Towards Technologies for Promoting Nutritional Health in Older People with Dementia Living in ...

298 Pages·2017·27.38 MB·English

Towards Technologies for Promoting
Nutritional Health
in Older People with Dementia
Living in Their Own Home
Asangi de Silva Jayatilaka
Supervisors: Professor Katrina Falkner
Dr Damith Ranasinghe
Professor Anne Wilson
School of Computer Science
University of Adelaide
This thesis is submitted for the degree of
Doctor of Philosophy
July 2017
I would like to dedicate this thesis to my beloved family, teachers, and mentors who
have helped me to become the person I am today.
Declaration
I certify that this work contains no material which has been accepted for the award of
any other degree or diploma in my name, in any university or other tertiary institution
and, to the best of my knowledge and belief, contains no material previously publis
hed or written by another person, except where due reference has been made in the
text. In addition, I certify that no part of this work will, in the future, be used in a
submission in my name, for any other degree or diploma in any university or other ter
tiary institution without the prior approval of the University of Adelaide and where
applicable, any partner institution responsible for the joint -award of this degree.
I give consent to this copy of my thesis when deposited in the University Library,
bein g made available for loan and photocopying, subject to the provisions of the
Copyright Act 1968. I acknowledge that copyright of published works contained
within this thesis resides with the copyright holder(s) of those works.
I also give permission for the digital version of my thesis to be made available on
the web, via the University’s digital research repository, the Library Search and also
through web search engines, unless permission has been granted by the University to
restrict access for a period of time
Asangi de Silva Jayatilaka
July 2017
Acknowledgements
This thesis is a result of many experiences which I have encountered at The University
of Adelaide and it would not have been possible without the support of several people.
I want to thank Professor Katrina Falkner for her useful comments and guidance
provided for this thesis, and for her valuable support, encouragement and strength
provided throughout my PhD.
I want to thank Dr Damith Ranasighe for giving me the valuable opportunity to
conduct further studies at the University of Adelaide, and for the guidance and valuable
feedback provided throughout the PhD.
I want to thank Professor Anne Wilson for the guidance provided throughout the
qualitative descriptive study which is a signifcant part of this thesis, for the valuable
feedback provided on the thesis, and for the her extraordinary support and motivation
which helped me to move forward and achieve my goals.
I want to thank the managers and offcers at Southern Cross Care (SA & NT) Inc,
ECH Inc, ACH Group and Resthaven Inc, for their signifcant support provided for the
research. Especially, I appreciate their assistance in releasing their staff, despite the
extremely tight schedules, to attend the group meetings. I also want to thank all the
home support workers and care coordinators who participated in the focus groups and
all the participants who participated in the technology development studies.
I want to thank Professor Renuka Visvanathan for the feedback and advices pro-
vided, and for her assistance in collaborating with aged-care organisations.
I also would like to thank Professor Ali Babar and Dr Neha Mahajan for their
support provided during the frst year of my PhD journey.
I recognise that this research would not have been possible without fnancial
support from The Hospital Research Foundation (THRF), the Government of South
Australia (CPP39) and the School of Computer Science.
I would like to thank the School of Computer Science for providing me with an
excellent working environment with all the resources needed to carry out my PhD.
I am thankful to Alison-Jane Hunter for her professional support in editing this
thesis.
I also would like to thank my close friends in Adelaide for all their kind support,
love and care provided throughout this PhD journey.
v
Last, but not least I would like to thank my beloved husband, parents and parents in-
law for standing beside me, and for providing support and encouragement throughout
the ups and downs of this journey.
Abstract
Dementia compromises older people’s ability to maintain good nutrition, which in turn
hinders their capacity to live in their homes for longer. Thus, they need signifcant
support to maintain their nutritional health, often through care workers, especially
when living with limited or no family support. However, with the rapid growth of
the older population, the burden on care workers continues to increase, resulting
in an urgent need to consider ways to assist people with dementia to maintain their
nutritional health as well as their care workers to provide better support for their clients.
Through a cross-disciplinary study, this thesis investigates how technologies can be
used to promote nutritional health in older people with dementia living in their own
homes. This involves an in-depth qualitative descriptive study and two technology
development demonstrations.
