Report M1.2 Design Project Hulpje

HULPJE

Manon Barendse s198282- M1.2 Industrial Design TU/e Coach: Rens Brankaert 18-06-2015

1. Designing for Dementia When designing for people who are suffering from dementia, it is all about small gains; the creation of little valuable moments and experiences.

Read about the context on Pp. 02 -11

2. Emotions & small gains I believe that in this context, the design challenge is to transform every day tasks into opportunities for engagement, accomplishment and self-dependency.

I explain it in depth on Pp. 12 -21

4. Characteristics Hulpje gives a little support to people who like to give the best care for their plants, but who sometimes get confused how to do so.

The requirements of Hulpje are described on Pp. 30 -41

6. Reason to believe What do experts and users think about Hulpje? .

See Pp. 62 -71

HULPJE

3. Caring for plants Caring for plants is exactly such a task that naturally has the ability to fulfill these essential emotional needs.

Read more about it on Pp. 22 -29

5. Concept Not in a digital application, not with flashing lights or tilting pots, but simply with symbols on the actual pot; designed for everybody’s understanding.

See Pp. 42 -61

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Designing for people living with dementia.

When designing for people who are suffering from dementia, it is all about small gains; the creation of little valuable moments and experiences.

Introduction I like to start a design process with embedding myself in the context to fully understand the end user and the context. Thereby, it helps me to discover interesting design directions that can be the basis of my design space.

For the Innovative Dementia project, this meant that I have visited patients at home and in a care home, I have spoken to expert in the field, read a lot of academic articles, but also websites of health care funds and organisations. I have also discovered pretty inspirational design projects in the same field, as well as insightful documentaries. As part of the understanding, I have done a quick and dirty ideation round to feel the context as designer as well.

In this chapter, I will share the most important facts and insights that together are the very broad foundation of my project.

In the Netherlands, the number of people aged 65+ will rise from 2,5(27%) million to 4,7 (51%)million, a trend reflected in other developing countries around the world. Ageing is a large socio-economic threat in North West Europe and a top priority issue at European level. The number of persons living with dementia are increasing and are causing increased demand for health care while the number of professional health care providers is not able to keep pace. This project begins with a need to find better ways for those living with dementia to live well in their homes and to improve their overall quality of life. This will indirectly reduce the need for expensive hospital care and lighten the feelings of isolation and fear. (websited Nationaal Kompas and Innovative Dementia).

‘Some dry facts’ to understand dementia Dementia as an non reversible decease Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.

Treatment of dementia depends on its cause. In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms. The same medications used to treat Alzheimer’s are among the drugs sometimes prescribed to help with symptoms of other types of dementias. Non-drug therapies can also alleviate some symptoms of dementia. (http://www.alz.org/what-is-dementia.asp) 5

EARLY

MID

LATE

Difficulties with recent memory and forgetfulness

Impaired ability for activities of daily living such as dressing, eating or shopping

Reduced capacity to reason or make decisions

Anxiety and depression often occur Loss of concentration Disguising difficulties may be successful for some of the time

Significant memory lapses such as not recognising a person they know well Challenging behaviour and social disinhibition may be experienced Sleep disorders are common

Significant communication difficulties, including fragmented speech Immobility, rigidity and recurrent falls Physical deterioration and difficulties with eating result in progressive physical weakening

EARLY

Threatened self

L

Stages of dementia Timlin & Rysenbry (2010) Client is faced with the loss of opportunities due to cognitive impairment (ie memory and orientation disorders).

What to do?

Trying to reduce the feeling of fear and insecurity.

Furthermore: invoke skills that have not gone backwards, inform the client about the concrete reality around him (realiteits orientation).

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Clien ingly d in th

Offer turing

Also possi and n

Stages of Dementia Health professionals sometimes discuss dementia in “stages,” which refers to how far a person’s dementia has progressed. Defining a person’s disease stage helps physicians determine the best treatment approach and aids communication between health providers and caregivers. It also gives me the possibility as designer to refine my context.

Within the ‘people centred- care’ they focus on the ‘self experience’, there are defined four stages that are more or less positioned in the early and mid stage. For the Innovative Dementia project, I like to design for people in the first two stages, that are specified as ‘the threatened self and the lost self. Within these stages, people will still live at home, but the level of care need is increasing.

My interpretation of dementia after imbedding in the context

MID

Lost self

Dementia has a big effect on both the people living with dementia themselves as their social environment. There are direct health problems involved, such as incontinence, sleeping problems and personal hygiene, but in the first two stages dementia has the most influence on the self-experience, social relations and safety. A person living with dementia is changing, some even say that they are slowly dying – and perhaps even more shocking is that sometimes the person with dementia is aware of this negative transformation. Whether the patient accepts the diagnosis or not, their self-esteem often decreases and people find it hard to trust their selves (but they often don’t like to admit that…).

nt becomes increasdisoriented and lost he world and their own past.

What to do? r grip on life, strucg the daily environment.

o: Stay as close as ible to the interests needs of the client.

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Metaphor My interpretation of dementia in the first two stages is a head that is temporarily filled with little pieces of cotton candy that block thoughts and memory, but also stick some together that are not meant to be . Because of the sugar rush your senses and emotions are increased and you are looking for things with which you can prove that you are yourself. It is confusing and shameful and tiring and make you feel that you can’t control the situation.

An expert from the GGzE, Monique Peeters has introduced the ‘emotional memory’ to me. Apparently people who are living with dementia don’t remember the what and the why (cause) exactly, but they do remember the emotion. They are also more dependent on their senses: feeling, hearing, seeing, tasting and smelling. Going back to my metaphor, you can taste the sweetness of the memory, but the cotton is blocking the memory itself.

