cutting-edge technology with human-centered design concepts, creative solutions that are dementia patients can easily utilize and find effective can be produced. Creating a thorough and rigorous validation process that incorporates quantitative and qualitative measurements to evaluate the efficacy and usability of the reminder clock with other existing tools or traditional methods (like physical reminders or caregiver interventions) can highlight its unique benefits and limitations, providing a fresh perspective. Customization and Adaptability: Emphasizing the customizable features of the reminder clock that adapt to the changing needs of dementia patients over time can be a unique aspect. This could involve adaptive algorithms that learn and adjust to the patient’s routines and preferences. Longitudinal Study: Conducting a longitudinal study to observe the long-term effects and sustainability of using the reminder clock can provide novel insights into its efficacy over time.

Objectives

• To assess the need of reminder clock in people with Dementia

• To assess the development and validation of reminder clock for daily task completion in people with Dementia

• To evaluate the effectiveness of reminder clock in people with Dementia

Material and Methos

Study design and setting

This study looks at the creation and assessment of an activity reminder device for dementia care using a sequential exploratory design with a multi-phase methodology.

Study participants and sampling

Physicians, caregivers, and dementia sufferers are among the study participants. To collect both qualitative and quantitative data, semi-structured interviews and user testing sessions with dementia patients and caregivers are examples of sampling strategies.

Data collection tool and technique

Semi-structured interviews were the main method of data collection used in phase 1 of the study, with participants being physicians and caretakers. The purpose of these interviews was to obtain in-depth information about the need for an activity reminder clock in dementia care, as well as to examine past experiences with assistive technology and examine perspectives on the difficulties involved. Phase 1’s qualitative results served as a reference for Phase 2’s development of the activity reminder gadget. During this stage, caregivers and dementia patients participated in user testing sessions to verify the device’s usability and applicability in real-world situations. In Phase 3, a cohort of thirty participants—caregivers and perhaps dementia patients—were asked to rate the activity reminder device’s usefulness and efficacy using a Likert scale. The high Cronbach’s alpha coefficient of 0.89 underscored the reliability and internal consistency of the Likert scale responses, affirming the robustness of the quantitative evaluation process.

Ethical considerations

Approval of IEC was obtained and letter number is – SIU/IEC/56 The permission is taken from different dementia center in Pune to perform the study. The consent is taken by the participants before conducting the study and the permission letter for the conduction the study in dementia center is also taken.

The permission is taken from different dementia centers in Pune to perform the study. The consent is taken by the participants before conducting the study and the permission letter for the conduction the study in dementia center is also taken.

PHASE I- Qualitative data

Section A- Demographic variables of doctors, people with Dementia and their caregivers

Section B- Assessment the need of development and validation of activity reminder clock through semi structured interview of doctors.

Section C- Assessment the need of development and validation of activity reminder clock through semi structured interview of Caregivers

PHASE II -Development of device

PHASE III- Quantitative data

Description of ACTIVITY REMINDER CLOCK

Clocks consist of several key components that work together to display the time accurately. The crystal serves as a protective layer, typically made of glass or plastic, covering the clock’s face. Next, the dial, often round but available in various shapes, provides the backdrop for displaying time. Positioned on the dial is the face, featuring numerals that indicate hours and sometimes minutes. The hands of the clock are pivotal—they rotate around the face to show time’s progression. The hour hand points to the current hour, while the minute hand indicates the precise number of minutes past the hour. Additionally, the second hand moves swiftly, marking each passing second. These components collectively ensure the clock fulfills its fundamental purpose of timekeeping [Figure 2].

Figure 2.

Illustrates the perception and interaction model between caregivers and dementia patients in relation to the use of the activity reminder clock

The clock assembly includes a one-piece rubber nut and a heavy hanger hook, enclosed within a case measuring 55 mm x 16 mm. The clock hands—hour (65 mm), minute (91 mm), and second (120 mm)—are powered by a 1.5V power cell. Plywood round sheets form the back cover of the clock mechanism, supported by wooden sticks. This design facilitates the display of a daily schedule with labeled activities such as waking up, taking medication if required, having breakfast, exercising, reading the newspaper, performing chores together, having lunch, taking a short nap, playing games or puzzles, going for a walk, having dinner, and preparing for bed. Users can easily remove and replace activity labels to match their daily routines [Figure 3].

