Reminiscence Map
Insights to Design for People with Dementia from a Tangible Prototype
Alina Huldtgren
1, 3
, Anja Vormann
2
and Christian Geiger
1
1
Department of Media, University of Applied Sciences Düsseldorf, Josef-Gockeln-Str. 9, Düsseldorf, Germany
2
Departmente of Design, University of Applied Sciences Düsseldorf, Josef-Gockeln-Str. 9, Düsseldorf, Germany
3
Human-Technology Interaction Group, Eindhoven University of Technology, PO Box 513, Eindhoven, The Netherlands
Keywords: Dementia, Reminiscence Therapy, Human-computer Interaction, Tangible Interfaces.
Abstract: With higher life expectancy and an increasing number of older people, the number of people suffering from
dementia continues to grow. Dementia impacts all areas of daily life and, in particular, communication with
other people and maintenance of personhood. Technology is a promising means to address these challenges,
yet approaches to design with and for people with dementia remain sparse. In our work we aim specifically
to design interactive systems that can be used by people with dementia, e.g., as part of reminiscence therapy
or generally to remember the past and communicate with others. In this paper, we present our research and
design approach and exemplify one design case: the interactive Reminiscence Map, which was developed
together with a person with early stage dementia. We show how this design served us as a lens into life of
the care home residents and caregivers and provide design insights.
1 INTRODUCTION
Demographic changes and longer life expectancy
lead to a growing number of people with dementia.
In 2014, about 36 million people worldwide had
Alzheimer’s or a related form of dementia, the
highest percentage living in Western Europe
(Alzheimers.net, 2014). Over the course of the
disease, dementia severely impacts memory, speech
and language, thinking, orientation and social
behaviour. As a result people with dementia have
difficulties in all areas of daily life, often become
frustrated and experience lower life quality. In
extreme cases such frustrations can even lead to
challenging behaviours such as unrest, aggression or
apathy (Ferri et al., 2004). Unfortunately, there are
no medical treatments available at this point to cure
the disease. Instead psychosocial interventions play
an important role in order to increase the wellbeing
of people with dementia. Psychosocial interventions
include among others reminiscence, reality
orientation or memory training, which have proven
to positively and sustainably influence challenging
behaviours of people with dementia (Gallagher-
Thompson et al., 2012).
Technology has recently started to play an
important role in the area of care, mostly in the form
of assistive systems for the home care context
(AAL). Systems for people with dementia often put
users in a passive role, e.g., when GPS is used to
track lost people (Miskelly, 2005). However,
“[l]iving with dementia presents a range of
challenges ripe for creative applications of
technology” (Astell, 2009).
We believe, that the currently prevailing
technology-led developments miss some important
values and needs of people with dementia. Design
approaches involving the target group resulting in
technical artefacts for people with dementia have a
higher potential to address these people’s needs.
Especially in the area of designing for reminiscence,
maintaining personhood and communication new
media technologies can be utilized in supportive
ways.
In the so-called ‘NutzerWelten’ (English:
UserWorlds, www.nutzerwelten.de) project our
interdisciplinary team investigates ways in which
multimedia technologies can be utilized to support
and enhance the experience of reminiscence and
communication for people with dementia. Until
now, we conducted exploratory field research in
different settings (e.g. a care home, day care and
support groups) and developed a number of
interactive multimedia artefacts to be deployed in
233
Huldtgren A., Vormann A. and Geiger C..
Reminiscence Map - Insights to Design for People with Dementia from a Tangible Prototype.
DOI: 10.5220/0005442702330242
In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AgeingWell-
2015), pages 233-242
ISBN: 978-989-758-102-1
Copyright
c
2015 SCITEPRESS (Science and Technology Publications, Lda.)
these settings for observation and discussion with
people with dementia and caregivers. We intend to
identify design possibilities for multimedia
technologies that integrate smoothly into people’s
daily lives.