Understanding needs prior to technology development is crucial for technologies
to be effective, accepted by users and able to reach their desired maturity; however,
this necessitates greater research investment. This thesis presents, for the frst time
to the best of the researcher’s knowledge, a qualitative descriptive study with the aim
of obtaining an holistic perspective of needs for technologies promoting nutritional
health in older people with dementia living in their own home, involving focus groups
with 27 care workers who provide care to older people with dementia, recruited from
four leading aged care providers. Eight categories emerged from synthesising the care
workers’ voices. These categories provide deep, reliable insights useful for designing
nutritional health-promoting technologies. In particular, nutritional health challenges
faced by older people with dementia and challenges faced by care workers when
providing nutritional health assistance to their clients demonstrate the demand and
need for technological assistance and opportunities for developing technologies to
promote nutritional health for the target cohort. Furthermore, this thesis proposes
important elements need to be considered in technology development in the form of
eleven technology design considerations.
Based on the formulated design considerations, two technology development
demonstrations are presented. Firstly, poor fuid intake is identifed as a signifcant
problem and therefore, recognising fuid intake related primitive human motions using
vii
batteryless Radio Frequency Identifcation (RFID) technology is investigated. To this
end, a smart cup to collect fuid intake data is designed and experiments are conducted
with young (30.7± 1.6 years) and old (69.0± 4.6 years) participants. The promising
results demonstrate the feasibility and effcacy of recognising short distance, short
duration natural fuid intake gestures using batteryless RFID technology for the frst
time to the best of researcher’s knowledge. Secondly, a study that focuses on an
architecture, Home of Things for Ambient Assisted Living—HoTAAL, suitable for
facilitating the development of a collaborative environment, having heterogeneous
technologies that can have seamless integration with each other as well as humans is
conducted. It is expected that such an infrastructure would allow the development of a
broad range of innovative technological applications to promote the nutritional health
of older people with dementia. A demonstration of providing meal preparation assis-
tance employing HoTAAL with three kitchen appliances was conducted. Additionally,
possible technological applications based on HoTAAL architecture are described for
several scenarios extracted from the focus group fndings.
Table of Contents
List of Figures xiv
List of Tables xvii
Acknowledgement of material arising from this thesis xix
I Overview and background 1
1 Introduction 2
1.1 Contributions of the thesis . . . . . . . . . . . . . . . . . . . . . . . 5
1.1.1 List of contributions . . . . . . . . . . . . . . . . . . . . . . 5
1.1.2 Description of the contributions . . . . . . . . . . . . . . . . 6
1.2 A guide to the thesis . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.3 Researcher position . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.4 Defnition of terms used in this thesis . . . . . . . . . . . . . . . . . . 13
2 Related work 15
2.1 Nutrition and mealtime situations of older people with dementia . . . 16
2.2 Identifcation of technology needs . . . . . . . . . . . . . . . . . . . 18
2.2.1 Technological needs of older people with dementia . . . . . . 18
2.2.2 Technological needs of care workers . . . . . . . . . . . . . . 20
2.3 Development of technologies . . . . . . . . . . . . . . . . . . . . . . 20
2.3.1 Technologies to support older people with dementia . . . . . 21
2.3.2 Technologies to support care workers . . . . . . . . . . . . . 27
2.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
II Investigation of technological needs 31
3 Theoretical framework 33
Table of Contents ix
3.1 Explanation and justifcation of the research methodology . . . . . . . 35
3.1.1 The research paradigm selection . . . . . . . . . . . . . . . . 35
3.1.2 The research design selection . . . . . . . . . . . . . . . . . 37
3.2 Research methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.2.1 Participant selection and recruitment . . . . . . . . . . . . . . 41
