Category Archives: cognition/memory

Medication Adherence Case Study

I talked with an 80 year old man last weekend about how he remembers to take his medication. His solution?

Put all the pills in one bottle and take out what he needs each day. It appears to be an anti-organizer.

If you or your loved ones are more interested in environmental support, a new free application created by Consumer Reports helps to record what was taken when. Importantly, it also tries to catch potential side effects, which are a larger problem than one would hope in the age of the computerized pharmacy.*

*After trying out the application, I take this back. It allows you to enter all the information about any drug, using the information you are given with your prescription. However, it does not do any cross-checking with a database or alert you if two medicines you are taking could interact.

If anyone wants to give the application a try and post their experience, we’d welcome the comments. If you have ideas for improvement, Consumer Reports is just the kind of company that would like to hear them. I already have a few suggestions on the screen shots below:

Medication Tracking Application

Medication Tracking Application

HFES Conference in San Antonio, Part 4 – Hearing and Understanding

The paper described in this post was part of the Aging Technical Group sessions at HFES.

Hearing Levels Affect Higher-Order Cognitive Performance – Carryl L. Baldwin, George Mason University

46324162_87eda38e57 / CC BY-NC-ND 2.0

Perhaps I was excited by this talk because I could see how the information could be used in the book Rich and I are working on. This presentation was a fascinating exploration of the types of trouble adults over sixty-five might have with auditory interfaces. These problems are not necessarily related to the function of the ear: in general, older adults may have more poor hearing, but it is due to environmental exposure rather than aging of the ear. Many older adults show no detectable hearing loss, yet still have trouble with auditory interfaces, as found by Carryl’s experiment.

An important contribution of this paper was the connection found between decline in a sensory ability (hearing) and decline in cognitive ability, even on tests that had no auditory elements. Carryl addressed this years ago in her article Designing in-vehicle technologies for older drivers: application of sensory-cognitive interaction theory. Essentially, when most of us study cognitive aging, we either omit or control for sensory ability. For example, in my work, all older adults must have corrected vision of 20/40 or better and if there is any auditory component, must meet hearing level requirements.  Sensory ability may well predict their task performance, but I do not study it.

Carryl pointed out in her talk that even older adults with no measurable hearing loss showed worse working memory capacity as stimuli got harder to hear. This was true for younger adults as well, but the older listeners were harmed differentially worse as the stimuli dB levels decreased.  It isn’t hard to see why telephone menus and other auditory interfaces can be so frustrating: what requires more working memory than a softly spoken voice menu with 9 options? Eek.

Take home messages:

“The observation that scores on an assessment of working memory capacity decreased in young listeners indicates that hearing level, irrespective of age, can impact performance on aurally presented working memory tests.” (p.124)

“…functional hearing level may play a substantial role in the performance of older adults.  Subclinical hearing loss may result in the need to expend greater effort to process test stimuli – thus compromising performance in higher order stages.” (p.124)

Primary Sources

Baldwin, C. (2009). Hearing Levels Affect Higher-Order Cognitive Performance.
Baldwin, C. (2002). Designing in-vehicle technologies for older drivers: application of sensory-cognitive interaction theory. Theoretical Issues in Ergonomic Science, 3, 307-329.

HFES Conference in San Antonio, Part 3 – Health/Internet…and ROBOTS!

One of my major interests at the moment is in the use of technological tools (primarily the Web) in the management of health.  So it was with great pleasure that there was so much research on this topic (I will mention more in future posts).

The first was presented in the Aging session (where Anne was program chair).  Jessie Chin and her co-authors were interested in a cognitive dilemma faced by older adults.  With increasing age, fluid cognitive abilities (those used in rapidly changing situations like working memory) decline with age.  These abilities seem particularly crucial when using the web as well as other tasks.  However, it is known that older adults often compensate for fluid ability declines by capitalizing on pre-existing knowledge (so called crystallized knowledge) which increases with age. (For an adequate and publicly available elaboration of the fluid/crystallized distinction, see the Wikipedia entry).

09AMlogoThe researchers examined the relationships between fluid and crystallized intelligence on illness knowledge in older adults (hypertension knowledge).  Consistent with their hypothesis, they critically found that illness knowledge (a form of crystallized intelligence gained through time) was a significant predictor of illness knowledge and that this knowledge may moderate the reduced fluid abilities.

Continue reading HFES Conference in San Antonio, Part 3 – Health/Internet…and ROBOTS!