In this paper we focus, in particular, on one
design case that emerged from our field research in a
local care home. We describe the development of a
tangible interface called Reminiscence Map – a
physical map allowing the user to select a timespan
and remember places and stories from that time. The
map was co-developed with a person with early-
stage dementia as a personalized artefact and
discussed in an interview with the person and a
focus group with the caregivers in the institution.
Our intention was not to evaluate this particular
design for the purpose of generalization, but to use
the interactive artefact (like other prototypes created
in the project) as a lens into the lived world of
people with dementia. Similar to Wallace et al., our
Reminiscence Map “[a]s a tool of enquiry it revealed
valuable spaces for design in dementia that have
wider implications for interaction design” (Wallace
et al., 2012). In particular, the analysis of the case
surfaced themes for technology design (e.g., leaving
a legacy) that had not originally been considered.
2 RELATED WORK
2.1 Psychosocial Interventions for
People with Dementia
Researchers investigating dementia, especially those
following a person-centred perspective (Kitwood
and Bredin, 1992), believe that “the symptoms [e.g.
depression and fears] and behaviours [e.g. unrest,
aggression, wandering] of demented individuals are
not solely a manifestation of the underlying disease
process, but also reflect the social and environmental
context, as well as the demented individual’s
perceptions and reactions. Psychosocial
interventions can address these factors.” (Kasl-
Godley and Gatz, 2000). Psychosocial interventions
are even more important in light of the limited
success of pharmaceutical interventions for
dementia. Kasl-Godley and Gatz (2000) reviewed
the six main psychosocial interventions for people
with dementia: psychodynamic approaches,
reminiscence and life review therapy, support
groups, reality orientation, memory training and
cognitive/behavioural approaches. Each intervention
targets particular factors and addresses different
goals. For instance, while psychodynamic
approaches are helpful for gaining insight in the
intra-psychic experiences of the individual,
reminiscence and life review help with creating
interpersonal connections. Behavioural approaches
as well as memory training, on the other hand, are
less concerned with the subjective experiences, but
target specific cognitive deficits. Generally, it is
recommended to involve others in these
interventions in order to “increase social contact,
interpersonal communication and psychological
health” (Godley and Gatz, 2000).
2.1.1 The Role of Reminiscence
As dementia progresses individuals experience
memory loss, disorientation and in later stages a loss
of their sense of self. As such, it becomes
increasingly difficult for them to engage in
meaningful activities, although this is of high
importance for their quality of life (Wood et al,
2009). „It is argued that reminiscence may be
particularly important for demented individuals’
psychological health given that the progressive
deteriorating nature of the disease erodes the ability
to achieve present successes and makes individuals
increasingly dependent on past accomplishments for
a sense of competency“ (Godley and Gatz, 2000).
Since remote memory is usually spared for large
parts of the dementia process, people are often able
to recall events from the past. Even while processing
memories may be compromised due to the brain
damage, reminiscence can still provide structure in
developing relationships or engaging with others
(Woods et al., 1992).
2.2 Multimedia and Dementia
Especially when it comes to providing a window
into the past, and thereby triggering memories,
technologies have a supportive role. Multimedia
including music, digital photographs and video can
be used for reminiscence. Moreover, advanced
technologies such as touch displays or tangible
interfaces provide new opportunities to make media
contents more easily accessible.
In the CIRCA project (Gowans et al., 2004)
researchers created a multimedia application using
video, photo and music to support one-to-one
reminiscence sessions. The interface was intended to
be used by caregivers initiating conversations with
people with dementia. The authors reported positive
results from user testing and even people with
dementia being able to use the touch screen. More
recent work of the same research team (Alm et al.,
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Figure 1: Research & Design Process.
2009) focused on multimedia for leisure. For
instance, computer-generated 3D environments
provided means for people with dementia to enjoy
environments they once liked, but cannot visit
anymore, e.g. a garden or a pub. Siriaraya and Ang
(2014) utilized immersive 3D technology, in
particular Unity3D and the Kinect, to create
environments for reminiscence and meaningful
activities (like gardening). However, people with
progressed dementia had problems with the
interaction.