3.2.2 Data collection . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.2.3 Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3.3 Study rigour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4 Findings I - Support received by older people with dementia living in
their own home to maintain their nutritional health 51
4.1 Participant characteristics . . . . . . . . . . . . . . . . . . . . . . . . 52
4.2 Category: Care worker support . . . . . . . . . . . . . . . . . . . . . 53
4.2.1 Concept: Plans . . . . . . . . . . . . . . . . . . . . . . . . . 53
4.2.2 Concept: Documentation and communication . . . . . . . . . 55
4.2.3 Concept: Dental care . . . . . . . . . . . . . . . . . . . . . . 56
4.2.4 Concept: Shopping . . . . . . . . . . . . . . . . . . . . . . . 57
4.2.5 Concept: Meal preparation . . . . . . . . . . . . . . . . . . . 59
4.2.6 Concept: Food consumption . . . . . . . . . . . . . . . . . . 61
4.2.7 Concept: Fluid consumption . . . . . . . . . . . . . . . . . . 64
4.2.8 Concept: Food quality . . . . . . . . . . . . . . . . . . . . . 66
4.3 Category: Family Support . . . . . . . . . . . . . . . . . . . . . . . . 67
4.3.1 Concept: Care plans . . . . . . . . . . . . . . . . . . . . . . 67
4.3.2 Concept: Shopping . . . . . . . . . . . . . . . . . . . . . . . 68
4.3.3 Concept: Meal preparation . . . . . . . . . . . . . . . . . . . 69
4.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
5 Findings II - Older people’s nutritional health challenges as perceived by
care workers 72
5.1 Concept: Shopping . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
5.2 Concept: Meal preparation . . . . . . . . . . . . . . . . . . . . . . . 76
5.3 Concept: Food consumption . . . . . . . . . . . . . . . . . . . . . . 78
5.4 Concept: Fluid consumption . . . . . . . . . . . . . . . . . . . . . . 85
5.5 Concept: Food quality . . . . . . . . . . . . . . . . . . . . . . . . . 85
5.6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Table of Contents x
6 Findings III - Care workers’ challenges in supporting their clients’ nutri-
tional health and their information needs 91
6.1 Category: Care workers’ challenges in supporting their clients’ nutri-
tional health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
6.1.1 Concept: Allocated time . . . . . . . . . . . . . . . . . . . . 93
6.1.2 Concept: Personal preferences and problems . . . . . . . . . 94
6.1.3 Concept: Communicating with other care workers . . . . . . 96
6.1.4 Concept: Food consumption . . . . . . . . . . . . . . . . . . 97
6.1.5 Concept: Fluid consumption . . . . . . . . . . . . . . . . . . 100
6.1.6 Concept: Food quality . . . . . . . . . . . . . . . . . . . . . 101
6.1.7 Concept: Shopping . . . . . . . . . . . . . . . . . . . . . . . 102
6.1.8 Concept: Meal plans . . . . . . . . . . . . . . . . . . . . . . 105
6.1.9 Concept: Meal preparation . . . . . . . . . . . . . . . . . . . 106
6.1.10 Concept: Enabling the clients . . . . . . . . . . . . . . . . . 108
6.1.11 Concept: Uncooperative families . . . . . . . . . . . . . . . 109
6.1.12 Concept: Uncooperative clients . . . . . . . . . . . . . . . . 111
6.1.13 Concept: Documentation . . . . . . . . . . . . . . . . . . . . 112
6.2 Category: Care workers’ information needs related to clients’ nutri-
tional health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
6.2.1 Concept: Food and fuid consumption . . . . . . . . . . . . . 113
6.2.2 Concept: Inventory . . . . . . . . . . . . . . . . . . . . . . . 115
6.2.3 Concept: Rewards . . . . . . . . . . . . . . . . . . . . . . . 116
6.2.4 Concept: Meal and shopping plans . . . . . . . . . . . . . . 116
6.2.5 Concept: Meal preparation . . . . . . . . . . . . . . . . . . . 119
6.2.6 Concept: Routines . . . . . . . . . . . . . . . . . . . . . . . 119
6.3 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
7 Findings IV - Care workers’ wishes and concerns about technologies 122
7.1 Category: Care workers’ wishes for technologies designed to support
their clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
7.1.1 Concept: Shopping support . . . . . . . . . . . . . . . . . . 123
7.1.2 Concept: Meal preparation support . . . . . . . . . . . . . . 125
7.1.3 Concept: Food and fuid consumption support . . . . . . . . . 125
7.1.4 Concept: Cleaning support . . . . . . . . . . . . . . . . . . . 130
7.1.5 Concept: Toileting support . . . . . . . . . . . . . . . . . . . 131
7.1.6 Concept: A single platform focusing on nutrition . . . . . . . 131
7.2 Category: Care workers’ wishes for technologies designed to support
them . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132