Figure 3.

Presents the key components and features of the activity reminder clock developed for this study

Salient Features: These clocks have contemporary features including automated task reminders, large, easy-to-read displays, and straightforward designs. Clocks designed specifically for those with dementia, such as those with large displays, clear labeling, and simple operations, can reduce feelings of confusion and frustration, increase independence, and provide a sense of security and familiarity. The clock’s hardwood construction material was stained in a range of hues, including white, black, green, and yellow. There are significant ramifications to the many colors we can use that complement the infrastructure and interior architecture of the dementia center. By giving their loved ones, a clock that suits their requirements and preferences, caregivers can help them maintain routines and a sense of normalcy in their everyday life. Automated daily task schedule-equipped clocks Advanced functions like automated task reminders. Clocks made especially for people with dementia, like those with big displays, obvious labeling, and easy-to-use controls, can help people feel less confused and frustrated, become more independent, and foster a sense of familiarity and security. The hardwood material used to make the clock was stained in a variety of colors, including white, black, green, and yellow. The many colors we can choose by the dementia center’s interior design and infrastructure has important implications. Carers can assist their loved ones in staying on schedule and preserving a feeling of normalcy in their daily lives by providing a clock that meets the individual’s needs and preferences. Clocks equipped with automated daily task schedule reminders.

How does the device work?

The process comprises labeling mealtimes, exercise, medication schedules, and social interactions—all essential everyday activities for those with dementia. Subsequently, these labels are fastened to a clock, with a distinct task indicated on each hour. Hourly alarms that are programmed to remind the patient of the time are used to prompt them to check the clock for their next job. At the start of each day, caregivers go over the routine with the patient using the labeled clock as a visual aid. Patients are encouraged to physically adjust the activity sticks as they complete exercises to foster independence and engagement. Caregivers constantly monitor the system and make necessary adjustments in response to patient feedback and changing needs. Patients receive support and encouragement all day long from caregivers to effectively manage their everyday schedule. Additionally, it is an annual process, and they are free to alter their schedule of activities.

Result

This study yields significant findings across various aspects. And the study findings are given below.

Section -A (Demographic variables)

The percentage-wise distribution of dementia patients according to their demographic attributes is covered in this section. From the study population, a handy sample of thirty people was picked from a dementia center located in Pune city. The information gathered to characterize the sample’s attributes, such as age in years, gender, marital status, occupation, religion, length of stay in a dementia center, and length of time you have had dementia. According to the study results, 56% of the individuals with dementia were between the ages of 61 and 70, and 51–60 years old made up 44% of them. It demonstrates that the age range of 61 to 70 years old comprised the bulk of the samples. Semi-structured interviews with physicians and caregivers were conducted as part of this extensive inquiry procedure.

Section -B (Semi structured interview)

Tables 1 and 2 present the themes identified through interviews with doctors and caregivers.

Table 1.

In the qualitative phase, thematic analysis revealed several insights from doctors, which contributed to the design of the reminder clock. Themes identified through interviews with doctors

Theme		Subtheme		Quotation
Enhancing daily activities Empowering daily living Challenges in implementing Enhancing dementia care Improving Quality of life		Cognitive support through technology Promoting independence Adoption challenges Support for personalized care Support for caregivers and personalized care Enhanced independence		I believe, Reminders integrated into smart devices can assist individuals in remembering important tasks or daily routines” “I believe, one significant benefit is the promotion of independence empower individuals with dementia to manage their daily schedule” In their view, overcoming usability challenges linked to complex devices and addressing cost barriers are crucial tasks. “In my opinion, Assistive technology enables personal care based on individual needs, aspects of daily living and it will help to improve independency” “I think if we are using device like, reminder system and memory aids it will assist in managing cognitive challenges.