Davis and colleagues (2014) examined, in
particular, which type of video content elicited
conversation in people with dementia. The authors
found in an observation that generic video triggered
more diverse comments and a broader spectrum of
conversation topics. Two works (Waller et al., 2008;
Wallace et al, 2012) investigated the television as a
medium to provide media from the past or
personalized media to people with dementia. This
research showed that contents targeted to the
individuals were catalysts for reminiscence and
communication with relatives or caregivers.
Many of the works above prove that multimedia
has indeed desired effects of supporting
reminiscence and communication. However, the
majority of systems were either not meant to be used
by people with dementia or posed difficulties in
interaction for them – an aspect we focus on.
3 PROJECT CONTEXT
In the NutzerWelten project, researchers and
designers from four disciplines (Media
Technologies, Design, Electrical Engineering and
Social Sciences) collaborate on solutions for people
with dementia. Our research focuses on empowering
people with dementia, on the one hand, through
active integration in the design processes of new
care technologies, and, on the other, by designing
solutions adapted to their needs, values and abilities.
While from the perspective of informal
caregivers providing safety is one of the most
important functionalities of technology (Topo 2009),
experiences from studies with people with dementia
emphasized other values. For instance,
communication with their surrounding, having a
meaningful activity and establishing a connection
with biographic aspects were identified to be of
highest relevance for a good quality of life (Astell et
al. 2009, Wood et al. 2009, Orpwood et al. 2007).
Therefore, we focus on the design of technical aids
to improve communication of people with dementia
and people in their surrounding, preferably through
the use of biographic aspects.
3.1 Research and Design Approach
Designing for and with people with dementia is a
sensitive endeavour and requires an empathic design
approach (Lindsay et al., 2012). Emphasizing and
creating trust is a first crucial step. This is why we
had a 3-months period in the beginning of the
research process (Fig.1) in which we gathered
information about dementia through literature
research, expert presentations and documentary
films about dementia to sensitize the design team.
Before visiting the field to get a first hand
perspective we engaged in an activity where all
design team members reflected about their own
ways to reminisce, which objects trigger memories
and in what ways. The first field visits were
organized in close collaboration with the dementia
service network in our city. We established contacts
to several welfare organizations and were transferred
to the key personnel in care homes (with stationary
and day care) and in support groups for people with
dementia. Several team members did (participant)
observations and conducted either semi-structured
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235
with caregivers or relatives or narrative interviews
(Rosenthal and Loch, 2002) with people with
dementia in order to elicit insights into their lived
world.
In particular, these first visits were done during
the course of one month and included: one visit of a
day care centre with observation and an interview
with a care manager, three visits to a care home
including observations and interviews with five
residents, several visits to three different support
groups including participant observations (i.e. our
team members took part in the groups’ program),
two interviews with relatives of people with
dementia in their homes, one visit to a geronto-
psychiatric unit of a care home with observations as
well as one interview with a caregiver and one with
a resident, and, last, one interview of a person
suffering from Lewy-body dementia. Observations
focused mainly on the (everyday) activities people
engaged in, and on the interactions between people.
The interviews with caregivers focused mainly on
the practical aspects of care, the communication and
ways to support people in reminiscence. Interviews
with relatives were similar, but focused also on the
emotional aspects of dealing with the disease of their
loved ones, from diagnosis and throughout the
course of dementia. Interviews with people with
dementia in the care homes focused on biographical
aspects and life experiences.
The collected data in form of video, photos, field
notes and interview transcripts were discussed with
the team and used in the ideation phase, where two
brainstorming sessions were held involving around
6-7 groups of ca. three people each time (mixed
groups composed of students and researchers with
backgrounds in design, HCI, computer sciences and
media technologies). The result was a large number
of ideas ranging from interactive furniture (mirrors,
carpets), technology-enhanced everyday objects
(stuffed animals, books) to completely newly
designed artefacts. While some ideas focused more
on functional aspects such as day planning, we
selected a final set of ideas based on their expected
potential to foster reminiscence and communication,
their expected ease of use for people with dementia,
their practicality to deploy in different environments
and their potential to stimulate different senses.