Concluding, the biggest hurdles within the two first stages of dementia are the confrontation, the acceptance, changing relationships and stigmatization as well.

For two of the four people living with dementia I have visited, I was told to not mention the word dementia as such – it was better to call it aging memory problems.

Now I know a little bit more , how to approach this context?

Within the UK Design Council case study about dementia in 2012 (http://www. designcouncil.org.uk/knowledge-resources/case-study/living-well-dementia) they formulated quite well what the ‘design treatment’ is for people who are living with dementia: dignity and dependency support. Subjects I saw back in the people centred care approach of the Land van Horne (care home) as well during our visit.

The UK Design Council named their whole project Living Well With Dementia. and with my interpretation of dementia in mind, I like to translate this as (1.) support to continue to live how you have always lived and (2.) support to continue to be how you always have been.

This translation allows me to state very early ‘draft’ design challenges, that are (1.) building extensions of the self that help to replace or to support the loss and help to bring back the control, and (2.) create jobs and moments of value.

These jobs (or activities) and moment can be very subtle and simple – moments of understanding, engagement and .. can have a huge effect on.. The accomplishment of small tasks is for example very important for self-respect & dignity.

Within this context it’s increasingly about the engagement and , and less about the complexity of the task.

Furthermore, I hate most of the practical dementia-help devices – they are so clinical and stigmatizing. In this project I would like to make a refreshing and stimulating design that is more person than healthcare or safety focused. Within this project I want to emphasize the positive instead of preventing the negative: the design of little valuable moments, experiences and/or interactions.

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Reflection Like I will do for every chapter, I will finish with a reflection. Within this reflection, I will describe how some activities and insights have influenced my design practice, identity and vision.

First of all, I liked the design context from the start and I have analyzed why to get more grip on my identity and vision. More than other projects I have done, Innotavive dementia was straight forward - more on the ‘real/practical’ side than the conceptual side of deisgn. Still, the project context had enough possibilities to be creative and shape the design space that I found interesting. The emphasis and goal of Innovative Dementia, wellbeing, has de variables of social and health in it, a combination for which I like to design(I believe that in this combined area, designers can add a lot of meaning).

More on a practical level, Rens Brankeart, my coach and PhD student within the same context, has built a significant network and I considered myself very lucky that he wanted to share it with us. This has given my project a kickstart and some unique changes to have a ‘view’ in the kitchen (like the visits at the elderly care centre and the visits with the GGzE at people’s homes). My design practice increasingly begins with design intuition. By embedding myself in the context, a design incentive or direction ‘pops up’ and then I will validate it with research. The network of Rens enabled me to directly discover in depth and sense many opportunities.

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2.

An increased ‘emotional life’

e in/output

Hippocampus Process information

Amygdala Process emotions

Engagement

phase 1.

nding

Habit on Amygdala compensates loss of hippocampus due to Alzheimer

aesthetics h plants y

on

30% People

phase 2.

++ Dementia

ve, enting

ns physical port the blems12

25%

Toolbox

75%

Everyday tasks and emotional needs I believe that in this context, the design challenge is to transform everyday tasks into opportunities for engagement, accomplishment and self-dependency.

Introduction One thing that Monique Peeters (GGzE) has said during an expert meeting kept on floating in my head: “People living with dementia have an increased emotional life”. I made the assumption that if I want to create value for people living with dementia, I have to focus on experience and emotion.

In this chapter I will describe how I validated this assumption and what notions I have used to generate my personal design framework and design challenge within the context of innovative dementia.

To be able to do this, I have done literature research, I have consulted experts and brainstorm sessions with other designers. By means of the visuals I have created, I will explain my design scope, framework and design challenge.

Why is it important to support emotional needs from people living with Dementia? “ It’s no surprise that people with Alzheimer’s have trouble recalling memories. It is, after all, the hallmark symptom of the disease. However, a new study has found that events can have a longer term and profound effect on how they feel, even if they do not remember the particular event. In the study, researchers from the University of Iowa asked 17 adults with probable Alzheimer’s and 17 without the disease to watch film clips that were intended to make them feel sad or happy.

They collected real-time emotion ratings at three different points and also gave a memory test after each point. Not surprisingly, the participants with Alzheimer’s had trouble recalling the film clip. Of the participants with Alzheimer’s, four could not remember any single fact about the film and one could not remember seeing a film. However, all participants reported elevated emotions from the film lasting for more than 30 minutes, long after the memory of the film clip faded. The study’s authors hope that their findings will impact the actions of caregivers and improve the quality of life for people living with Alzheimer’s. “

- (website Alzheimers.net)

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self actualization

creativity

self esteem

proficiency

love

usability

safety

reliability

physiological

functionality

Compensation When a certain part of the body is not functioning like it has to do, other parts of the body will take over and compensate. In our brain it works the same. When a part of the brain is affected, other components of the brain will compensate the loss. This explains why the feeling (senses) and emotional life of people living with dementia advance in most cases.

The parts of the brain that regulate emotions and feelings are barely touched or affected by dementia in the early stages. This counts for example the amygdala, that plays an key role in our intuition and feeling. When people living with dementia are losing their capacity to reason and memory, the parts of our brain that regulate feeling and emotion will compensate. Hence, a person with dementia has an increased level of feelings and intuition. In combination with the shrinking Hippocampus, people living with dementia are less capable of controlling and interpretting these (enhanced) emotions.

The fact that the emotional life of people living with dementia increases, has a lot of consequences in how to approach and interact with them. It makes them more vulnerable for depression, but they will also intensively enjoy, showing affection, pride and ecstasy.

Ruud Dirkse from Zorginnovatie bureau DAZ a consequently argues that these (increases) feelings and emotions are of great concern for the welfare of people living with dementia. This is also why I think that I can create value in this particular ‘scope’ within the context of dementia.

