Hi-tech for dementia patients boosts quality of life and frees up nursing staff
Aug. 13—BRENTWOOD — In the dementia unit at Rockingham Rehabilitation and Nursing Center, four residents 69 to 89 sit captivated around the "magic table," waiting for the next game, puzzle, art project or music-composing challenge to launch.
The scene is a far cry from the stereotype of people with mid-to-later stage dementia, and the activity is a game-changer for nursing homes looking for lasting ways to engage and stimulate patients who struggle with cognition, memory and the basics of daily life.
A projector mounted on the ceiling flashes interactive images on a smooth table according to the activity the players select. To make choices and move pieces, they tap the surface or move their hands, interrupting beams of light.
The Tovertafel — "magic table" — installed here in June is perhaps the first such device in a New Hampshire nursing home. Designed in Holland in 2015, it combines features of a video game, a Ouija board and artificial intelligence to provide purposeful, research-based interactive play — without the need for staff to supervise or direct players of widely varying skills and capabilities.
"We could go to Fenway and some of the residents wouldn't be interested," said Ken Wing, the unit's recreation director. Some "tend to self-isolate by choice," he said.
"We get them out to do this and they light up. They remain engaged for longer periods of time. They're having a social interaction, working together on a goal with the person next to them — whatever the game is."
Staff say it's widely appealing to patients, many of whom shirk interaction as time goes on and have difficulty with conversation.
Some play at the Tovertafel before breakfast or lunch, others for relief and distraction during the day, including when they're anxious or disoriented.
It's a boon to nursing staff who must tend to other residents' personal or medical needs. For the dementia patients, who struggle with memory, words and simple or complex tasks, it's a brave new world.
Living in the moment
"Relating to peers is a social skill and it can be hard when you have dementia," Wing said. "When we set up these games, they're working on a common goal." In virtual soccer or beach ball, "Someone will say, 'Nice shot. Pass me the ball.' Even those small social interactions are helpful."
In tabletop soccer, touching, hovering, and pushing the image of a ball is rewarded with a 'plunk' as it enters the net, followed by a chorus of cheers.
In a masterpiece re-creation, artist-players send colored pieces to a virtual canvas in the middle of the table to create a still-life, portrait or landscape.
To compose a melody, they tap revolving images of notes, which slide into position on a virtual music sheet and play a score. It can be lively or soothing or reminiscent of carnival, marching band or classical music they heard at different points in their lives.
The magic table is an icebreaker, too, for visitors who don't know what to do or talk about with residents whose abilities to speak, act and remember names vary day to day.
"When we're doing the magic table, he is definitely more likely to speak and interact in the moment," said Cindi Martin of Epping, visiting her 87-year-old dad, Bill Hull, who has advanced dementia. "It's a game he can plaY that doesn't draw on his memory."
The picnic game involves squashing bugs before they gobble up all the coffee and pie.
"You get to the point where you're just killing bugs and you don't care about the pie and the coffee," Martin said.
An activity that requires quick reaction and dexterity, it appeals to people who can live moment to moment, without analysis or reflection.
"They're sitting and talking about what's happening. It's nice to see some of then come out of their shell," Martin said.
"People of all abilities can use it," said Jeseca Wendel, community outreach manager at Rockingham County Nursing Home. "It's kind of like sneaky exercise because they're moving their arms and reaching. Even people with a limited range of motion can do this. There are no winners or losers. No one has a negative response. It's all positive and affirming."
Elaine Pike and three other unit residents collaborate on puzzle. The virtual picture fills in piece by piece. 'It looks like a guitar," Pike says. "Sometimes it just comes up. It just happens."
Resident Jack Halligan pushes musical notes to the center of the magic table, which began to play calliope music. "You almost look like a pianist," says a staff member.
"Thank you!" says Halligan. "I played piano when I was 30."
Addressing a need
Dementia can cause perceptions and interactions with the world to collapse as the illness progresses, robbing short term memory, speech, comprehension, social skills, dexterity and gross motor skills. The magic table is a workout for all of it, Wendel said.
As New Hampshire's elderly population balloons as a percentage of the state total, the number of people diagnosed with Alzeheimer's disease, vascular dementia, frontal lobe dementia, Lewey body dementia and Parkinson's dementia — or any one of nearly 100 types of dementia — is expected to swell, according to the Alzheimer's Association.
A 2023 study by the American Health Care Association found that the average nursing home patient in New Hampshire is 81 , compared to 77 nationwide. The percentage of New Hampshire patients with dementia is 56.2%, compared to 48.9% across the U.S.
As many as 1 in 10 Granite State residents 65 and older are estimated to have dementia, according to a county-by-county study presented last month at an international conference on Alzheimer's Disease.
"We have one of the nation's oldest nursing home populations," said Brendan Williams, president of the New Hampshire Health Care Association, which represents most of the state's nursing homes and assisted-living facilities.
Technology advancements, including the use of algorithms, have enabled robotic pets — the most common technology used by dementia sufferers — to be more interactive and life-like. "I think (long term care) providers would be open to any new innovations" that enrich social, emotional and intellectual life, Williams said.
Expanding horizons
In an adjacent room in Rockingham's dementia unit, eight residents gathered on chairs before the IN2L, which stands for 'It's Never Too Late.' The wall-mounted screen and audience seated on chairs resembled a home movie theater.
In "Balloon Burst," a game similar to hangman, eight dementia sufferers took turns guessing the letters in a six-letter word. Correct letters popped into a space. After a wrong guess, a balloon rose and popped.
Tension mounted as more letters were volunteered by players, some of whom typically are self-conscious, withdrawn and lacking in confidence and verbal skills. The group clapped when anyone guessed correctly.
"In my opinion, you can see them concentrating," said Ginger Cole, a life enrichment aide in the unit. "They're really using their memory and their minds to think of words they've known."
IN2L provides brain teasers, trivia games and logic challenges. Patients can tour the world virtually and visit national parks. Family members can send photos to upload to a resident's personal IN2L account.
"A jukebox enables them to listen to music, which brings back memories. They can watch the panda cam, the puppy cam, the kitty cam. If you can't get out of the house, you can virtually visit a museum," Cole said.
"Sometimes we forget how small the world gets when you move into a nursing home," said Wing, the unit's recreation director. "This helps to widen it. They're able to see different aspects of the world without leaving these walls. It's a way to bring the outside to them. It's a quality of life thing."
The IN2L contains 385 hours of research-based programming, which is accessible day and night. It helps people calm down and soothes those who can't sleep. Others use it for stimulation, to get going in the morning.
"It's pretty remarkable how far technology has come," Wing said.