All selected ideas contained multimedia content
(video, audio, light and sound), either as original
content from the past, recorded stories about the
past, or recorded content from today that reminded
of events or places of personal significance. Six
prototypes were built in the next phase that have
been tested with people with dementia in the field.
Figure 2: Concept Design Sketch.
Figure 3: Marking important places during the interview.
We also conducted a focus group with two
caregivers and two care managers in the care home,
where we presented all prototypes and discussed
ideas for further development. Each prototype was
assigned to a different caregiver in the home, who
helped with the further development and provided
test settings with residents.
In the following, we will discuss one of the
designs in detail to show how this interactive object
gave us insights into the needs of a person with
dementia and possible uses of interactive
technologies in the care home. These perspectives
are valuable for interaction design in this domain.
4 DESIGN CASE: INTERACTIVE
REMINISCENCE MAP
4.1 Design Concept
In one of the interviews in the first field research
phase, a person suffering from mild dementia (called
Mrs Smith in this paper) expressed the wish to own
a world map to mark all places that she had visited
to use it as a memory aid for later.
A map is a well-known visual representation of
geography. While physical maps provided guidance
to people in the past, people use digital maps today.
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In addition, a map is a good interface as „combining
location information with visual images [or in our
case recorded stories] might allow people to better
situate past activities in context“ (Kalnikaite et al.,
2010). In the brainstorming session the idea was
developed to create an interactive map for Mrs
Smith to not only support memories of places, but
also have a way to link Mrs Smith’s stories to the
right places and time (Fig. 2). While this could
easily be built as, e.g., a tablet app, we decided to
use a physical map, in order to create an intuitive
user interface that does not require another digital
device. A common representation for time is a time
bar. To set a certain time span of a person’s life, we
therefore, used a horizontal time slider with a big
handle. To indicate visited cities in the chosen time
span we used LEDs.
The stories told by Mrs Smith in a first interview
were audio-recorded and could be played back for
the chosen time span by pressing a physical button
with a speaker icon. During the interview analysis
we found that some important temporal information
was missing to place all narratives onto the timeline.
Therefore, a second interview was conducted to
focus on the stories and missing dates and to
reconstruct all events in Mrs Smiths’ life. Some
difficulties occurred in this process due to memory
deficits, but with the help of a world map and small
needles (Fig. 3) most narratives could be placed in
time.
4.2 Prototype Implementation
The prototype was developed as a tangible interface.
The basis is a printed map of 60 times 40cm that was
glued onto a corkboard (Fig. 4, top). The size was
chosen as a balance between providing a good
resolution and portability. The lightweight material
allowed the map to be easily held with one hand.
The heart of the technical backend (Fig. 4
bottom) is an Arduino Uno microcontroller equipped
with an audio-shield. All places were marked on the
map using coloured 3mm LEDs to be controlled
through the time slider, which was build from 6 mm
cardboard (Fig. 5), a material used in advanced
prototyping. We used two parallel rods on the
backside of the slider, one made from copper and a
plastic one wrapped with resistance wire (10 Ω). The
current of 5V sent through the wire drops depending
on the position of the handle, which makes the
electricity flow back through the copper rod that is
connected to the analogue input of the Arduino.
When a new position is retrieved, the respective
LEDs are controlled via the PWM output of the
Figure 4: Prototype (top: backside, bottom: front side).
Figure 5: Cardboard Modelling of the time slider.
Arduino (using a shift register to control several
LEDs in parallel). The speaker button is
implemented as a simple push button with a
cardboard interface. For each time span an audio file
is saved on the micro SD card inside the audio-
shield. When the speaker button is pushed, the
position of the time slider is used to access the
particular audio file. We used two miniature
speakers (1 Watt) hidden on the backside of the map
for audio output.