When doing this research, I had to think about the Hierarchy of needs from Maslow, in which human needs ar specified. The higher level of the hierarchy corresponds to higher level of perceived value. I believe that in the first stages of Dementia, this hierarchy or structure is even more on the surface/foreground, because this is where things are changing.

(Lidwell, Holen, & Butler, 2003) There also exists a hierarchy of needs model for design, that is adapted of Maslow’s pyramid. This hierarchy indicates that a design must address lower-level needs before higher-level needs can be addressed. Partly based on this principle, I have made my own framework to support emotional needs.

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How to support emotional needs?

ng

old

Strenght Reduced Learning Capacity

Ge tti

Basically, when to address/support a certain emotional need, I can make a path or web of connections, starting from the inner to the outer rings. In fact, for me as designer of products and systems, the outer rings can be seen as the bridge to reach the emotional needs: this is where I find my design incentives. Like in model of the hierarchy of needs: to address the for example Self-Esteem, one has to begin with addressing physiological and safety needs first.

Clear-cut, I design product/ systems (getting old, symptoms) that address activities/interaction (physical needs) that address emotional need that address worth/ value. The design challenge will be the following: “I want to support people living with dementia (creating a product) in doing what they always did, so they can continuously feel like themselves/remain their identity as long as possible (emotional needs)”

Incontenence

s on pt

*Mem (organisa problems)

*Apraxia

Taste & Smell

*Sense of direction

e l ne a c i *De ys *Timing

*Mobility

Require more light

E

First of all, I have tried to make a map the symptoms (of getting old and dementia) and needs (of people with dementia) for the first two stages of dementia: the threatened self and the lost self. How I have positioned it is how I approach the challenge. First of all, I always have to think about the symptoms of getting old – they are always present on the background of my project. Then, there is the ring in which I have placed the symptoms of dementia. These are firstly the indication and characteristics of dementia and secondly the cause of (the intensification of) the physical and emotional needs that I have positioned in the inner (most essential) rings.

Sy m

Mobility

Ph

But how am I building towards emotional support? I am an industrial designer, not a psychologist, family member of friend. With this question I started my brainstorm session in order to create a framework that would represent the ‘route’/ path.

*Vision *Tasks become complex

Fear of Falling

*Audio *Personal appearance

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*F *Inse

*Contro *Accom

*Defen *Lost& *Dig *Co-ordination

*Routine

*Cognitive

Vision Dexterity

*Selfawareness

*Friendship (love, interlectual, on ‘their level

Co-ordination

*Shift of memory focus from ratio to emotion

Smell

Lonely Breating problems

The accompanying design foci are: Create value for people living with dementia THEIRSELVES Take aging into account Emphasize on the positive rather than on preventing the negative

mo

Foot pro

Phase 1.

The threatened self

How am I building towards the emotional support?

Memory Sleep disorder Depression

mory ational

*Memory (loss of self, place, others)

eds

exterity

* Lack of nutricion *Agitation

onal needs oti

*Fear Familiarity ecurity

*Friends *Purpose *Aggression

*Defendence *Understanding

ndence &Burden gnity

*Feeling lost *Self Respect *Pride *Capability

onal nal

*Incontinence *Activity

Thin skin

* Recognition of obejcts

*Boredom *Sleep *Eyecontact *Touch *Physical contact

*Personal Safety ’)

Reaction Time

*Inability to learn complex tasks and skills

*Eye contact *Personal Hygene

ol mplishment

Slow

Heart problems

*Apraxia *Personality change *Filtering *Inactivity *Boredom

*Language expression understanding

*Reduced concentration

Other possible future symptons

Temp.

Regulation

Chewing problems Personal Hygiene Infection increase Dwelling

Hearing

Reduction muscle mass

*Decision making *Amplified emotions

Body Fat increase

Support emotional needs

oblems

cus

Fo

Phase 2.

The lost self

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Small gains – creation of valuable moments How does my newly made framework and design challenge build on my draft design challenges I have created in chapter one ( (1.) building extensions of the self that help to replace or to support the loss and help to bring back the control and (2.) create jobs and moments of value.).

Within the new framework, I define the moments of value as (design for) activities that support, stimulate, activate or fulfill emotional needs. The extensions of the self are embodied by the physical needs within the circle and therefore converted in a means to reach the design challenge, rather than being a challenge itself.

Tangible design, sensory stimulation As I have mentioned shortly before, people living with dementia rely more on their emotions, as well as their senses. This is the reason I like to design something tangible that triggers the senses.

As Alzheimer’s progresses, a senior’s ability to communicate and perform everyday activities declines. Giving these seniors means to express themselves, when they can no longer do so with words, can help them relax and feel safe.

This can improve their mood, self-esteem and, in turn, their well-being.

By drawing attention to a particular item, sensory stimulation encourages memories and responses of seniors suffering from Alzheimer’s. For instance, art or photos can trigger memories and emotions for seniors who no longer speak. A senior who has not expressed a word in months might suddenly smile or want to pick up a pencil and draw. That art form eventually can become a means for the senior to communicate, either through personal works of art or simply by sharing the experience.

Sensory stimulation is intended to bring enjoyment to seniors with dementia, reduce their anxiety and depression, and increase their social interaction. Activities are aimed at seniors, but they are still shared with a therapist, caregiver or loved one. Those shared experiences and memories can help bring seniors back to a time that they remember fondly, which can help them feel meaningful again. (website Alzheimers.net/sensory stimulation)

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Reflection Especially in this stage of defining the design space/challenge/framework, the choices I made are based on my identity and vision. I will try to analyze these choices, to understand why I made them and how I can refer them back to who I am as designer and person.

