3. SUPPORT: TOOLS FOR INTERACTION BETWEEN PEOPLE WITH ALZHEIMER’S DISEASE AND THEIR RELATIVES OR CARERS
Can communication design aid people with Alzheimer’s disease? SUPPORT
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This group of experiments aims to support directly people with Alzheimer’s disease and their relatives or carers. Daily challenges for my grandparents were used as inspiration for possible small products aimed to help relatives or carers to interact and stimulate the person with Alzheimer’s disease.
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CAN COMMUNICATION DESIGN ADD VALUE TO THE CONTEXT OF ALZHEIMER’S DISEASE?
Can communication design provide a better understanding on Alzheimer’s disease?
1. INFORMATION: Mapping Dementia 1st year
2. REFLECTION & DISCUSSION: What if graphic design was affected by Alzheimer’s disease symptoms?
Can communication design aid people with Alzheimer’s disease?
2nd year – before Work in Progress show
3. SUPPORT: Tools for interaction between people with Alzheimer’s disease and their relatives or carers Playing
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Communicating
P. 15
Enabling
P. 23
2nd year – after Work in Progress show
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PLAYING: CARD GAME
My grandmother has great difficulty identifying people from the close family. She knows the names are important and recognizes the faces, but she cannot put the two together and does not know how we are related. Moreover, my grandparents on mother’s side live in their hometown with the help of a carer, who is not part of the family. Even though they speak everyday on the phone to my mother and aunt, who live in a different town, and has pictures of the family at home, it is not enough to maintain her awareness of the family. To address this issue, I thought about the possibility of using a family tree, in which she could see pictures and read the corresponding names, and to help the carer encourage conversation. However, this idea was too static, and I wanted to add a playful character to it.
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FIRST PROTOTYPE A set of cards was produced, each having a picture of a family member on the front and their name on the back. The pictures were meant to be visual cues for my grandmother to try to identify the faces before reading the name. Hints were given through colour and patterns to help her to understand the relationships between people. The goal was to create a game to stimulate the recognition of relatives by positioning the cards according to kinship. The game was tested with my grandmother, who, despite the interest shown, was not really able to use it. She demonstrated difficulties in recognizing the pictures, even when comparing them to the person. The patterns and colours seemed to confuse her and everything was too small for her to clearly see. The test resulted in a frustrating and exhausting session, both for my grandmother and for the relatives participating. However, the relatives found the concept worth developing because they thought it was an interesting way to stimulate my grandmother’s memory.
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SECOND PROTOTYPE A second iteration of the family card game was developed, reducing the complexity of the first one, but maintaining the same structure: pictures on the front, name on the back. Layout The cards were made bigger, allowing bigger pictures. The pictures were all close-ups with faces clearly visible. A small description about the person on the card was added, as well as a question regarding kinship that would redirect to another person/card. Several other layouts were tried, but the decision was to keep it as simple as possible. No use of colour or patterns was made. The text was black on white background, increasing contrast and facilitating legibility. Typography The typeface was carefully chosen and used according to research done on typography and legibility for elderly people. This suggested distinguishable forms for each character, open counterforms, uniform stroke widths, wider horizontal proportions, and pronounced ascenders and descenders1.
1 Nini, P. (2006) Typography and the Aging Eye: Typeface Legibility for Older Viewers with Vision Problems. AIGA. [Internet] Available from: http:// www.aiga.org/typography-and-the-aging-eye/ [29 March 2012] American Printing House. [Internet] Available from: http://www.aph. org/edresearch/lpguide.htm [29 March 2012]
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I tried several typefaces and sizes with my grandmother: a sans serif, two serifs and a slab. She read all of them without any problem, as long as the size was large enough. Although American Printing House for the Blind (APH) suggests the use of a sans-serif typeface, the serifs facilitate the recognition of letter shapes. Therefore, I opted for Lexia, a slab typeface that combines the characteristics recommended with a harmonious and friendly look. Moreover, the capital letters also had characteristics that make them more identifiable. APH also recommends the use of white space. The spaces between letters were made more even, and the spaces between words were increased to help recognition. Result My grandmother engaged with the game, being able to recognize the people in the cards more easily, although not always. She was interested in reading the small sentences about the people in the cards. However, without help she would sometimes get lost with the questions. It revealed to be helpful for my family to enhance conversation with my grandmother, but also something that she could look at and maintain interest for some time on her own. The card game works as a set of visual and written cues to trigger memories in someone with Alzheimer’s disease in a playful way, allowing different ways and levels of interaction.
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Template Although this project started from a particular everyday challenge for my grandmother – remembering her family – generalization was considered in this prototype. Since memories are very personal and symptoms manifest differently across people with AD, it is essential to consider personalization. The card is a template that other people can use and modify according to what is most appropriate to the person with Alzheimer’s disease. It does not have to feature family members – it could for instance also show places or objects – thus building a set of cards that are meaningful to them. I asked another family to participate and customize their own cards. The next step would be to make it available online, so more people can use it. Moreover, the cards can also be a valuable resource for people with dementia living in care homes. As residents are not living with their families, this might be even more relevant.