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4.3 Mrs Smith’s Life
At the time of the interview Mrs Smith was 94 years
old. She was born in 1920 in Landsberg an der
Warthe, Germany, which belongs to Poland today
(and is called Gorzów Wielkopolski). At the age of
six she moved to Berlin where she had a carefree
childhood. Early on she found her calling in taking
care of children and already worked for a year in a
Kindergarten when she was 13. Later on, she
became a paediatric nurse and worked for the Red
Cross during World War II. After the war, she felt
the desire to see the world. Working as a nanny for
rich people this could be satisfied. Her first
appointment as a nanny for a jeweller’s children
brought her to Italy and Switzerland, the second to
the US and Denmark, and a third to Germany and
France. In her stories today she refers to the children
she took care of as “her children”. During her
retirement she continued traveling including trips to
Russia, Scandinavia, Spain, Singapore and Africa.
Today Mrs Smith lives in the care home where she
is mainly tied to her bed due to limited mobility. She
suffers from mild dementia, which was hard to
recognize for us at first, but became apparent due to
the difficulties when placing her stories in time.
4.4 Feedback from Field Visits
4.4.1 Mrs. Smith’s Feedback
We visited Mrs Smith a third time after the
prototypical interactive map was built. We did not
intend to do a controlled user test, but to elicit her
feedback in an unstructured interview. The
following vignette (based on the first author’s field
notes) presents what happened.
We enter Mrs. Smith’s room together with a
caregiver. We greet Mrs. Smith and she immediately
recognizes my colleague. I introduce myself and take
a seat. Mrs. Smith asks curiously if there was
already something to see. My colleague brought her
a map as a gift to keep, where he marked all her
visited cities. Mrs. Smith is surprised to find all the
places on it. “Even Breslau is on it!” Then she says
proudly, “but I was also in Africa.” It seems that she
hadn’t immediately seen that Africa was also on the
map. My colleague points it out to her and Mrs
Smith starts telling a story about her stay in Africa.
When her story is told my colleague demonstrates
the interactive prototype and shows how it works by
setting the slider on 1920. An LED lights up. “That’s
when I was born!” Mrs. Smith exclaims. After the
demonstration Mrs. Smith teases the caregiver in the
room “That’s great! Do you also have a map like
this?” He says jokingly that there would not be any
lamps lighting up on a map for him, because he has
not seen much of the world. “What are you going to
do with the map? Will it be in an exhibition?” Mrs.
Smith asks. My colleague is surprised and says that
our intention was to improve the map and maybe
give it to her, but Mrs. likes her idea of making the
map and her stories publicly available. “It could be
interesting to other people to hear my stories,” she
says. Later in the conversation Mrs. Smith suggests
that we could also give the map to her GP, who
seems to be dear to her, after she passed away.
“Then he can remember my stories.” she says – her
eyes filling with tears.
The conversation stops, it is quiet. Mrs. Smith
looks at the marked places on the map and suddenly
begins a new story about when she was crossing the
border between the GDR and West Germany and
was held captive at the border. A bit later, we hear
another story about Mrs. Smith crossing the Atlantic
Ocean by boat, to which we listen reverently.
When my colleague invites her to try out the map
herself she takes it in her hand (Fig. 6). With shaky
fingers she moves the slider and places it on a
timespan. She presses the speaker button to start the
audio, but the sound is a little low, so that she has to
move the map closer. When we ask her whether it is
strange to hear her own voice telling the stories, she
says that she doesn’t care. The caregiver suggests
that we take a photo together. When he lifts her bed,
she starts fiddling with her t-shirt to get ready for
the picture.
Throughout our visit Mrs. Smith looks at the map
several times and starts telling different stories
about the places marked on the map. In another
conversation break, I take the initiative to learn
something about Mrs. Smith. I see on the map that
she has also visited Scandinavia, where I once lived.
