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Hardy MS, Fanaki C, Savoie C. The use of technology by seniors with neurocognitive disorders in long-term care: a scoping review. BMC Geriatr 2024; 24:573. [PMID: 38961323 PMCID: PMC11220951 DOI: 10.1186/s12877-024-05174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND To map the current state of knowledge about the use of technology with seniors with neurocognitive disorders in long-term care to foster interactions, wellness, and stimulation. METHODS Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus); MEDLINE; PsycINFO; Embase and Web of Science were searched in eligible literature, with no limit of time, to describe the current use of technology by seniors with neurocognitive disorders in long-term care. All types of literature were considered except for theses, editorial, social media. This scoping review was built around the recommendations of Peters et al. (2020 version). Three researchers collaborated on the selection of articles and independently reviewed the papers, based on the eligibility criteria and review questions. RESULTS The search yielded 3,605 studies, of which 39 were included. Most technology type reported was robotics. Included studies reports different positive effects on the use of such technology such as increase of engagement and positive. CONCLUSION The study highlights different types and potential benefits of technology for long-term care residents with neurocognitive disorders, emphasizing the crucial need for additional research to refine interventions and their use.
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Affiliation(s)
- Marie-Soleil Hardy
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada.
| | - Chaimaa Fanaki
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Camille Savoie
- Faculty of Nursing Science, Université Laval, Québec, QC, G1V 0A6, Canada
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Nichol B, McCready J, Erfani G, Comparcini D, Simonetti V, Cicolini G, Mikkonen K, Yamakawa M, Tomietto M. Exploring the impact of socially assistive robots on health and wellbeing across the lifespan: An umbrella review and meta-analysis. Int J Nurs Stud 2024; 153:104730. [PMID: 38430662 DOI: 10.1016/j.ijnurstu.2024.104730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Socially assistive robots offer an alternate source of connection for interventions within health and social care amidst a landscape of technological advancement and reduced staff capacity. There is a need to summarise the available systematic reviews on the health and wellbeing impacts to evaluate effectiveness, explore potential moderators and mediators, and identify recommendations for future research and practice. OBJECTIVE To explore the effect of socially assistive robots within health and social care on psychosocial, behavioural, and physiological health and wellbeing outcomes across the lifespan (PROSPERO registration number: CRD42023423862). DESIGN An umbrella review utilising meta-analysis, narrative synthesis, and vote counting by direction of effect. METHODS 14 databases were searched (ProQuest Health Research Premium collection, Scopus, PubMed, Web of Science, ASM Digital Library, IEEE Xplore, Cochrane Reviews, and EPISTEMONIKOS) from 2005 to May 4, 2023. Systematic reviews including the effects of socially assistive robots on health outcomes were included and a pooled meta-analysis, vote counting by direction of effect, and narrative synthesis were applied. The second version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was applied to assess quality of included reviews. RESULTS 35 reviews were identified, most focusing on older adults with or without dementia (n = 24). Pooled meta-analysis indicated no effect of socially assistive robots on quality of life (standard mean difference (SMD) = 0.43), anxiety (SMD = -0.02), or depression (SMD = 0.21), although vote counting identified significant improvements in social interaction, mood, positive affect, loneliness, stress, and pain across the lifespan, and narrative synthesis identified an improvement in anxiety in children. However, some reviews reported no significant difference between the effects of socially assistive robots and a plush toy, and there was no effect of socially assistive robots on psychiatric outcomes including agitation, neuropsychiatric symptoms, and medication use. DISCUSSION Socially assistive robots show promise for improving non-psychiatric outcomes such as loneliness, positive affect, stress, and pain, but exert no effect on psychiatric outcomes such as depression and agitation. The main mechanism of effect within group settings appeared to be the stimulation of social interaction with other humans. Limitations include the low quality and high amount of overlap between included reviews. CONCLUSION Socially assistive robots may help to improve loneliness, social interaction, and positive affect in older adults, decrease anxiety and distress in children, and improve mood, stress, and reduce pain across the lifespan. However, before recommendations for socially assistive robots can be made, a cost-effectiveness analysis of socially assistive robots to improve mood across the lifespan, and a quantitative analysis of the effects on pain, anxiety, and distress in children are required.
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Affiliation(s)
- Bethany Nichol
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Jemma McCready
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Goran Erfani
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Dania Comparcini
- Section of Nursing, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | | | - Giancarlo Cicolini
- Section of Nursing, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | - Kristina Mikkonen
- Research Unit of Health Science and Technology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Miyae Yamakawa
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita City, Japan.
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; Research Unit of Health Science and Technology, University of Oulu, Oulu, Finland.