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COMMUNICATING: FAMILY BOOK
The same idea of facilitating communication and conversation about family members was adapted to my grandfather. He was never keen on cards, so the previous approach would probably annoy him. Ever since my grandfather had Alzheimer’s disease, he has been very passive and difficult to communicate to. However, he still reads a lot, which is not very common for people with Alzheimer’s disease. It is unclear whether he can really make sense of what he reads or if he is just following the words. I wondered if we could communicate to him through this medium that he still really engages with and enjoys. I asked members of the closer family to write him a letter, in which they introduced themselves and telling him something they once did or used to do together. These letters were compiled into a book, which was called Para: Vasco Branco (To: Vasco Branco), reinforcing the idea that these letters were directed at him. At the end of the book, I included a page for him to write or draw, in the case the book had stimulated him enough to do that.
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Format and Layout The book had to look as a textbook, so my grandfather would engage with it. He likes picture books, but he easily loses interest on them. For the same reason, the cover also had to be attractive enough, arising interest. Therefore I chose an imagery of his hometown, Aveiro. I used a screen grab from a short documentary he filmed in the 1960s about the town. Due to his fine motor impairments, the book could not be very big or heavy, and also not very small. The layout is very simple, with small amounts of text in every page to help concentration. As the texts of different family members extend for some pages, people/sections were colourcoded to clearly distinguish them. All sections start with a picture of who has written, so he could also recall and associate visually. Moreover, all pages contain the name of who has written near the page number. A table of contents was created in the beginning of the book to get an overall picture of the family. Typography The same typographic considerations were used as in the cards project. The type size was big and the spacing was generous. With the recommended characteristics in mind, I chose Courier for a personal reason: my grandfather used to write everything with a typewriter, even 14 published books. Therefore, using a typewriter typeface would probably look familiar to him. Additionally, it also related to the content of the book, made of
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letters to him. With the aim of triggering memories in my grandfather, specific names of people, places, expressions, etc. were highlighted, by increasing the text size. A second group of expressions, or sentences that we wanted him to look at, were underlined. No use of italics was made according to the recommendations of APH. Including the family needs When producing the book, I also tried to address the needs of the family participating. Because it is difficult to communicate with my grandfather, everyone was excited with the idea of finding different ways to do it. Nevertheless, we were a bit uncomfortable with the fact that my deceased uncle was not being mentioned or included. He died 6 years ago, when my grandfather was already in a moderate stage of the disease. For that reason, my family decided to not tell him what happened, to save him from sorrow and just let him slowly forget about his son. Having this in mind, I created a “publisher” called Edições O Menino e o Caraguejo (The kid and the crab editions), referring to a short film my grandfather produced in the 50s, which had my uncle as the main character when he was a child. It is a subtle detail that pleased the family members.
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Result My grandfather showed immediate interest in the book and enjoyment while reading it. He recognized the family members - with some help of the grandchildren. After some weeks, he became attached to it, always keeping it near him. He reads it several times a day, and already made some comments and asked about the people in the book. At the moment, my grandmother has to hide it for him to have more variety of stimuli, as he doesn’t want to read anything else. My family is really happy with the result and we are already thinking in a second book for “the kid and the crab editions”.
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ENABLING: TABLE MATS
The third experiment focused on the idea of enabling people with Alzheimer’s disease. As procedural memory is affected, which deals with tasks and how to do things, simple tasks like laying the table can become quite complex. As a former housewife, my grandmother was always very keen on helping out at home. In the last years, she has been not able to do it anymore. A tablecloth with the silhouettes of the cutlery and crockery was created to see if it this was helpful for her laying the table. Siimilar to the previous experiments, simplicity was crucial. The line drawings are simple and identifiable. It was made sure that the thickness of the lines was appropriate and visible, and contrasting colours to the background were used. In the first iteration of the experiment, the silhouettes were screen printed on cloth to be used on my aunt’s dinner table. My aim was to test it with my grandmother when the family was together on Easter holiday.
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Results The tablecloth was on the table with the plates and cutlery in the middle. We made her notice the drawings on the tablecloth. She understood and followed them, laying the table correctly. The tablecloth made her more confident when performing the task, contributing to self-empowerment. Generalization After the positive results, the tablecloth seemed a possible idea to be generalized. Therefore the project evolved to tablemats, making it more flexible to be extended to other families. The drawings were made bigger, as the original drawings were slightly smaller than the real crockery and cutlery. Also, more colours were used, while taking into account the contrast with background.
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Rita Maldonado Branco MA Communication Design Central Saint Martins College of Art and Design