Mobile Phone Use by People with Mild to Moderate Dementia: Uncovering Challenges and Identifying Opportunities
Mark Dixon, Jess Hartcher-O'Brien, Amanda Lazar, Leah Findlater · 2022 · Proceedings of the 24th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS '22) · doi:10.1145/3517428.3544809
Summary
This paper investigates how people with mild to moderate dementia use mobile phones in their daily lives, going beyond the common research focus on dementia-specific assistive apps to examine mainstream smartphone use. The authors conducted semi-structured interviews with 14 participants diagnosed with mild to moderate dementia, recruited through dementia advocacy organizations in the United States. Participants ranged in age from 52 to 83 and included people with various dementia subtypes including Alzheimer's disease, frontotemporal dementia, Lewy body dementia, and vascular dementia. The study explored three research questions: what activities people with dementia use their phones for, what challenges they encounter, and what design opportunities could better support their needs. The researchers employed thematic analysis to identify patterns across participant experiences. Notably, several participants had early-onset dementia (diagnosed before age 65), which meant they had established digital literacy and strong relationships with their devices prior to diagnosis. The study positions itself within a broader shift in dementia research from deficit-focused perspectives toward understanding the capabilities and agency that people with dementia retain, particularly in technology use. By centering the voices of people with dementia themselves rather than caregivers or clinicians, the research provides direct insight into lived experiences of technology interaction as cognitive abilities change over time.
Key findings
Participants used their phones for a wide range of activities including navigation and wayfinding, shopping and banking, health management, productivity tasks, and purposeful work such as advocacy after their diagnosis. Three major categories of challenges emerged. First, participants struggled with navigating to apps and features, often losing track of where things were located on their devices and having difficulty with multi-step navigation sequences. Second, task execution was impaired by contextual factors including time pressure, stress, fatigue, and environmental distractions — participants described how cognitive demands compounded under these conditions. Third, software updates and interface changes disrupted learned task flows, forcing participants to re-learn processes they had previously mastered, which was particularly frustrating given the cognitive effort required. Participants proposed four design opportunities: customizable user interfaces that could be simplified to show only needed functions, activity-based customization that bundles related apps and features together for specific tasks, proactive technology assistance that anticipates needs and offers help before problems arise, and extended voice-based interactions to reduce visual navigation demands. The findings reveal important tensions around designing for progressive conditions — adaptive interfaces must balance simplification with maintaining user autonomy, and proactive assistance raises privacy concerns about monitoring behavior.
Relevance
This research has significant implications for accessibility practitioners and designers working on mobile platforms. It demonstrates that people with cognitive disabilities are active, purposeful technology users whose needs extend far beyond specialized assistive applications. The findings challenge deficit-based assumptions about dementia and technology, showing that design improvements benefiting people with dementia — such as simplified navigation, consistent interfaces across updates, and activity-based organization — would likely benefit all users. For practitioners, the study highlights the importance of maintaining interface consistency across software updates, a consideration rarely addressed in accessibility guidelines. The tensions identified around adaptive interfaces for progressive conditions — balancing simplification with autonomy, and proactive assistance with privacy — represent important design challenges that current accessibility standards do not adequately address. The research also underscores the value of involving people with cognitive disabilities directly in design research rather than relying solely on caregiver perspectives.
Tags: dementia · cognitive accessibility · mobile phones · qualitative research · user interviews · inclusive design · older adults
Standards referenced: WCAG 2.1