Like I have mentioned in the reflection in the first chapter, I think that we can add a lot of value as designers in the field of social-health. For this project I choose to primarly add meaning for the end-user, in the line of the experience-care that focusses on the self-experience.

I conceive this decision as an essential one in my process, because it defined the place of the endgoal but it also says a lot about my identity: I generally start thinking out of the perception of the end-user (instead of for example the care takers/familiy/etc. int this context). After, I like to connect this to ‘what can be capitalized on existing skills and knowledge and how I can accomodate this behavior (no change)’. How can I support people to do a meaningful activity?

In my vision I think that the most fruitful products are the ones which do not push, but facilitate a change: products that are easy understandable and not ask for a lot of extra effort. With this in mind I started thinking about the next step:

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Caring for plants Caring for plants is exactly such a task that naturally has the ability to fulfill these essential emotional needs.

Introduction The everyday task I have chosen ‘to design with’ is taking care for plants. In this chapter I will explain why ‘caring for plants’ is a perfect task to fulfill the emotional needs of people living with dementia..

The research I have done here is very narrowed down on one subject and intertwined with conceptualization/designing. Parallel to analyzing articles about caring, plants and dementia, I have developed and tested two prototypes . At last, I have given my project a final shape in sense of requirements, described in the next chapter.

Why is caring for plants valuable?

“It is also the satisfaction of watching the plants grow, and enjoying their colors and smells and their textures. Gardening can be very enjoyable, even if the person with dementia does not have a garden. You can get indoor plants and flowers.

Smelling a flower is enjoyable. “

- Tommy Dunne

1. Plants Make You Happy The American Horticultural Therapy Association (ahta.org) says that the benefits of plants can be seen across many studies in the cognitive, psychological, social, and physical realms. Some of the psychological benefits include: Increased self-esteem Improved mood and sense of well-being Reduced stress, anxiety, and depression Increased feelings of calm, relaxation, and optimism Increased sense of stability and control One area that has been explored is the effect of indoor plants on stress levels.

Several independent studies have shown that interior plants can help reduce stress and improve well-being.

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2. Plants Enhance Cognitive Function Then.. Keeping plants indoors can make you think better as well. The mental benefits observed during this research include: Improved concentration Improved memory Better goal achievement Heightened attention Indoor plants have also been linked to a boost in creativity. In a study from Texas A&M University workers who were in a room with two potted plants and a bouquet of flowers generated 13 percent more ideas than workers in a room with sculptures. Bring more greenery--and less stress--into your home life! (website healthline.com) Gardening & Dementia Studies show that gardening helps battle with Alzheimer’s as well as dementia.

Because many patients with Alzheimer’s are able to experience only the present moment, gardening creates a powerful connection to the past and future.

At some point in patients’ life, they were involved with working in their own gardens or yards and many caregivers work to tap into the hobbies that patients enjoyed in the past. Additionally, as the gardens grow and fruits and vegetables are harvested, the concept of time is demonstrated in a very concrete way.

Rappe and Linden (2009) write about a study in which they have documented nursing personnel’s observations regarding plants in homes for people suffering from dementia. Based on a survey of 65 nursing staff from ten homes it could be concluded that both indoor and outdoor plants were used as tools in the care work and staff believed that it had a beneficial impact on the environment of the homes. Plants created a lush, homelike atmosphere and improved the quality of indoor air according to the survey respondents. They reported that the contribution of the plants to the psychological and social well-being of the residents was prominent. Their reported observations included: plants stimulated residents’ senses, created positive emotions, and offered opportunity for rewarding activity.

The residents were interested especially in colorful plants and berries. This study provides evidence that professionals in the field of eldercare believe that plants can contribute significantly to the well-being of individuals with dementia.

On the website from Nursetogetherm they also argue that choosing plants that reflect seasonal changes, like fruit plants and vegetables, will also help to orient people in time and place. The benefits are amazing and magnified in those diagnosed with Alzheimer’s and dementia. Especially as the gardener’s begin to enjoy the fruits of their labor. (website nursetogether.com)

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Exploring this context in my process Having dementia or not, caring for plants have a calming effect on people and they increase a sense of stability and control. But those are emotional needs that are extra valuable for people with dementia. And that’s why I have chosen to develop a concept that is about small adjustments that support people’s ability to remain caring for plants when aging or getting dementia.

To come up with ideas, I have done a plant study (which characteristics does a plant need to have?), I have made a scenario with actions, interactions and feeing described in detail, and like I have mentioned before, created two prototypes.

My ideal project would involve a three folded outcome – a green (plant) design, a toolset and a support system. This is based on the my belief that the right choice of plants will enhance the effect of interacting with plants, the toolset can make it easier for aging people (who are living with dementia) to care for plants physically and the support system especially provides help with reasoning and abstracting.

The different parts of the design will strengthen each other – The tools can for example give a direct visual and tangible link (reference) to the support system.

To not just focus on dementia, but also on general aging symptoms, I hope to develop a concept that doesn’t get a clear stigmatizing dementia-care stamp.

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An

What is needed to grow a plant ?

plant ?

nvestment Capability

Fundamentals

Primary tools Necessities

Seeds Soil Water Qualitive in/output Nutritients Space Engagement Oxygen Understanding Container Care Sunlight Reward Routine/Habit Satisfaction Success Sense of aesthetics Bond with plants Familiarity Interest Pride Contribution Ease

Personal investment

An increased Taking care of ‘emotional life’Capability

Hands Towel Hippocampus Fork Process Watering can information Gloves Water Platter Window

100%

Engagement

Eyes Knowledge Amygdala Time Process Effort emotions Attention phase 1.