Table 2.

In the qualitative phase, thematic analysis revealed several insights from caregivers, which contributed to the design of the reminder clock. Themes identified through interviews with caregivers

Theme	Subtheme	Quotation
Utilization of technology Care planning Establish structured care Memory support strategies Memory training approaches	Monitoring enhanced care Daily care planning and management Improve flexibility Creating Memory aids Games, read newspaper, puzzles, mobile games	“Yes, I believe technology can greatly assist in caregiving” “Yes, I believe that daily care plans help to establish a sense of routine and provide a framework for the day” “Yes, definitely it will help a person to take enough rest as per the schedule it will fit in their mind that I have to sleep for these many hours in a day or night, basically it improves their sleep pattern and rest” “Yes, I follow daily routine because it is essential for them so it will balance between thein routine and their needs” Memory support strategies “If some groups of people or foundation come to the center, they make them to play games and puzzles”

Section - C (Quantitative phase)

The response of dementia patients regarding the use of an activity reminder clock for improving daily living activities is given in Table 3.

Table 3.

Response of activity reminder clock n=30

Response of activity reminder clock		Frequency		Percentage
Good Response (Score 45–34)		26		86.67%
Average Response (Score 33–22)		4		13.33%
Poor Response (Score Below 21)		0		0%

The study findings show that all the patients with dementia showed good responses (score 45-34) for the activity reminder clock for the improvement of daily living activities.

Analysis of data related to the opinion of people with dementia regarding activity reminder clock.

Results about the Need for Reminder Clocks for Individuals with Dementia: 93.33% of respondents, a sizable majority, concurred that a reminder clock is necessary when providing care for individuals with dementia. This highlights how difficult it may be to manage everyday tasks for those who have dementia and how utilizing reminder clocks to help with caregiving may be beneficial. The usefulness of Reminder Clocks: According to the poll, 76.67% of respondents firmly think that reminder clocks are a helpful tool for assisting people with dementia in remembering their everyday tasks. This emphasizes how valuable these technologies are seen to be in improving the quality of life for caregivers and the people they look for. Visibility and Ease of Use: Most respondents (86.67%) concurred that reminder clocks are simple to use Furthermore, 93.33% of respondents said that these clocks are visible, indicating that the way they are designed may help people with dementia access and comprehend the information that is displayed. Cost-Effectiveness and Affordability: In terms of cost-effectiveness, 76.67% of participants think that reminder clocks are a reasonable investment for individuals suffering from dementia. In a similar vein, 73.33% of respondents said these clocks are reasonably priced, suggesting that families and caregivers view them as a worthwhile investment.

Recommendations and Satisfaction: A resounding 90% of respondents said that individuals with dementia would suggest reminder clocks to others dealing with the same difficulties. In a similar vein, 93.33% said they would suggest these clocks to other senior citizens. Additionally, 93.33% of respondents said they were certain that using reminder clocks would satisfy individuals, demonstrating the potential benefits of the individuals. dementia would suggest reminder clocks to others dealing with the same difficulties.

In a similar vein, 93.33% said they would suggest these clocks to other senior citizens. Additionally, 93.33% of respondents said they were certain that using reminder clocks would satisfy individuals, demonstrating the potential benefits of the individuals.

Discussion

The purpose of the current study was to assess the need for an activity reminder clock among physicians and dementia patients’ caretakers. The current study’s need assessment for an activity reminder clock was conducted with treating physicians and caregivers, and the results indicate that the reminder clock can help improve everyday activities and help people become more independent. The study’s aforementioned conclusions were backed.

A mixed-methods strategy was used in this investigation. A semi-structured interview guide and validated tools were used to conduct a telephone evaluation of 114 dementia patients and their careers. The quantitative data was gathered and utilized to create a baseline, while the qualitative data was subjected to thematic analysis. According to the study, there were challenges faced by people with dementia and their carers throughout the pandemic. These challenges included behavioral deterioration, trouble receiving treatment, interruptions of daily routines, and challenges in enforcing infection protection, all of which led to caregiver anguish.

