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Draft:SimPres

SimPres, also known as Simulated Presence, is a deceptive technological device used for dementia patients to communicate with their loved ones. SimPres is used on dementia patients to deceive the patient to believe he/she is actually on the phone, particularly with a loved one.

It is believed that this device gives positive results as dementia patients respond by active communication via talking and smiling. Stimulated Presence is designed specifically for Alzheimer patients to manage negative behaviors and improve his/hers well-being.

SimPres, also known as, Simulated Presence Therapy (SPT) reduces levels of anxiety and challenging behaviors for those struggling with dementia. SimPres is a specific audiotape that was previously made by a family member of the dementia patient. Prior to the recording of the audio, the family member is trained in special communication techniques and selects cherished memories shared with the selected patient. Because Alzheimer's affect memory, the tape can be played repeatedly and still be seen as a new conversation time and time again.

Dementia is known as the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. The most common type of dementia is Alzheimer’s Disease. Approximately, there is about 5.0 million adults with dementia in 2014 and by 2060, there is to be projected to be nearly 14 million.

One study done to test the SPT was called the pilot test. This test involved recruited nine nursing home residents from two separate units in a large nursing home. The criteria’s in this study included the diagnosis of DAT, history of behavioral problems, verbal interactions, and a family member willing to participate in the study. Participants of this study were given SimPres twice daily. The problem behavior did not change in only seven percent of the observations and SimPres was rejected only two percent of the time. Improvement of SimPres ranged from 68% to 100% and was deemed effective for aiding in disruptive behavior and social isolation.

Another study was done in 2020 that involved three different trials on 144 nursing home residents. Most were women 80 years and over that were diagnosed with severe dementia. The trials all tried to measure an outcome on restless manners but used diverse methods in finding these outcomes. The diverse trials negatively impacted the results by not being able to point out a specific outcome due to the varied methods used. This resulted in the trials not being able to pool the results. Due to the problematic methods used and the small studies, the quality of the evidence was left biased, unconfident, and faulty. The individuals in this study were unable to judge whether SimPres could aid in distressed dementia patients due to the lack of high-quality research that was conducted.

Despite the study done in 2020, a different particular study suggested that Simulated Presence, or SimPres, can be effective in increasing well-being and can be used a substitute to traditional care. This study was done in nine nursing homes in Eastern Massachusetts and Southern New Hampshire to determine the effective of SimPres. The participants involved included fifty‐four subjects 50 years and up with current Alzheimer’s or dementia diseases. All individuals had a prior history in agitated behaviors. There random treatments were done during the design of the study. The factors were treatment, time, and facility type. To measure the direct outcomes of the study, there were six different observation scales used; these included: newly developed scale, the Scale for the Observation of Agitation in Persons with Dementia, an agitation visual analog scale, the Positive Affect Rating Scale (mood and “interest”), a withdrawal visual analog scale, and facial diagrams of mood. Additionally, the Mini‐Mental State Exam, the Test for Severe Impairment, the Bedford Alzheimer's Nursing Scale, and the ADL Self‐Performance Scale were measured to determine the severity of dementia. Chi‐square analysis of direct observations, using facial diagrams, revealed that Simulated Presence was equivalent to usual care (P =. 141) and superior to placebo for producing a happy facial expression (P =. 001). All but five subjects accepted the intervention used due to a positive effect in Analysis of Variance techniques during SimPres. SimPres was greater to the placebo and usual care used.

The use of SimPres has resulted in a controversial topic: Is it justified to deceive or lie to a dementia patient if it prevents them from emotional or physical harm? Based on the Formula of Humanity, the most fundamental forms of wrongdoing is coercion and deception. However, paternalistic deception is defined as deception that is performed for the deceived individual's own good by a person assuming an authoritative role. The way a doctor or nurse communicates the use of the device is based on whether or not a lie is being occurred. Although the device is deceptive, if a nurse states, "Here is something to listen to" rather than "Your son is on the phone" the nurse is not lying yet deceiving to protect and aid the well-being of the patient.

SimPres does result in demented patients to feel good based on scientific evaluation. SimPres is meant to be an enjoyable experience for dementia patient in which it resolves agitated and withdrawn behavior and increases positive feelings and emotions. Because the use of this communicative device is ultimately used to deceive dementia patients, individuals question if this actually adds to a patient's well-being or does it diminish the trust in professional care. Other communicative devices used to aid the emotional well-being on dementia patients includes the Experience Machine. The Experience Machine was created by Robert Nozick and lets his audience question preferred experience like the false experience or the reality of coming in contact with real life. Even though SimPres is a temporary solution to dementia patients, the patients are still unaware of the illusion of the experience. Writers like Maartje Schermer believe that temporary illusionary experiences do add to well-being and because of that it is deemed fair. Once patients cannot differ or find concepts like true and false, reality and illusion, or fact and fantasy meaningful, it logically becomes impossible to deceive or lie to them. Therefore, it becomes conceptually impossible to lie to someone who is in a state of dementia. Patients in the later stages of Alzheimer's would have to repeatedly go through a painful truth without properly having to deal with it permanently. Because of this, the concept of true and false loses its meaning.

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 * Draft AfC submissions
 * AfC submissions by date/14 December 2020