Exersize Instructions Relatives

Understanding Care Reward Routine/Habit Satisfaction Success Sense of aesthetics Bond with plants Familiarity Interest Pride Amygdala compensatesContribution loss of hippocampus Ease due to Alzheimer

90%

50%

30%

People

Plant 50%

H

Qualitive in/output

30%

People

phase 2.

++

Support emotional needs Focus on the positive, rather than on preventing the negative

25%

Everyday tasks can be transformed into opportunities for engagement

ti

old

The use of symptons Find a bridge over physical needs you can support the core emotional problems

To

Fu

75% Fundamentals

ng

Focus on the positive, rather than on preventing the negative

Toolbox

cus

Fo

The use of symptons Find a bridge over physical needs you can support the core emotional problems

When designing for people suffering from dementia, it is ++ Dementia all about small gains; the creation of little valuable moments and experiences.

Applicable for all elderly people

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Prototypes To feel the context a bit better as designer, I have created and tested prototypes.

They were vere useful to discuss my scope with fellow students, but also for evaluating with the end-user, like I have written down in my reflection: Reflection In this reflection, I will emphasize on my making practice and the making/testing of prototypes and concepts. This semester, I have set the goal to make all my prototypes at least ‘high low-fidelity’ in order to be ablle to communicate my concepts better, but also to reveil design requirements and problems. Thereby, it would also allow evaluation with the target adience and experts.

For this project - within this stage - it meant that I have professionalized my sketching and photography skills, but also my rapid prototyping competencies (Solid Works - Illustrator - Laser cutter).

Within my first user test, I have experienced how valuable ‘high low-fidelity’prototype was. Before I showed it to my users, I had explained them my context and they were not convinced or interested at all. This changed when I presented my prototype; they became enthusiastic and started to add their own ideas and thougths to it.

Furthermore, I feel more confident in my position as designer when my deliverables look good - having nice photographs were in my opinion essential in my presentation to the GGzE.

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4.

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Requirements – Characteristics of my design Hulpje gives a little support to people who like to give the best care for their plants, but who sometimes get confused how to do so. ntroduction Once I have created my design space and tested some of my first ideas in low-fidelity prototypes, I was able to make a list of requirements about the interaction for my final concept(ualization): what are the essential things that I have to integrate in my concept?

Though, I liked to experience myself how it is to garden with an aging body; what are things I miss when I observe other people, but feel when I experience it myself? For this reason I have made an empathy suit. Besides, I have tried to capture the quality and moment of interaction in mappings, in order to define the needs.

At the same time, I had to determine the goals for my prototype (and ‘ideal’ concept) in terms of material, technology and other fundamentals. Those decisions are not only influenced by context and user, but also by my skills, my preferred development as designer and the making possibilities in my environment. I will write about these decisions in my reflection on the end of this chapter.

In this chapter I will explain the requirements within three major areas: 1. Caring for plants when aging – Ease of use 2. Dementia symptoms and needs focused 3. Basic fundamentals - Plant, pot and technology

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ERGONOMICALLY DESIGNED FOR ELDERLY

EASY TO PICK UP EASY TO REACH FOR

SPILL PROOF FIRM & LIGHT

STABILITY AND BALANCE (SHAPE)

STABILITY AND BALANCE (SHAPE)

FIRM & LIGHT VISUAL SIGNS/REFERENCES: BIG & BRIGHT CONTAINING CONTRAST SAFE

(McGowan, 2012) (Choi, 2009) (Douglas & Zatovska, 2010)

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1. Caring for plants when aging “Ease of use� - frailty & disability Although it is common knowledge that nobody ages in exactly the same way, it is useful to specify some of the sensory, motor and cognitive limitations experienced by sizable percentages of this population. Age-related hearing and visual deficits are common, alike an increased reaction time, mobility impairments and the occurrence of decreases in strength. (Fisk, Rogers, Charness, Csaja, & Sharit, 2001) Loss of memory does not only happen when living with dementia; it becomes more prevalent with age. This makes it often difficult to remember complex sequences of instructions. Also, older adults might also be more likely to be distracted and to have difficulties both directing and inhibiting their attention in relation to irrelevant information.

(Fisk, Rogers, Charness, Csaja, & Sharit, 2001)

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Requirements user interaction “Dementia symptoms focuses” (Mihailidis, 2002) (website alzheimer-europe.org) Besides the fact that every human ages differently, it is common for person with dementia to have different needs and abilities from one day to another. There cannot be a one-size-fits all & one-product-accomplishes all – approach to address the needs of every individual.. Instead, optimally, design must take in account the unique needs of each user, and fluctuations in those needs.

Like with aging, there are some symptoms/ characteristics that often occur in the population of people with dementia, and they are worth considering while setting the requirements of my design.

For the interaction, I want to emphasize on the communication with people with dementia – how to approach them and what works to trigger a certain behavior?

On Www.caregivers.org, I have found very useful advices that have been an inspiration within my design process. I will describe the most essential here: Communication/behavior 1. Set a positive mood for interaction.

Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.

2. State your message clearly.

Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or question. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.

3. Ask simple, answerable questions.

Ask one question at a time; those with yes or no answers work best.

Refrain from asking open-ended questions or giving too many choices.

For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clarify your question and can guide her response.

4. Break down activities into a series of steps.

This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own.

Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.

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VALUABLE FOR MORE THAN ONLY PEOPLE WITH DEMENTIA: ANTI STIGMA LANGUAGE SIGNS: SIMPLE, UNIVERSAL & EXPRESSIVE

EASY TASKS & ASSIGNMENTS - BUILDING ON EXISTING KNOWLEDGE & SKILLS - JUST ONE TASK A TIME

REWARD FUNCTION PARTLY SELF SUSTAINING

RECOGNIZABLE SHAPES

SIZE INTERACTION S

PLANTS CHARACTERISTICS SAFETY

REPETITIVENESS

EXPRESSIVENESS

VISUAL SIGNS/REFERENCES: BIG & BRIGHT

ACTIVITY TRIGGER RE-ASSURANCE EXTRA REFERENCE MATERIAL SENSORY STIMULATING

UNITY IN PARTS CONCEPT TANGIBILITY FOCUS

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5. When the going gets tough, distract and redirect.

