Real World Worst Case Design

My father-in-law has Alzheimer's, so when I saw a post about a device that was supposed to help people with dementia, of course I read it.

The Memento Memory Lifebook is designed as a "wearable mobile product solution" to serve as a multi-faceted holistic mobile memory aid device as well as providing a security safeguard for elderly individuals with mild-to-moderate dementia.

It's a cool concept, the designer (Peter Sin Guili, a product design student at LaSalle-SIA College of the Arts in Singapore) thought a lot about the problems of potential users, and the design reflects thinking about those problems. That's a good start for any designer right there. The design is a "diploma project," meaning it will probably never see the light of day as a real product. Unfortunately, that's probably a good thing. I say it's a good thing because I think the design is off-base for its target market. And I say it's unfortunate because it would be great if there were a product that could help like Peter aimed to.

To say that there are special needs for people with dementia is an understatement.

Even in the early stages of Alzheimer's, I saw a gap between what my father-in-law thought he could do and what he could actually do. After retiring, he acquired a PC at home (he'd had one at the office), but, despite many hours of computer lessons, he was unable to learn how to use Outlook Express, Quicken, or Internet Explorer. They were the only programs he needed and they're not complicated programs.

As the disease has progressed, that gap has widened. At this point (about five years in), he has lost many skills that he once had. He thinks he can drive, but he can't. He thinks he can make phone calls, but he can't without assistance. And, perhaps surprisingly, it's more likely that he could drive than make a phone call on his own. If you're not going any place in particular, driving is very reactive -- the car is moving and you respond to what's happening. (I'm not saying this is safe!) But, to make a phone call, it's necessary to remember the number being dialed, and which digits you've already dialed, from start to finish. It's beyond him. And the gap applies even more to learning new things than to things that he already knows. At one point, we considered getting him a simple cell phone (like one of the ones with just two buttons) but we realized it would make less sense to him than the cell phone he already had and couldn't use. Even though it's simpler, it would be new. As he has declined, we kept thinking of technological solutions to help him and kept realizing that they wouldn't help at all.

In executing the design of the Memento Memory Lifebook, the designer made a list of things that would be a problem for someone with dementia, then came up with solutions for each of those problems -- a phone directory, a GPS locater, an RFID scanner for tracking belongings, medical reminders, photo reminders, etc. The device has a few clearly-targeted functions, clearly marked with simple icons. For many situations, those would be good designs.

But, the dementia patient doesn't know what they don't know.

They're confused, but they think they don't need any help. This means that, here, you need to look at the worst case, not the best case, or even the average case, and the sad reality is that people with dementia won't be able to figure out a device lke this at all or, for that matter, remember to use it. Normally, worst case design means that you're trying to avoid breaking in the worst case -- optimize for the average case, survive the worst case.

Here, we need to optimize for the worst case, because all of the users will eventually get there. And, unfortunately, the intended users are incapable of learning to use and using the device. From my experience, I think this is probably true even with people in early stages of dementia. And we complain when users don't read the manuals! Looking at the worst case, I would posit an underlying design axiom -- the product has to work without user interaction. For example, I see my father-in-law wandering around his house, looking for something to remind him of what he's supposed to be doing. He always thinks he's busy, but he can't remember what he's busy with. If you took the idea of using an RFID sensor and made it programmable by a caregiver, then made it announce recognized places and objects automatically as they were noticed, you might have something. But, even then, there are huge hurdles, like having him remember to wear this foreign object, him wondering why it's talking to him, etc. I honestly don't know if there are any technological solutions that can help.

It's nice to see designers, even a student designer, thinking about problems like this. I do applaud that. And I wish it was an easier problem.

See also: Gizmodo, MedGadget.