Usability issues in navigating your life

BookGordon Bell, a Microsoft Researcher, is recording his life in excruciating detail in a project dubbed MyLifeBits:

Web sites he’s visited (221,173), photos taken (56,282), emails sent and received (156,041), docs written and read (18,883), phone conversations had (2,000), photos snapped by the SenseCam hanging around his neck (66,000), songs listened to (7,139), and videos taken by him (2,164).

Why is he doing this?  He sees some appeal in the ability to always remember:

By using e-memory as a surrogate for meat-based memory, he argues, we free our minds to engage in more creativity, learning, and innovation (sort of like Getting Things Done without all those darn Post-its).

In a work context, this is true.  A large part of my time is spent looking for files or trying to remember.

A whole slew of interesting human factors and usability questions are elephants in the room:

  • Currently, a portion of the recording is done manually.  How and what should be automated?
  • How does one efficiently search/browse through potentially petabytes of lifedata?  I don’t think a search engine would suffice (not all material would be textual).
  • This seems to solve the “encoding” problem in memory.  But it wreaks havoc with the “retrieval” portion.  You still need a good retrieval cue.
  • What are the implications of off-loading so much memory?  How will it change the way we currently learn/work?
  • As a type of automation, what will happen when it fails or is unreliable?
  • What are the privacy implications of recording this much data (especially the sensecam)?

His book outlining this idea comes out September 17th (Amazon link). article on Anne’s research with Games & Aging

Our own Anne McLaughlin was featured in a recent article in  Anne and her colleagues Jason Allaire (NCSU) and Maribeth Gandy (Georgia Tech) were recently awarded a $1.2 million grant from the National Science Foundation to study using games to moderate cognitive decline in older adults.

Their plan is to study what parts of games might help cognitive performance and then to create a new game based on these components.

There is, of course, no cure for memory loss, and no preventive vaccine. Yet a rapidly growing body of evidence suggests that certain behaviors may reliably slow the effects of age-related cognitive decline. Chief among them: eating right, exercising and engaging in social activity and mentally challenging tasks.

McLaughlin and Allaire’s new study will follow 270 seniors as they play the Wii game Boom Blox. Gameplay involves demolishing targets like a medieval castle or a space ship using an arsenal of weapons such as slingshots and cannonballs. While those particular skills may not seem transferable to off-screen life, McLaughlin says she and her colleagues chose Boom Blox specifically because it does require a wide range of real-world skills, including memory, special ability, reasoning and problem solving.  [ed: ‘special ability’ should be spatial ability]

Why Boom Blox?  Anne tells me that she:

“…actually chose the game after doing task analyses on many games, seeing what fit our profile, then showing those games to OA [older adults] in a focus group and getting “buy in” for what they said they would play.”

Below is an annotated screen shot of Boom Blox and an excerpt of the task analysis of the game and what abilities are required.

Annotated screen shot of Boom Blox
Annotated screen shot of Boom Blox

Task analysis (cognitive requirements of the game)

[Can Gaming Slow Mental Decline in the Elderly? at]

Smartphones as Event-based Prospective Memory Aids

The calendar functions of devices such as personal digital assistants (PDAs) and  smartphones have always been types of time-based prospective memory aids.  An item to be remembered in the future (e.g., go to meeting at 4 pm) is entered into the calendar and when that time arrives we are reminded with a notification or alarm (hence the term time-based).

Prospective memory is remembering to perform an action in the future.  Whereas retrospective memory is remembering something from the past.  In many ways, prospective memory is much more important, from a human factors prospective, than retrospective memory.  For absent-minded people like me, prospective memory failures (like missing a meeting) is of low consequence (depending on who I am unintentionally blowing off).

But imagine the situation where a nurse forgets to carry out a procedure, a doctor forgets to remove gauze in a patient, or when a patient forgets their medication instructions.  The consequences for prospective memory failure are much greater (and potentially deadly).

Prospective memory events can be “fired” by two main types of cues or “reminders”:

  • The first is time-based (like the example above): At 3 pm, call cable company, or in 30 minutes call Chris.
  • The other way is event-based: When I see Anne, let her know that the paper is due, or drop deposit check when I pass the ATM.

Android App Electronic calendars are great at aiding time-based prospective memory tasks but only recently do they now cue event-based tasks.  For example, phones using the Android operating system can download a program that tracks your location (using the phone’s GPS unit) to fire off a reminder based on your current location.  So if you are near the grocery store it can remind you to pick up bread (event-based cue).