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Schneider C, Nißen M, Kowatsch T, Vinay R. Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review. BMJ Open 2024; 14:e080545. [PMID: 38341210 PMCID: PMC10862336 DOI: 10.1136/bmjopen-2023-080545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Digital assistive technologies (DATs) have emerged as promising tools to support the daily life of people with dementia (PWD). Current research tends to concentrate either on specific categories of DATs or provide a generic view. Therefore, it is of essence to provide a review of different kinds of DATs and how they contribute to improving quality of life (QOL) for PWD. DESIGN Scoping review using the framework proposed by Arksey and O'Malley and recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. DATA SOURCES Cochrane, Embase, PubMed, Scopus and Web of Science (January 2013 to May 2023). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Completed scientific literature with a primary focus on DATs for PWD, perspectives of caregivers, family members or healthcare workers in relation to a PWD, people living in diverse settings and all severities of dementia. DATA EXTRACTION AND SYNTHESIS Screening and data extraction were conducted, followed by quantitative and qualitative analyses using thematic analysis principles and Digital Therapeutics Alliance categories for DAT grouping. RESULTS The literature search identified 6083 records, with 1056 duplicates. After screening, 4560 full texts were excluded, yielding 122 studies of different designs. The DATs were categorised into digital therapeutics (n=109), patient monitoring (n=30), digital diagnostics (n=2), care support (n=2) and health system clinical software (n=1). These categories were identified to impact various aspects of QOL: preserving autonomy, engagement, and social interaction, health monitoring and promotion, improving activities of daily living, improving cognition, maintaining dignity, managing behavioural and psychological symptoms of dementia and safety/surveillance. CONCLUSIONS Various DATs offer extensive support, elevating the QOL of PWD. Digital therapeutics are predominantly used for ageing-in-place and independent living through assistance with daily tasks. Future research should focus on less-represented digital health technology categories, such as care support, health & wellness or software solutions. Observing ongoing DAT developments and their long-term effects on QOL remains essential.
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Affiliation(s)
- Charlotte Schneider
- Department of Management, Technology and Economics, ETH Zürich, Zurich, Switzerland
| | - Marcia Nißen
- University of St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Department of Management, Technology and Economics, ETH Zürich, Zurich, Switzerland
- Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Rasita Vinay
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Bergschöld JM, Gunnes M, Eide AH, Lassemo E. Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews. JMIR Aging 2024; 7:e50286. [PMID: 38252472 PMCID: PMC10845034 DOI: 10.2196/50286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. OBJECTIVE This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. METHODS The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. RESULTS A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. CONCLUSIONS Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.
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Affiliation(s)
| | - Mari Gunnes
- Department of Health, SINTEF Digital, Trondheim, Norway
| | - Arne H Eide
- Department of Health, SINTEF Digital, Oslo, Norway
| | - Eva Lassemo
- Department of Health, SINTEF Digital, Trondheim, Norway
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Eost-Telling C, Yang Y, Norman G, Hall A, Hanratty B, Knapp M, Robinson L, Todd C. Digital technologies to prevent falls in people living with dementia or mild cognitive impairment: a rapid systematic overview of systematic reviews. Age Ageing 2024; 53:afad238. [PMID: 38219225 PMCID: PMC10788098 DOI: 10.1093/ageing/afad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/27/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVE Falls are a common cause of potentially preventable death, disability and loss of independence with an annual estimated cost of £4.4bn. People living with dementia (PlwD) or mild cognitive impairment (MCI) have an increased fall risk. This overview evaluates evidence for technologies aiming to reduce falls and fall risk for PlwD or MCI. METHODS In October 2022, we searched five databases for evidence syntheses. We used standard methods to rapidly screen, extract data, assess risk of bias and overlap, and synthesise the evidence for each technology type. RESULTS We included seven systematic reviews, incorporating 22 relevant primary studies with 1,412 unique participants. All reviews had critical flaws on AMSTAR-2: constituent primary studies were small, heterogeneous, mostly non-randomised and assessed as low or moderate quality. Technologies assessed were: wearable sensors, environmental sensor-based systems, exergaming, virtual reality systems. We found no evidence relating to apps. Review evidence for the direct impact on falls was available only from environmental sensors, and this was inconclusive. For wearables and virtual reality technologies there was evidence that technologies may differentiate PlwD who fell from those who did not; and for exergaming that balance may be improved. CONCLUSIONS The evidence for technology to reduce falls and falls risk for PlwD and MCI is methodologically weak, based on small numbers of participants and often indirect. There is a need for higher-quality RCTs to provide robust evidence for effectiveness of fall prevention technologies. Such technologies should be designed with input from users and consideration of the wider implementation context.