When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect.

You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”

Behavior 6.We cannot change the person.

The person you are caring for has a brain disorder that shapes who he has become. When you try to control or change his behavior, you’ll most likely be unsuccessful or be met with resistance. It’s important to: 7. Try to accommodate the behavior, not control the behavior.

For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable.

Remember that we can change our behavior or the physical environment.

Changing our own behavior will often result in a change in our loved one’s behavior.

8. Behavior has a purpose.

People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why. It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behavior—and, when possible, try to accommodate them.

9. What works today, may not tomorrow.

The multiple factors that influence troubling behaviors and the natural progression of the disease process means that solutions that are effective today may need to be modified tomorrow—or may no longer work at all.

The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.

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WATERPROOF

LIGHT MATERIAL MOBILE (partly) SUPPORT IN POT

SENSORS

ISOLATE WATER AND ELECTRONICS

WATER MOVEMENT LIGHT LITTLE ENERGY USE ARDUINO

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FIT IN POT

Fundamental requirements In the figure, I have shown some fundamental requirements of the technology, the pot and the material. I have also tried to incorporate the next universal design principles in my concept: 1. Affordance pot (combination of pots - stack in just one way) - physical properties!

A property in which the physical characteristics of an object or environment influence it function 2. Form follows function Beauty in design results from purity of function Functional aspects of a design are less subjective than aesthetic aspects, and therefore functional criteria present a clearer and more objective criteria for judgement of quality. But boring and uninteresting?!

3. Ockhams razor Given a choice between functionally equivalent designs, the simplest design should be selected. Simplicity is preferred to complexity in design.

(Lidwell, Holden, Butler, 2003)

Reflection 39

Identity

Steps

eco sy

Tools Fun Grip

Safe

Simple

Weight Patience

Co-ordination

Balance

Support system

Mobile Recognizable

Social

Structure Re assurance Sensory

Trigger

Reminisence

Plants

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Fast growth rate

Familiar

ystem

Exercise

Personal investment

Repetitive culture

Within this reflection I will focus on the discrepancy between concept and prototype, as well as the most important decisions and concessions I have made.

First of all, in the whole project I have searched for the balance between my personal goal for this semester and the main goal of the project: professionalizing practical skills and designing (testing) an interaction.

Reflecting on the total project, I have deliberately given the practical skill development more weight, because without a decent prototype I did not want to present on the Think Dementia Fair ánd (like I have mentioned in the last reflection) it would allow me to do evaluation with the target audience/expersts.

Hence, it enabled me to close the design process properly; I have asked experts and people living with dementia to give feedback on the interaction.

Naturally, I had to make concessions when setting the requirements for making my prototype. My material/technology plan for the ‘real world’ concept was too ambitious. It involved too many parts, too many new techniques and material to learn/ work with in the time I still had (especially when you consider my ‘China time’).

Therefore, I have decided to only focus on the support system (& tools & plants are too much), to develop the Rapid Prototype techniques I have learned this semester (during the Modules) further and to use material that looks nice and is easy shapeble (but is not as light as the material I envisioned).

Within this project and context, ‘originality’ got a new meaning for me. Because of the mental (memory) impairments of the end-user, the foundation of innovation is familiarity and the originality lies in creating new understandable connections.

Refering to the hierarchy of needs for design, I have learned that every design context has a different focus according to the needs. To comprehend it for this project, I have made the time & quality mapping and I have made the empathy suit.

The last method made me understand the user from first perspective, without directly incorporating the user. The experience was very inspirational because it gives the opportunity to sense the context with other senses than just your eyes (observing).

rity

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5.

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Design – Making of Not in a digital application, not with flashing lights or tilting pots, but simply with symbols on the actual pot; designed for everybody’s understanding.

Introduction This chapter is all about the creation of my final concept/design, based on the requirements: from sketches to the milling machine to the presentation during the Think! Dementia Business Fair. I will explain the most important choices I have made, using sketches, visuals, photos and text.

Within the Appendix, there are more visuals of the making process.

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green design

Plant/Green Design

pot design

Requirements

Concept Characteristic

Concept Characteristics

Sketches

Sketches

3D CAD

3D CAD

Render

Render

Material

Material

Prototype

Prototype

Finish off

Finish off

Assemblage

Assem

Electr PROJECT TIME 44

Te

Exh

tech design

graphic design

cs

Choice electronics Test all parts seperately

Symbol directions

Code

Sketches design

Integrate in one circuit

Illustrator/Paint TFT Screen Test

mblage x 4

ronics test

est pot

hibition

HULPJE

MAKING PROCESS 45

Sketching & Shaping To explore the shape and the function of the support system, I have done a lot of iterations in Solid Works, Illustrator but I have also sketched by hand. Because I couldn’t make multiple pots by milling, I relied a lot on my 2D and 3D visualization skills to end up with a suitable shape.

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Milling and (hand) drilling My final CAD model is milled by a CNC machine. This has given me the opportunity to have more complex and precise shapes. Though, because I could use only two drills (who were not longer than 80 mm), I was also limited by the machine in the form & senses.

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TFT SCREEN

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ARDUINO UNO

MOISTURE

Technology For my prototype, I have used an Arduino Uno, a moisture sensor and a TFT screen. Ideally, I would have integrated more sensors, but this circuit showed off my concept pretty well.