I recently discovered a feature in Palm WebOS phones (like the new Palm Pre) that can fire off reminders based on who you are communicating with (via phone conversation, instant messaging, or I think email). When I contact Anne (or she contacts me), a notification will remind me of what I needed to tell her.

Say that I need to tell Anne of an upcoming deadline when I see or hear from her.  I select her contact entry and type in a note to myself to remind her.  Next time I call her or we instant message I will receive this reminder:

contacts_2009-16-06_234845 contacts_2009-16-06_234921

Again, this is an event-based cue (communicating with Anne is the event) and not a time-based cue (there is no specific time when it might happen).  Cool!  More information about prospective memory can be found in this book (Google Books link) and countless articles.

Applied Decision Making Aids in the News

NPR covers ways psychologists have discovered to nudge irrational decisions  in a better direction.

An excerpt:

In the city of Greensboro, N.C., there’s a program designed for teenage mothers. To prevent these teens from having another child, the city offers each of them $1 a day for every day they are not pregnant. It turns out that the psychological power of that small daily payment is huge. A single dollar a day is enough to push the rate of teen pregnancy down, saving all the incredible costs — human and financial — that go with teen parenting.

Most of the article focuses on “economics,” but of course money is only a context for the decisions they discuss.

Invisible Lines and Laundry Detergent

Consumer Reports tackled a pet peeve of mine: the invisible fill lines for laundry detergent. Most of you are probably using too much.. I finally took a sharpie to mine. Some excerpts from the Consumer Reports article:

“If the lines aren’t clear or are hard to see, it’s easy to overdose and use too much detergent,” says Pat Slaven, a program leader in our Technical department who conducted the detergent testing. “Plus, for all the products we tested, the line for a medium load—the most commonly done load—is less than a full cap, which makes it easier to use too much detergent.” The line for a maximum load is also typically less than a full cap.

Even a textiles expert can face issues with detergent caps. “The salesman who sold us our energy-efficient washer emphasized that we should follow directions to the letter—or fill line, in this case. Of course, I have to stand under a floodlight in the garage to see the fill line,” says Margaret Rucker, Ph.D., a professor of textiles and clothing at the University of California at Davis. “If a study on cap design hasn’t been done, then it should be,” she adds.

Another manufacturer has taken a different approach to solving the problem. “We feel the best practice is to include a picture of the cap on the directions, where we call out exactly where the dosage lines are on the cap,” says Bill Littlefield, executive vice president and general manager of branded products of the Sun Products Corporation, which makes All and Wisk detergents. Littlefield admits, “It’s a struggle to find proper dosage.”

Procter & Gamble, whose detergents include Cheer, Era, Gain, and Tide, also shows images of the actual caps and fill lines on its labels. “We have specific fill caps that are clearly marked, and we feel people understand the product,” says Lauren Thaman, a chemist and head of U.S. external relations at P&G.

Although the companies “feel” that consumers know how to use their product, field testing might show otherwise. Using a picture of the cap on the box separates the information from the action, adding an extra step.

Consumer Reports was tactful enough not to mention that overuse of detergent benefits the companies making the detergent bottles and their indicator caps.

Emergency Checklists and Aviation

The recent water landing into the Hudson is still being investigated. This AP article focuses on whether flight attendants were trained not to open the back door of the plane during a water landing, but the most interesting bit comes at the end:

Another concern is whether the FAA and airlines need to revise emergency procedures for pilots in the event both engines fail. Those procedures usually involve a sequence of many steps called a checklist. There are different checklists depending upon the problem, but most are based on the expectation that the problem will occur while the plane is flying at a high altitude — airliners typically cruise above 20,000 feet, giving pilots time to identify and correct the problem.

Flight 1549’s first officer, Jeffrey Skiles, told a congressional panel in February that he only had time to make it part of the way through a checklist for restarting the engines when Sullenberger sent the plane into the river.

Sumwalt suggested it would be better for airlines to train pilots to remember one procedure for a low-altitude dual engine failure, rather than go through a long checklist of items while altitude rapidly diminishes.

Cannot be Undone (double negatives on iphone)

I just saw this image from Apple’s introduction of the new iPhone:

From Gizmodo

Notice the wording:  I understand that this action cannot be undone or cancelled [ed: British spelling, huh].

Does that mean it can be done?  Not a huge deal but the double negative slowed me down for a second.  Not a place where there should be any confusion!  Off-topic, I just got a Palm Pre this weekend and love it!