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Affiliation(s)
- Charlotte Eost-Telling
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Yang Yang
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
| | - Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Alex Hall
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - Martin Knapp
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Louise Robinson
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - Chris Todd
- National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester M13 9PT, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Kiselica AM, Lin SSH, Ranum R, Mikula CM, Hermann G, Boone A, Scullin M, Mechanic-Hamilton D, Wolf T, Stevens A, Benge JF. The Technology in Caring Questionnaire: Development and Psychometric Properties. Alzheimer Dis Assoc Disord 2024; 38:77-84. [PMID: 38277628 PMCID: PMC10922679 DOI: 10.1097/wad.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE We developed the Technology in Caring Questionnaire (TCQ) to assess the use of technology-based strategies by dementia caregivers. METHODS One hundred caregivers completed a survey that included TCQ items along with measures of technology proficiency and patient and caregiver-centered outcomes. RESULTS The final 34-item TCQ scale had adequate to excellent internal consistency (raw Cronbach alpha = 0.75; standardized Cronbach alpha = 0.95; Guttman lambda-6 = 0.97). TCQ scores demonstrated modest convergent associations with scores from measures of smartphone ( r = 0.265, P < 0.01) and computer proficiency ( r = 0.230, P < 0.05) but a strong association with overall technology experience scores ( r = 0.578, P < 0.001). Elevated TCQ scores were associated with reduced informant-reported cognitive symptoms ( B = -0.003, P < 0.05), increased ability of caregivers to find support and information ( B = 0.03, P < 0.001), and increased direct care strain ( B = 0.03, P < 0.05), after controlling for dementia severity and demographics. CONCLUSION The TCQ has good psychometric properties for the assessment of technology-based care strategies among dementia caregivers. Findings imply that the use of technologies may aid in symptom management and finding support and information but may also increase caregiver strain.
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Affiliation(s)
| | | | - Rylea Ranum
- Department of Psychology, University of Houston—Austin
| | - Cynthia M. Mikula
- New York State Psychiatric Institute, Columbia University Irving Medical Center—Austin
| | - Greta Hermann
- Department of Health Psychology, University of Missouri—Austin
| | - Anna Boone
- Department of Occupational Therapy, University of Missouri—Austin
| | - Michael Scullin
- Department of Psychology & Neuroscience, Baylor University—Austin
| | | | - Timothy Wolf
- Department of Occupational Therapy, University of Missouri—Austin
| | - Alan Stevens
- Center for Applied Health Research, Baylor Scott and White Health—Austin
| | - Jared F. Benge
- Department of Neurology and Mulva Clinic for the Neurosciences, University of Texas—Austin
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Feenstra M, Zuidema SU, Janus SIM. Long-term care needs guidance for the implementation of digital health technologies. Age Ageing 2023; 52:afad223. [PMID: 38037227 DOI: 10.1093/ageing/afad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Marlies Feenstra
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, Groningen, The Netherlands
| | - Sytse U Zuidema
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, Groningen, The Netherlands
| | - Sarah I M Janus
- University of Groningen, University Medical Center Groningen, Department of Primary and Long-term Care, Groningen, The Netherlands
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Brouwers M, Broekharst DSE, de Boer B, Groen WG, Verbeek H. An overview of innovative living arrangements within long-term care and their characteristics: a scoping review. BMC Geriatr 2023; 23:442. [PMID: 37464287 PMCID: PMC10355008 DOI: 10.1186/s12877-023-04158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Within long-term care, a culture change (e.g. focus on increasing autonomy in everyday life) is leading to the development of innovative living arrangements for older adults. Insight into characteristics of innovative living arrangements, which are described as an alternative to regular nursing homes, is lacking. This review aims to provide an overview of innovative living arrangements and to describe their defining characteristics. METHODS A scoping review was performed following the framework of Arksey and O'Malley. The preferred reporting items for systematic reviews and meta-analyses with extension, for scoping reviews (PRISMA-ScR) was also followed. The databases PubMed, PsycInfo, CINAHL, and Web of Science were searched. Articles, published between 2012 and 2023 were included when they presented an innovative living arrangement as an alternative to regular nursing homes. A thematic analysis was performed, describing the physical, social, and organizational environment of the innovative living arrangements. RESULTS Fifty-six articles were identified describing seven types of distinct innovative living arrangements: small-scale living, the green house model, shared housing arrangements, green care farms, dementia villages, group homes, intergenerational living, and an 'other' category. The themes included supporting autonomy and creating a small-scale and/or homelike environment, which were emphasized in most innovative living arrangements. Other themes, such as involvement of the community, focus on nature, integration of work tasks, and involvement of family members, were emphasized in a subsection of the described living arrangements. Twenty-eight articles reported on the effects of the innovative living environment on residents, family members, or staff members. Most articles (N = 22) studied resident-related outcomes, focusing mainly on quality of life and aspects of daily life. CONCLUSION More insight into the mechanisms of the social and organizational environments is needed, which may lead to greater transparency and homogeneity regarding the description of living arrangements. This review shows that more knowledge is needed about the potential key elements of innovative living arrangements, especially related to their social and organizational environment. This may provide a better guide for developers within long-term care.
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Affiliation(s)
- Mara Brouwers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. BOX 616, Maastricht, 6200 MD, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Damien S E Broekharst
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- University Network for the care sector South Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Bram de Boer
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. BOX 616, Maastricht, 6200 MD, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. BOX 616, Maastricht, 6200 MD, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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