SENSOR

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Most important features of

Hulpje Interaction with the plant The movement sensor ‘knows’ when somebody has intensively interacted with the plant.

Bring the fresh herbs on the table!

This one way how the pot can tell that the plant it’s leafs are cutted for example.

An opening to lift up the inner pot without any effort.

The inner pot is mobile and without any electronics.

Most plants prefer dry feet!

Between the inner and outer pot is a small water resevoir that can also be filled with hydro korrels.

Thirsty plants need the right amount of water The moisture sensor that is integrated in the outer pot has a very important task: sensing if the plant has enough water or not.

What care does my plant need on this moment?

The screen communicates with the plant’s caregiver. It does not shout or wave - it functions as a reference.

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Customized care In the bottom of the pot, you can select the category of plant.

The code will be adjusted to the plant and the pot will give the right information.

Electronics in the pot All the electronics were in the (bottom of) the outer pot, the inner pot was mobile and waterproof.

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Finishing For the finishing, I have sanded and oiled the pot a lot. I topped it off with bee wax, which gave a nice shine to the pot. I have made the inner pot water resistant with PU vernis.

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‘Assemblage’ Because of my calculations, the assemblage worked out pretty well. Everything fitted in the pot, what made it ready for tests and evalutions, as well as presentations at the business fair and Final Demo Day.

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Symbols I have created symbols and a reference book that are the basis of the interaction

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Reflection One of the main goals of this semester was to professionalize myself in practical design skills. I have chosen to do the Rapid Prototyping Module, to learn and experience various ‘designer making’ skills and I did not want to pass the opportunity to use those in my project.

For the making process, I have had a couple of brainstorm sessions with a friend of mine, who is a typical classic product designer (focused on physical design and production). Working together with him was a very valuable experience, because it made me aware that as designer I am more research/interaction/concept centered.

The reason behind this is probably that I have quite a large background in doing research (when taking my Bachelor degree in Human Geography into account), and less experience in ‘product design’. Though, I enjoyed both a lot and I would like to have a more equal balance between the two, what meant that my main goal for this semester was the perfect choice/start.

Five weeks before the final project deadline, I went to China for three weeks (Module). I liked to have the making of the prototype finished before this moment.

Hence, I had two weeks after the SDCL weeks to make my prototype based on the requirements I had set. There was no time to do a lot of extra prototype explorations for my final concept and that why I have done a lot of 2D and (digital) form exploration. I have learned new techniques such as using Solid works E-drawings as basis for changing the shape of my concept.

I am content with the prototype I have as endresult. I have received a lot of positive reactions on the shape of the pot and the material I have used. It reflects the design principles I have used and it represents my skills in making. Though, next time I would incorporate more time for evolutionary prototyping, to collect more information about the functionality and performance of different parts. For example, the opening for my screen should be shaped a little differently to increase the visibility.

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6.

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… Reasons to believe Introduction The pot looks nice and all the electronics work, but what are the reasons to believe in this concept? In other words: what is the feedback from experts, end users and the target audience? Has the concept been tested and how do I consider the product in its competitive environment?

During the creation of my concept and having presented my product on both the fair and the final demo day I have received a lot of (expert) feedback from people out of the field: care takers, people living with dementia, designers and..

I have also been doing a symbol test, which is essential for my product to work and which is providing me a lot of interesting insights about common understanding, connotations and associations. Advised by my assessor Lu Yuan to do another short test/expert meeting, I am going to visit the .. care home to receive more feedback from out this approach The proof of concept is devided in four main parts and that is also how I bave structured the feedback. I have written down the most important notions that value my project and give inspiration for iteration.

Proof of context Monique Peeters - Social Worker, GGzE “The moestuintjes of the Albert Heijn supermarket are super popular, you could do something similar for people living with dementia” Monique Peeters is directly working with people with dementia and she has given me the advice to always add extra reference material to the support system; for example a booklet with explanations of the symbols.

She did not perceive any problem in the risk that plants die, it belongs to nature and people would not feel that they are failing.

Monique planten, dat hoort bij de natuur. Ik denk niet dat mensen dat zien als ‘falen’.

De moestuintjes ( van AH) zijn momenteel erg populair bij kinderen, ik denk dat je dit ook in een andere vorm voor mensen met een dementie kunt gebruiken.”

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Proof of scope Presentation GGZE “The scope you have chosen is very good, we experience the increased emotional life everyday “ The ‘Mid-Term’ presentation for the GGzE experts has helped me lot validate the value of the scope I had created. They have given me insights about the plants I should use (ones that show quick results and can be eaten), but they thought that the interaction I had in the preliminary prototypes was too difficult. Too many actions had to be taken. Lastly, they have triggered me to think about defining my end user. Do I design for people who already have gardening skills or for new users?

Expert: Gail Kenning, artist, researcher and educator, University of Technology, Sydney “The pot might be too small- a scale model-, but I can see the opportunity. It gives people a bit of their interdependence back and that is the most important in this context” The question where the GGzE presentation ended with, is a nice bridge to Gail Kennings feedback. When I told her that especially for people living with dementia, it is complex to motivate them for an activity that they (have never) like(d), because of the increased emotional life In this sense my end-user would be someone who has always liked gardening. Though, Gail told me that she has the experiences that dementia provides the perfect opportunity to introduce ‘new’ things: the interests of people with dementia often modificates, hence it is valuable to propose new activities.

Furthermore, Gail pointed at the emotional connection I am creating by adding expression to the pot. What if the plant dies?

She gave me the positive feedback that the tangibility of the scope is perfect, people living with dementia like to feel and to smell. It is good thing that the interaction with the pot is so subtle, what gives the interaction with the plant a bigger stage. Though, will people actually perform the actions that are told by the actions? Gail saw this as one of the biggers challenges to research within my project.

