Promoting Autonomy in Older Adults with Cognitive Impairment: Co-Designing an Interactive Calendar for Memory Support

Abstract: Alzheimer’s disease (AD) remains one of the most distressing public health challenges of our time, creating a critical need for tools that serve both care recipients and caregivers, especially in remote care settings. Interactive-Care (I-Care) is an innovative web-based remote caregiving platform designed to promote independence in AD patients while bridging both the physical and emotional gaps in caregiving. In this paper, we focus on I-Care’s calendar tool, developed to overcome the challenges presented by commonly used digital calendar platforms which impose high cognitive load and cause confusion among individuals with AD. We describe the iterative co-design process through which the calendar evolved, informed by multiple rounds of feedback and refinement.Participants/Methods: First, a calendar prototype was developed based on cognitive rehabilitation guidelines and existing calendar systems for individuals with mild cognitive impairment. The prototype was reviewed by experts in AD and dyads (care receiver and remote caregiver) who provided feedback and suggested modifications. The prototype was iteratively modified using this review-feedback-modification process 3 times. Next, two older adults (ages 84-88) with mild dementia (Montreal Cognitive Assessments of 19-20) participated in an iterative co-design process over the course of several interactions with the Calendar page. To quantitatively evaluate improvements, we conducted counterbalanced A/B testing comparing the pre-co-design and co-designed versions of the Calendar and additionally benchmarked its usability against Google Calendar. Participants also completed a custom Technology Acceptance Model (TAM) questionnaire that included Likert ratings (1-5, 5 being the highest) of Perceived Ease of Use, Perceived Usefulness, and Intention to Use. Results: Successive Calendar design refinements incorporated a shaded column highlighting the current day, step-by-step pop-up workflow for event creation, flashing notifications for new calendar entries, and multiple concomitant alarm options. The co-designed Calendar received high average TAM ratings in terms of Perceived Ease of Use = 5.0, Perceived Usefulness = 4.8, and Intention to Use = 5.0, indicating strong acceptance and usability. A/B testing also demonstrated substantial improvements. In the previous interface, built similarly to Google Calendar, participants were unable to complete key tasks without assistance. In contrast, with the co-designed Calendar, all tasks were completed independently, with a reduction in event creation time from 252 seconds to 94 seconds. Navigation between weeks and selecting today’s date also became faster and more accurate. Participants reported substantially higher satisfaction with co-design Calendar compared to the prior version, citing ease of navigation and clarity of visual cues. In contrast, Google Calendar task completion elicited very poor satisfaction ratings, with one participant refusing to continue using it due to its complexity.Conclusions: The I-Care Calendar design process demonstrates that individuals with cognitive impairment can engage in co-design to good effect resulting in a Calendar they can use independently. High satisfaction ratings highlight its clarity, intuitive design, and accessibility, emphasizing the value of tailoring digital tools to the cognitive needs of older adults. These findings underscore the importance of a co-design approach in developing assistive technologies that support daily routines, autonomy, and overall quality of life for older adults with cognitive impairments.

Keywords: Co-design, digital health, assistive technology

DOI: 10.54941/ahfe1006972

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