I ask her about a place there, and she tells us an
exciting story about a bus trip through Scandinavia.
In many of her stories she mentions ‘her
children’, but when I ask her about how many
children she had, she says surprised “None! I took
care of children of rich people.” She reflects for a
while and continues, “Others had families and I
travelled around a lot. That’s life. I made the best of
mine.” In this moment she looks content.
After 30 minutes had passed since we arrived,
she seems tired and we politely say our goodbyes
and tell her that we will improve the map further
and show her the results again, if we may. She
smiles and says “Of course, if I can be of help. You
are always welcome.”
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Figure 6: Mrs Smith trying out the map.
We will return to different aspects from this field
visit in the discussion section.
4.4.2 Feedback from Caregivers
Besides discussing the interactive objects with
people with dementia we also conducted a focus
group with four caregiver/-managers in the care
home. In a two-hour session we first explained the
goals of our research and then showcased all
interactive prototypes, among these the Interactive
Reminiscence Map. Each object led to discussions
about its multimedia contents, the user interface and
possible uses in different contexts in the care home.
The complete results will be published elsewhere.
Instead we focus here on the feedback that we
received for the Reminiscence Map. Two aspects
about the map were highlighted in the discussion:
(1) its potential as a communication trigger via
places and (2) its appearance (virtual/physical).
Although the map was originally designed as a
person-tailored object for Mrs Smith, her comment
about sharing her story with others, led to a
reflection that the map could be developed further in
a way that it holds several residents’ life stories.
With extended functionality it could then highlight
places where several people have once been. “That
sounds good, because it is often like that. … I often
visit places and then I usually find a conversation
partner, one person was also in Austria, the other
knows Mallorca, the other Southern Germany. It is
great [to communicate] via the cities.” (female
caregiver). Another aspect is that people may have
visited the same places, but at different times, which
would allow for conversations about how places
changed over time. “I think this is great, because it
connects people. There is this outsider status that
people with dementia still have – that would be
released a bit, because there are places where
everyone has once been. Places, everyone has
memories about. Even if some loose their memories
slowly, there are still points that connect people. I
think this is a great image.” (female care manager).
Adding functionality to the map, such as finding
overlap between users or showing additional media
content (e.g. photos from the times people visited
places) would be easier if the map was developed as
a digital system using a screen. While the caregivers
were not entirely against this idea, it was mentioned
that the old physical maps (that were used in
geography classes in school) would also be useful,
as residents would still remember them. At least
such old maps could serve as an inspiration, one
caregiver said, even if the interface was digital.
Another option could be a mixed reality solution
projecting media content on a physical map.
5 DISCUSSION
In the following we present the themes that emerged
from the field research, and, in particular, the
feedback we received from Mrs Smith and the
caregivers on the Reminiscence Map.
Trigger of Memories
In the session with Mrs Smith we noticed that even
the non-interactive world map with the marked
places triggered a conversation. At least at this early
stage in dementia it was easy for her to recognize the
places on the map as places that were important in
her life and she immediately started telling stories
about them. The interactive map added the time
dimension to this. When the time slider was set to a
certain time period, Mrs Smith saw the places light
up and referred to the time in the narratives. Given
our experiences from the first two interviews with
Mrs Smith, in which it was sometimes hard to match
the stories to the correct timespans, the map supports
remembering places and time. Similarly, Kalnikaite
and colleagues (2010) emphasized the value of
locational information for aiding memories, and, in
particular, for supporting inferences being made
about past experiences.
Communication Points for Others
Equally important to the memory support for the
person with dementia, we experienced ourselves the
benefit of the interactive map in conversations with
someone we know little about. One of the
researchers who had not met Mrs Smith beforehand,
could easily see on the map where Mrs Smith was
born and which places she had visited at which times
in her life. Especially in the case of places that the
researcher had also lived in, it was easy to begin a
conversation with Mrs Smith. It was also confirmed
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in the focus group that caregivers would use, for
instance, recent holiday trips to start a conversation
with residents, e.g., asking if they had been there.