Hans Wetten, Land van Horne, experience care “I can see your approach working in other devices. It could work as an catalytic converter” This concept is hard to translate to the carehome, because the symbols are too complex. For people who live alone, it’s good, it proposes an activity. Here in the carehome, they are in such a far stage of dementia, that they see the symbol of for example cutting, but they do not understand what the link is between te plant and cutting “Why does a plant has to be cut?” It is worth it to look at the Bliz-symbol system, they use in mental-handicap care.

For people living with dementia, you have to try to take actions away- that makes 65

it more comprehensible. To design tools next to the pot you have now that do this will be beneficial.

It does not only propose an activity to the people living with dementia, but it also gives inspiration to their caregivers what to do..

Hans could see my approach being adopted by other machines/products that help people maintain their interdependence.

Hans has gives me a contact to do a test for a week Proof of user experience Expert: Tommy Dunne, dementia patient “A little reminder is not bad at all, my wife would be interested and she doesn’t even have dementia! “ During the Think! Dementia fair, I have asked Tommy Dunne, who is an dementia patient himself, to give feedback on my concept. He liked it a lot because it proposes an activity and it triggers the senses.

Symbol Test Expert: mr & mrs Coppelmans “Does this icon mean shadow? I thought it meant space of that it represented one big leaf” I have evaluated my first set of icons with fellow students of Industrial Design and with mr. and mrs. Coppelmans (mr. Coppelmans lives with dementia). This has given me lots and lots of insights about the graphic design. I have never done UI-design on this particular level and I liked it a lot. They have shown me that I had to focus on reducing the ground for associations and to bring in as much expression as possible. Furthermore, the icons which were visually analogous to an action and objects were most effective: the plant ánd pot had to be in the icon, as well as the action.

Proof of Form & Senses The Think! Business Fair and the Final Demo Day have provided me direct and indirect feedback about the Form and Senses of my project.

Both in the (professional) after movie and photo album of Think! Dementia, my project and presentation is present. I perceive this as evidence that my concept as well as my presentation set-up was visually pleasing. ‘Worth” to be shown as part of the fair.

Next, visitors and business owners asked my whether my concept was already in production or not, what gives an indication of the professional look of my prototype.

During the Final Demo Day, a lot of people commented on the making process, shape and material I have used. Most of them shared the opinion what a differ66

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ence it makes to give a little more care about the material choice. When I would have used MDF, it would have looked like a concept-prototype. Now it looked like an (almost) finished product.

Reflection In the last weeks and even now I am writing this, I have been doing the last activity of my design cycle - the proof of concept.

For me personally, it does not matter whether this is a success or not, I am very curious which parts of my project are good, which need improvement and which sould me elimitated at all.

Though, I have experienced that experst can be biased as well, everybody has their own agenda and especially on a business fair as the Think! Dementia this comes apparent. It is good to be aware of it and to balance their feedback.

Essentially, I am doing this to be able to reflect on my decisions and design intuition, as well as my aesthetic skills.

Overall, seperately from the feedback and results out of the usertests, I am proud on what I have achieved this semester. I have ‘ticked off’ most of personal goals of this semester just by doing this project. I have learned so much about many different aspects of the design process ánd about myself as designer.

Like I have also discussed with Hans Wetten, this context has so much to offer for us designers: in a way it is practical, the context has it’s boundaries, but the focus on emotions and experiences creates a lot of freedom for our creativity. .. At least that is how I feel about it :).

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Sources Choi, S. (2009). Safety and ergonomic considerations for an aging workforce in the US construction industry .

Douglas, E., & Zatovska, S. (2010). Aging, Disability, and Frailty: Implications for Universal Design.

Fisk, A., Rogers, W., Charness, N., Csaja, S., & Sharit, J. (2001). Designing for older adults, principle and creative human factors approaches.

Lidwell, W., Holen, K., & Butler, J. (2003). Universal Principles of Design. Beverly: Rockport Publishers.

McGowan, B. (2012). Ergonomic Design Considerations for the Aging Populations.

Mihailidis, A. (2002). Context-aware assistive devices for older adults with dementia.

Rappe, E., & Linden, L. (2009). Plants in health care environments: experiences of the nursing personnel in homes for people with dementia .

Roland, P., & Chappel, N. (2014). Meaningful Activity for Persons With Dementia, Family caregivers perspectives. Geriatrics& Gerontology .

Timlin, G., & Rysenbry, N. (2010). Design for Dementia: Improving Dining and Bedroom environments in Care Homes. London: Royal College of Art. Websites: http://aja.sagepub.com/content/early/2015/03/17/1533317515576389.abstract http://www.nationaalkompas.nl/bevolking/vergrijzing/toekomst/ http://www.innovatedementia.eu/en http://www.designcouncil.org.uk/knowledge-resources/case-study/living-well-dementia http://www.alzheimers.net/11-10-14-emotions-after-memory-loss http://dementia.onourradar.org/2015/06/02/help-make-exercise-more-enjoyable http://www.alzheimers.net/2014-01-23/sensory-stimulation-alzheimers-patients http://www.healthline.com/health/importance-plants-home#2 http://www.nursetogether.com/alzheimers-and-dementia-care-bringing-garden-indoors http://www.alzheimer-europe.org/Dementia/Alzheimer-s-disease/Main-characteristics-of-Alzheimer-s-disease/Apraxia-Aphasia-Agnosia#fragment4 http://www.caregivers.org

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Appendix (Making)

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Exploration Shape

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3D Solid Works

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Milling and drilling

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Polishing and Finishing

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Assemblage

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Technology

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Arduino Code

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