One significant conclusion that came to light was the constant nature of caregiving for families. The absence of formal assistance and awareness for dementia was in stark contrast to the public health response to the COVID-19 pandemic, which was comparatively successful.[9]

In the present study, the creation and evaluation of a dementia patient’s activity reminder clock—the creation of reminder clocks specifically for those with dementia is a huge step in addressing the unique issues that these individuals experience. The needs of dementia sufferers are frequently not met by the current options, such as alarm clocks.

The research presented in this paper tries to uncover a refined subset of variables that offer increased accuracy in forecasting technology adoption. It builds upon our prior work on modeling the adoption of assistive technology, in the form of cognitive prosthesis-like reminder apps. Therefore, in order to reduce the possibility of non-adoption, an adoption model is constructed in this study employing a collection of features taken from a user’s background. Based on a review of thirty-one features—including age, gender, education level, and specifics about health— the article examines data from the Cache County Study on Memory and Aging (CCSMA).

Selecting the best classification models is the next step in the modeling adoption process, which also involves feature reduction and selection. The technology adoption model that was developed using the smaller collection of labeled features had an average prediction accuracy of 92.48% when tested on 173 participants. These technologies generally can improve people’s lives and increase their degree of independence. However, these technologies’ success depends on their adoption. One potential remedy for the provision of senior care is the use of assistive technologies.[10]

In the present study People with dementia were asked for their thoughts regarding the activity reminder clock. Thirty views of the activity reminder clock were obtained from the samples. Opinions were formed based on factors like portability, affordability, and utility. The reminder clock’s usefulness was taken into account while assigning an acceptable or unacceptable key score. Scores between 0 and 5 were deemed unacceptable, but scores between 41 and 80 were approved.

Eighty-eight informal caregivers representing a range of racial and ethnic backgrounds and degrees of severity of cognitive impairment responded to an online survey on the technology they utilized and the assistance they needed. The findings indicate that, in comparison to White/non-Hispanic individuals with moderate dementia, racial minorities viewed the need for assistance with basic activities of daily living as more significant. Additionally, it has been demonstrated that individuals with severe dementia who identify as Hispanic/Latino or Puerto Rican and White/non-Hispanic use technology intended to assist with instrumental activities of daily living more frequently than individuals with intermediate dementia. Last but not least, during COVID-19, White/non-Hispanic individuals with severe dementia have utilized these gadgets far more than Hispanics/Latinos or Puerto Ricans. These devices help with movement, meal preparation, and personal hygiene. The use of assistive technologies by patients and their informal caregivers is thought to be crucial in lowering the burden of Alzheimer’s disease.

However, rather than being designed to accommodate persons with different levels of cognitive disability and people of all races and ethnicities, these devices are manufactured in a “one size fits all” manner.[11]

The study evaluated the use of the Comprehensive Public Health Management (CPHM) application in a primary health center in Karnataka, India, comparing Maternal and Child Health (MCH) indicators from paper-based records with those from the CPHM App during 2016–2017. Key findings included varying consistency levels across different MCH indicators, with three indicators showing consistency above 80%. Over time, quarterly consistency decreased. Barriers identified included reliance on paper records due to regulatory requirements, technical challenges like limited expertise and internet connectivity in remote areas, and logistical issues with data synchronization. Facilitators included the CPHM App’s ability to aggregate data, ease of use, and support for field-based data retrieval and health activity planning. Proposed solutions included real-time technical support and improved field connectivity.[12]The study employed a quasi-experimental design with pre- and post-test measures, involving 24 students with disabilities divided into AR and control groups. Analysis using descriptive statistics and paired sample t-tests revealed a significant improvement in self-regulation skills among AR group students compared to controls. These findings highlight the potential of AR technology to enhance learning outcomes for students with disabilities, emphasizing its importance in educational settings for diverse learners.[13]

