For most of us, washing our hands, taking a pill or using the toilet are things we do without much conscious thought. But for people with dementia and their caregivers, these simple seconds-long tasks can stretch into minutes and become exercises in frustration.
So researchers at the Toronto Rehab Institute are working on artificial intelligence systems -- including a "smart bathroom" -- that they hope will one day help people with Alzheimer's and other forms of dementia live more independent lives in their own homes.
"Often when a person gets moderate to severe levels of impairment, they are taken out of their home and put into a care facility," said lead researcher Alex Mihailidis, a mechanical and biomedical engineer at Toronto Rehab.
"We are using artificial intelligence to support aging-in-place so that people can remain in their homes for as long as possible," the researcher said.
Dr. Mihailidis and his team have developed a prototype interactive "talking bathroom" that assists people with dementia through the process of handwashing by giving them verbal and visual cues if they become confused about the correct sequence of steps.
Over the sink, a video screen shows the identical setup the person sees in front of them: the counter with the sink and taps, a soap dispenser and a towel.
Two arms shown in the video are ready to make the motions needed to wash hands. A camera in the ceiling tracks the movements of a person with dementia as he or she goes through the handwashing process, then the computerized system provides verbal prompts if the person becomes confused about the correct steps.
"So for example, one person may respond to a very general prompt, like 'Use the towel,' whereas someone else needs to hear their name and hear a description of where the towel is or the towel colour," Dr. Mihailidis said.
"The system will automatically change the type of prompt that's being given to the person based on what it learns."
The technology is not intended to replace caregivers -- often a spouse or adult son or daughter -- but to cut back on the time they spend helping with basic hygiene tasks and to ease their frustration.
"Some people with early Alzheimer's disease can still live independently, let's say in their own home or in their apartment, but they need some supervision from a caregiver," said psychiatrist Ron Keren, medical director of the psychogeriatric program at Toronto Rehab.
"But even for someone in the mild, early stages of Alzheimer's disease, there is a lot of time that caregivers spend either directly or indirectly providing care that is non-remunerative time, that impacts on their quality of life, that impacts on their burden."
Dr. Keren said a lot of time is spent cueing people with Alzheimer's and other forms of dementia to perform tasks most of us take for granted, whether that be washing hands, taking medications or taking a shower.
"So if that can be relieved from the caregiver to some sort of automated system . . . that could be quite helpful."
A study of the intelligent bathroom's effectiveness, based on its use by a small number of people with dementia, showed the system significantly cut down on the amount of time a caregiver needed to spend supervising handwashing, Dr. Mihailidis said.
"In general, there was a 25-per-cent increase in the number of handwashings patients were able to complete without having a human caregiver there," he said.
As well, the time spent by a caregiver to help with handwashing dropped dramatically -- to about 30 seconds with the artificial intelligence from a typical eight to 10 minutes without the technology.
The system is also designed to be sensitive to a patient's needs.
"It's only when the person requires help, when something does go wrong, that the system will intervene and provide the assistance," he said. "It's really made to mimic the way a caregiver would act."
Dr. Mihailidis and his team have also designed prototype technology to detect when a person has fallen. Cameras in the ceiling monitor movement and position within a given space, and a computerized intelligent system can communicate with the person, asking whether they need help -- either by contacting a relative or neighbour or by calling an ambulance.
The person's privacy is not compromised -- there is no Wizard of Oz behind a computerized curtain watching one's every move -- because the system learns a person's normal movements and reacts only when that spatial status quo is altered, as when somebody takes a fall.
While all this smart technology could be used in long-term care facilities, Dr. Mihailidis said the long-term objective is to design various applications that could be installed in the home, something he predicts would take about seven to 10 years of further research to refine.
"But down the road, our goal is to have this ultimate intelligent home no matter what you're doing, whether you're washing your hands, using the toilet or you just can't find your keys or you misplaced your eyeglasses," he said.
"The home knows what you're doing, what your intentions are, what your preferences are, and then provides assistance accordingly."