Integration of Multimedia and Physical Objects
Existing multimedia systems already facilitate the
sharing of stories and life events. They are, among
others, available as online platforms, apps or other
software. However, these are often not accessible to
seniors, who are less technology savvy. Especially
people with dementia have limited capacity to learn
new interactions with digital user interfaces.
Physical objects, however, provide at least three
advantages: (1) interactions are based on familiar
and basic actions (such as grabbing, moving or
lifting objects), (2) they provide haptic stimulation,
and (3) they often allow for shared interaction in a
social setting. In our prototype we used the strength
of both tangible interaction and multimedia content
to provide a rich interface to cue reminiscence and
allow for active use by people with dementia. In the
user session with Mrs Smith, we could not observe
any hesitation to use the interface. Instead Mrs
Smith was curios about the map. We also did not
have to provide lengthy explanations of how to
operate the map. In addition, the caregivers
highlighted in the discussion about a digital
extension of the system, that the tangible aspect of
the prototype is important for the target group. They
suggested that the map could even have a more
antique look and feel to it to trigger memories about
maps used by the people in the past.
Equal Level Communication
Places provide a good means to trigger
conversations with people with dementia, not simply
because many people have visited the same places in
their lives, but also because places are deeply
intertwined with one’s life story, which (1) allows
residents to share their knowledge and (2) supports
their life review. Keeping in mind that “[d]espite
experiencing degeneration of short-term memory
function, people with dementia (including
individuals who are severely impaired) can very
often retain a facility for long term memory that will
function strongly given appropriate stimulation”
(Gowans et al., 2004), communication about their
past should be possible for people with dementia
until the later dementia stage.
As the care manager said in the focus group, an
interactive map showing several people’s places and
stories, allows for a communication on an equal
level between residents and caregivers. While people
with dementia may have difficulties in taking part in
conversations about everyday happenings or recent
events, talking about important stories in their lives
and discussing how places changed over time allows
them to feel empowered. It puts emphasis on the
vast experiences and knowledge that people of high
age have. The interactive artefact would support the
identification of interesting conversation topics
between people, who, e.g., visited the same city or
country at the same time or different times.
Leaving a Legacy
Closely linked to sharing one’s life story with others
in current conversations, is the aspect of leaving a
legacy. For us, as designers of technology to support
everyday life for people with dementia, Mrs Smith’s
reaction in the try-out session was rather surprising.
While we expected the Reminiscence Map to be a
tool for reminiscence for Mrs Smith herself, it
became clear in the conversation that Mrs Smith was
more concerned with preserving her life story for
others after she cannot tell it herself anymore.
Several times in the conversation she talked about
placing the map in an exhibition for others to see or
bequeathing it to someone she knows. She explicitly
pointed out that it would be interesting for others to
hear the stories, because she had travelled the world
so much. While it remains unclear to us whether
traveling the world was her own choice or simply a
result of her life circumstances, her reflections on
her life seemed to make her content and leaving her
stories as a legacy beyond her own life span seemed
important to her. Maybe it is especially important
because she has few people left and no family of her
own to continue telling her stories.
Important for the design of interactive artefacts,
is to revise our assumptions of what is important for
our target group and seeing the possibilities
interactive technology can play in addressing their
needs. While we assumed that communication in
everyday life is an important need that technology
should support, in this case, providing a means for
casting one’s experiences into an artefact that can be
made accessible to others beyond one’s life,
surfaced as an important need, not in the first
interviews, but in the session with the interactive
prototype. Thus, the technology becomes a tool for a
very different type of communication.
6 NEXT STEPS
Based on the feedback we received for the
Reminiscence Map, a wish to scale up the system
arose. On the one hand, from the perspectives of
caregivers, it could facilitate the moderation of
group activities. On the other hand, from comments
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of Mrs Smith, we realised that it could provide older
people a way to tell their stories and make it
available to a larger audience (e.g. in a web
platform, as an installation in a museum etc.).