According to recent data, approximately 3.9 million pediatric procedures are performed annually in the United States, affecting about 4.7% of children. A significant number of these children, up to 60%, experience anxiety before anesthesia, which is the most common emotion associated with surgery. Factors contributing to this anxiety include unfamiliar environments, strangers, noisy equipment, fear of harm, and separation from parents. This anxiety can lead to delayed wound healing, behavioral issues, increased pain, and adverse physiological responses. To address preoperative anxiety (POA) in children, both pharmaceutical and nonpharmacological interventions have been explored. While pharmaceutical treatments are effective, they pose risks such as nausea and prolonged recovery times. Nonpharmacological approaches, including audiovisual technologies like computer games, have emerged as safe alternatives without medication side effects. Recent research has focused on evaluating the effectiveness of these technologies in reducing POA, particularly during the period from admission to anesthesia induction.

A systematic review and meta-analysis were conducted to assess the impact of audiovisual interventions on POA in children undergoing general anesthesia. Three randomized controlled trials (RCTs) met inclusion criteria, conducted in Iran, Denmark, and China. These studies evaluated various audiovisual interventions starting from the holding room and measured anxiety levels using the Modified Yale Preoperative Anxiety Scale (m-YPAS). Statistical analysis indicated a significant reduction in anxiety levels among children exposed to audiovisual interventions compared to controls.[14]

Limitations and recommendation

As internal validity may be at risk. The existing study was restricted to individuals with dementia under the age of 70 and focused on a particular dementia center located in Pune, Maharashtra. In the Indian context, there is a dearth of literature and research on enhancing everyday activities and fostering independence in individuals with dementia.

The primary focus of the study was on the usability and immediate impact of the “Reminder Clock for Dementia Patients.” To evaluate the device’s long-term benefits and potential drawbacks, longitudinal studies would be helpful.

Strength and weakness of the study

Strength

The study employs a mixed-method approach, combining qualitative and quantitative methodologies to comprehensively assess the viability and efficacy of activity reminder clocks. It adopts a patient-centered design, ensuring the devices meet the specific needs and preferences of dementia patients. Thorough validation by subject matter experts enhances the reliability and validity of both data collection instruments and the reminder clocks. Pilot testing further confirms the feasibility, utility, and potential acceptance of the clocks in real-world environments.

Weaknesses

Duration and Long-Term Impacts: It’s possible that the study overlooked the sustainability or long-term impacts of the intervention due to its focus on the immediate findings of pilot testing. Potential Bias: Innate biases in dementia patients’ self-reported data or the subjective assessments of medical professionals may affect how the results are interpreted.

Conclusion

The study conducted a sequential exploratory design on activity reminder clocks for patients with dementia, and the results have been insightful and closely fit with benchmarks for health policy. The study effectively studied the development and implementation of these new gadgets by utilizing a mixed-method approach that included quantitative survey data from thirty participants with qualitative interviews with clinicians and dementia patients. Semi-structured interviews conducted during the qualitative phase guaranteed a patient-centered design process catered to the unique requirements and preferences of dementia patients.

The activity reminder clock and data collection instruments underwent thorough validation by subject matter experts, highlighting the validity and dependability of the results—important information for guiding evidence-based healthcare practices. The reminder clocks’ acceptability and feasibility were further shown through pilot testing, underscoring their potential to improve daily routines and independence for dementia patients. In the end, by supporting strong research methodology and patient-focused innovations targeted at enhancing dementia treatment and quality of life across healthcare settings, this study establishes a precedent in health policy. This research represents best practices in healthcare policy by supporting evidence-based innovations that focus patient-centred outcomes and strict methodological standards. It also advances dementia care by encouraging patient empowerment and individualized interventions.

Ethical consideration

The approval has been obtained from IRC and IEC team of the university SIU/IEC/567.

Permission is taken from different dementia centers in Pune to perform the study. The consent is taken by the participants before conducting the study and the permission letter for the conduction of the study in the dementia Centre is also taken.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.