blog

It scarcely needs saying that we live in a technological age. The microchip dominates our lives. There is very little that you can do or organise without using a computer or a smartphone, and often you need both, for example to confirm your identity for making online payments. Cash is virtually dead, a state of affairs that would have been unimaginable when I was growing up. Much of this progress is good, though there are some problems. These include the often toxic nature of social media, vulnerability to scams, invasion of one’s privacy (by allowing one’s whereabouts to be constantly tracked, and the difficulties that arise from digital exclusion (for example, if you don’t have internet access).

In the case of dementia, all this is highly relevant and there’s plenty of research about how technology may be used to support people with dementia and their carers. I’d like to explore something that doesn’t get much coverage, namely the interplay of IT with day-to-day functioning in people with cognitive decline. Function is an important concept in dementia as loss of function is an important criterion in making a diagnosis. In short, a diagnosis of the syndrome of dementia requires evidence of two things – cognitive and functional impairment. Function is usually assessed in terms of activities of daily living (ADL), and these are broadly of two kinds: personal care and instrumental ADL. Instrumental ADL include tasks that involve interacting with the outside world, and traditionally we would ask questions about using the telephone or handling money. Instrumental ADL are more complex than personal tasks (washing, continence, etc) and therefore are affected earlier in the course of dementia.

Considering how technology has changed our lives, it is clear that the traditional forms of instrumental ADL are becoming less relevant and, so perhaps we need to find new questions to assess someone’s competence in this area, e.g. Can you use email? Can you book hotel accommodation/train tickets online? Can you access different viewing options on your smart TV? Can you obtain a bank statement? But then how do we assess what degree of competence is required? The complexity of some tasks can be overridden by using devices such as smart speakers. If yours is set up, then you can access radio and TV by oral command without using any keypads. So perhaps the picture is mixed – some aspects of our lives are more complicated because you have to do them yourself online rather than going to see a friendly person in (say) a travel agents. But others may be simpler, as we can use voice-operated commands to turn on the heating or give us up-to-date information on just about anything.

As we get older, especially if we are developing dementia, we become cognitively less agile and take less kindly to the constant introduction of new systems. At some point, we may simply give up using email, online banking or online shopping; or else, we rely upon someone else to do it for us. What if we forget our passwords or PIN numbers? But maybe we do this quite often already, so the problems would really start if we lost the skills to retrieve them. And there is the ethically dubious issue of starting to share these personal details with someone else so that they can do the tasks for us that we can no longer do, e.g. we give our password to someone to help us with a railcard or bus pass application.

Even if we don’t have dementia, many of us struggle sometimes with the beast of IT. It is incredibly frustrating when we can’t get it to work for us. Among other things, it makes us feel stupid. It is this feeling, of lacking the nous to do something that a teenager would sail through, that needs a label as I think it doesn’t yet have one. I am grateful to my Manchester colleague, Dr Ross Dunne, for proposing terms using the German language, as it is a favourite of psychiatrists for the description of difficult things. He suggested ‘digitale Lernbelastung’ (digital cognitive load), while my offering is ‘technischbewirkt Dummheit’ (technology-induced stupidity). Either term could be applied to the feeling that we have when we can’t do stuff, or to the phenomenon whereby our (decreasing) ability with IT determines the limits of our day-to-day independence. If either term catches on, you saw it first here!!

Tom Dening

December 2024