Therefore, a more sophisticated multimedia
system that can store several people’s stories and
can be used in a care home or in dementia support
groups to foster the communication between several
residents/ participants and caregivers was
envisioned. Especially social workers in dementia
networks were interested in a support system that
could be used by a group moderator or therapist to
start up a communication between several people
with dementia. In support groups it is already
common that the group leader provides material
such as postcards, photos or picture books on
different topics that could be interesting for the
participants. In biography work with single patients
therapists or social workers explicitly work together
with the patients on their past. Making use of digital
technology to store information about (several)
people, to provide a range of either personalized or
generally relevant multimedia instantly and to have
the functionality for identifying commonalities in
the places experienced by users, was seen as an
added value in these settings.
Based on this feedback we decided to implement
an online platform that can provide this
functionality. A simple prototype was designed that
comprises of a database storing user profiles and
their stories linked to time and place. Each user’s, or
so-called narrator’s, places are marked on a map
with a different colour. By adjusting a time slider
one can see which users were at which place during
the selected time. By selecting a place, one can see
all stories of all users linked to the place. It is also
possible to select single narrators and retrieve only
their stories.
We have not tested the prototype yet, but would
like to highlight two challenges we foresee, (1) the
effort of feeding the system with the stories of
several users, and (2) making sure that people with
dementia remain in a position that empowers them
to take initiative in the communication. The first
challenge can be addressed by providing an easy-to-
use interface for social workers, therapists or
relatives to upload or connect media to the system
and record stories linked to time and place.
Providing this input could done in the sessions with
people with dementia, and thus become part of the
communication itself. While support groups work
with small groups of people, it has to seen in how far
it is, however, feasible to do this in a care home with
many residents. The second challenge is clearly
difficult to address with a purely digital system. As
discussed above, it is just the tangible aspect of the
slider and the map itself that allowed people with
dementia to initiate the interaction. Therefore, we
will work on a solution of combining an online
platform with tangible input devices.
We would like to note again, that the intention of
our work is not to develop each initial prototype into
a fully-fledged product that scales up to the market.
However, extending the map to a multi-user system
arose from the needs of our study participants in
their daily work/lives. In addition, the discussed
challenges are not unique to the Reminiscence Map,
but to other types of multimedia systems providing
personalized collections for reminiscence and
functionality to foster communication between
group members.
7 CONCLUSIONS
The work presented here provides a snapshot of our
larger research endeavour to design interactive
multimedia artefacts for people with dementia to
support their reminiscence and communication with
others. In this paper we put the focus on one of the
designed artefacts to show how this prototype could
give us insights into the experiential world of a
person with dementia and at the same time could be
used in a focus group with caregivers as a probe
triggering new ideas for designs in the care context.
Besides this specific design case we are also
field-testing several other designs (e.g. an interactive
book, a virtual window to familiar places and a TV
program for reminiscence). Based on the results of
all evaluations, we intend to provide general
guidelines for the design of interactive multimedia
artefacts that support people with dementia in
reminiscence and communication in different care
settings. We should take into account that
communication is manifold, and can also refer to
communication beyond one’s own life. In any case,
the current case taught us to look carefully into the
communication needs of people with dementia to
check our own design assumptions.
ACKNOWLEDGEMENTS
We thank all participants of this research, in
particular, social workers, caregivers and residents
of the Dorothee-Sölle Senior Care Home in
Düsseldorf and the dementia service network.
ReminiscenceMap-InsightstoDesignforPeoplewithDementiafromaTangiblePrototype
241
Furthermore, we thank Holger Wurbs and Danyel
Kemali for implementing the prototypes and
supporting the field research. This work has been
carried out as part of the NutzerWelten program at
the University of Applied Sciences Düsseldorf and is
funded by the ‘FH-Struktur’ program of the
government of North-Rhine Westphalia.
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