By Lauren Baff, MS, OTR/L, CNS
Occupational Therapist, NY Staten Island

Technology is all around us. It is difficult to think of a part of our day where we don’t use some kind of tech to increase our efficiency or simply just for leisure. But for some people, technology can truly change their meaning of independence. 

As clinicians, many of our patients experience mobility deficits, low vision, and impaired cognition. All while potentially living alone or with inconsistent access to caregivers. 

Luckily, most patients do have access to a specific technology called “Voice Assistant Software.” This is more commonly known as Alexa, Google, Siri, or Cortana. This technology usually takes the form of a speaker controlled by our voice commands that carry out a specific task. 

For example, just by saying, “Alexa, what time is it?” while close to the smart speaker, you will hear the answer, “it is 3 pm.” This technology is found on most smartphones and speakers, meaning there’s a good chance your patients already have access to it — even if they don’t know it. 

So how can we help our patients leverage Voice Assistant Software to maintain or regain their independence? 

How Can Voice Assistant Technology Help Patients Who Live Alone?

The best part of VA technology is how personalized it can be. In fact, two people who use VA Technology to support their independence will likely use it in very different ways. VA technology can act as an organization tool, as a calendar system, as a hands-free communication device, and more. Below are some examples of how VA technology can help those who live alone to stay safe and become more independent. 

• Setting reminders/alarms: take medication, home exercise program, appointments
• Gathering information: weather (stay safe from ice, drink water if hot), keep engaged in the daily news, orientation to day/month/year
• Making calls: emergency calls, family members, caregivers, delivery services
• Controlling the home environment: turning on-off/lights, controlling television, air conditioning/heat, leisure activities like audiobooks/music 

Let’s picture this in practice. You have a patient who lives alone with intermittent assistance from home health aides and whose family lives in another state. When you go to see the patient on Monday, you notice their pill organizer has a lot of compartments that still have medicine from the weekend. 

The patient has voice assistant technology present (Alexa on an Echo, Siri on an iPad, etc.) and you have the ability to set up a reminder system. Just command the VA system, “set up a reminder at 8 am, 12 pm, 4 pm, and 8 pm every day that says “take my medication.” Now, the system will alert the patient at the appropriate times and remind them to take their medication. 

This is not foolproof, and a cognitively impaired patient may not register the alarm/notification, but for the right patients, voice assistance software is another system you can put in place to help increase independence with medication management. 

VA Connects Independent Patients to Caregivers 

Another layer of safety that VA can provide is the connection to caregivers simply by voice. VA technologies can be paired to a family member’s device. Patients can utilize commands such as, “tell my daughter I just fell” or “send a message to my son that I took my medication this morning,” and the message will go directly to the caregiver’s paired device. 

Now, this also excludes clients with severe cognitive impairments who cannot recall how to activate the device and utilize appropriate commands. However, there are some automatic features like setting an alarm to go off daily that can still be used.

How to Train Older Adults to use VA

To learn anything new, we need attention and memory for carryover. These aspects of cognition will vary with the patients we are seeing, and as mentioned earlier, utilizing VA in a functional way will depend on cognitive abilities. 

For Patients with Cognitive Impairments

Training those who are cognitively impaired to use VA technology can be challenging. The patient may not remember they have voice assistant technology, or they may remember they have it but not remember how to utilize any of the commands. This is when the automatic features of the VA system come in handy, as these are likely the only features that will be useful in this scenario. 

For example, if you have VA connected to a smart outlet that has the toaster plugged in, you can command the VA to “turn off kitchen outlets every night at 8 pm,” to ensure there isn’t a risk of fire. Another example of an automatic feature would be to set a reminder daily at all mealtimes to make sure your patient is consuming adequate meals for the day. 

Most importantly, understanding that for the cognitively impaired we will likely be using automatic and repetitive features of VA for safety – but we all know how important it is to put in as many safety measures as possible!

For Patients with Higher Cognitive Abilities

Training those who are cognitively intact to use VA technology is a lot less challenging and can truly provide an expansive amount of helpful features. As with anything we do, the most important thing to do is to ask your patient what their goals are and use this to drive your use of VA. 

Once this is established, it is helpful to demonstrate the features available to your patient, as it is likely entirely new to them. Start by asking the VA what the weather is, schedule an appointment, and set a reminder. These are basic commands that can give your patient an introduction to VA capabilities. It will also open the conversation to new or expanded goals. Next, try a personalized command. For example, “schedule an appointment for OT with Lauren Tuesday and Thursdays at 9 am every week until March 1, 2022,” and show the patient how the VA can work for them specifically. 

For higher-level features such as making calls, connecting to a caregiver via VA intercom, or controlling features of the home, it is helpful to research the specific technology (Alexa, Siri, Google Assistant) and the steps to set these up so you can go in prepared and maximize your time teaching the patient as opposed to setting the technology up in-session. It is also helpful to have the caregiver present for this part. This will help show the caregiver what is available through VA to decrease caregiver burden. 

My Experience with Voice Assistance with Older Patients

Earlier in this article, I described a scenario that I actually experienced with a patient. He was living alone and was diagnosed with Parkinson’s Disease, which was affecting his cognition and subsequently his ability to carry out his IADL tasks. His family was not local, and his aides were only coming for a few hours a week. 

When I arrived for therapy, there were always intermittent pills remaining in the box that had not been taken. Sometimes, these pills were the ones meant to assist with cognitive function, which only made the patient forget his medication more often. We utilized Alexa to remind him to take his medication daily at each of the appropriate times, and slowly the pills remaining in the box decreased. 

I also trained his caregiver to check in with him through the speaker intercom feature at medication times if she had noticed he seemed more confused or disoriented on their daily phone call. As a team, using VA, we were able to help the patient achieve independence with medication management. 

What are the Best Voice Assistance Devices for Older Adults?

When choosing the device that will best support your patient, consider the devices they already own and use, if any. Currently, the most common VA technologies are Alexa via Amazon Echo, Siri via Apple HomePod, and Google Assistant via Google Home. All of the devices listed above are great tools. If your patient is already familiar with and uses Apple devices, I tend to lean towards the Apple HomePod. However, if the patient is not a technology person prior to VA, I tend to lean towards an Amazon Alexa or Google Assistant. 

These technologies range from $40 to $250 depending on if the user wants a speaker alone or the addition of a screen, etc. These VA systems can all be paired with caregiver devices and with home control devices such as Smart Outlets, Nest Thermostats, Simplisafe Home Security, and many other smart tools. 

Although VA cannot take over and complete tasks for us, it is a great layer of protection for safety and a great aid in accomplishing goals more independently. They are often cheap, easy to install, and can pair with existing technology in the home. Most importantly, the only thing we need to operate this machine is our voice!