[Consensus statement on severe dementia]

Telepresence Robot Intervention to Reduce Loneliness and Social Isolation in Older Adults Living at Home (Project DOMIROB): Protocol for a Clinical Nonrandomized Study

BACKGROUND

There is a growing prevalence of loneliness and social isolation among older adults (OAs). These problems are often associated with depressive states, cognitive decline, sleep disorders, addictions, and increased mortality. To limit loneliness and social isolation in OAs, some authors recommend the use of new communication technologies to maintain a social link with family members as well as with health and social care professionals. Among these communication tools, telepresence robots (TRs) seem to be a promising solution. These robots offer users the possibility of making video calls with their relatives, social workers, and health care professionals, to maintain social contact and access to support services while living at home. Nevertheless, TRs have been relatively unstudied in real-life environments.

OBJECTIVE

The main objective of this study is to measure the impact of a 12-week intervention using a TR on the feeling of loneliness and on social isolation of OAs living at home. Its secondary objective is to establish recommendations for the implementation of TRs in the studied context.

METHODS

A nonrandomized study will be conducted among 60 OAs living at home who will participate in the study for 24 weeks. During this period, they will host a TR for 12 weeks to use it in their home. After the end of the intervention a 12-week follow-up ensues. In total, 4 evaluations will be performed over the entire experimental phase for each participant at weeks 0, 6, 12, and 24. A multidimensional assessment of the impact of the robot will be performed using a multimethod approach including standardized scales and a semistructured interview. This assessment will also help to identify the ergonomic aspects that influence the robot's usability and acceptability among OAs.

RESULTS

Data collection started in September 2020 and is expected to be completed in early 2023. In August 2022, 56 participants were recruited for the study. Data analysis will take place between August 2022 and is expected to be completed in early 2023.

CONCLUSIONS

The DOMIROB study will provide new knowledge on the impact of social TRs in OAs living at home. The results will make it possible to suggest technological, ethical, and organizational recommendations for the use and implementation of TRs for OAs in real-life settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04767100; https://clinicaltrials.gov/ct2/show/NCT04767100.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40528.

Management in severe dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

ABSTRACT Alzheimer’s disease (AD) and other neurodegenerative dementias have a progressive course, impairing cognition, functional capacity, and behavior. Most studies have focused on AD. Severe dementia is associated with increased age, higher morbidity-mortality, and rising costs of care. It is fundamental to recognize that severe dementia is the longest period of progression, with patients living for many years in this stage. It is the most heterogeneous phase in the process, with different abilities and life expectancies. This practice guideline focuses on severe dementia to improve management and care in this stage of dementia. As it is a long period in the continuum of dementia, clinical practice should consider non-pharmacological and pharmacological approaches. Multidisciplinary interventions (physical therapy, speech therapy, nutrition, nursing, and others) are essential, besides educational and support to caregivers.

Manejo das demências em fase avançada: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

RESUMO A doença de Alzheimer (DA) e outras demências neurodegenerativas têm um curso progressivo com comprometimento da cognição, capacidade funcional e comportamento. A maioria dos estudos enfocou a DA. A demência grave está associada ao aumento da idade, maior morbimortalidade e aumento dos custos de cuidados. É fundamental reconhecer que a demência grave é o período mais longo de progressão, com o paciente vivendo muitos anos nesta fase. É a fase mais heterogênea do processo, com diferentes habilidades e expectativa de vida. Esta diretriz de prática concentra-se na demência grave para melhorar o manejo e o cuidado nessa fase da demência. Como um longo período no continuum da demência, as abordagens não farmacológicas e farmacológicas devem ser consideradas. Intervenções multidisciplinares (fisioterapia, fonoaudiologia, nutrição, enfermagem, entre outras) são essenciais, além de educacionais e de apoio aos cuidadores.

[Ethics and dementia: a three years' experience of a French "Alzheimer's ethico-clinic workshop"]

There is a growing interest concerning ethical questions. This ethical need is the more important in the field of dementia. Indeed, the ethical concerns related to this field are highly specific, which leaves some of our questions without pertinent answers.

METHODS

After three years of experience, it is a good time to assess the Alzheimer ethico-clinic workshop created by a French memory centre (in Grenoble) and encouraged by the French national Alzheimer disease plan.

RESULTS

Since their implementation, we have recorded 24 monthly coordination meetings, 10 of which have been held through videoconferences with various participants. Most of the time during the workshops, clinical situations that are experienced in our daily activities are brought up by one of us and then exposed for collective discussion. If no practical situation is available, we organize the meetings through critical readings of texts of law or through comments on articles dealing with Ethics. We retain four main ethical topics: the information given to the patient and his family, the acceptance of the person, the balance of benefits/risks and one's individual ethics as opposed to the ethics of a group. At this point in time, we are pleased with the organization of these workshops and feel that they meet our expectations. Thanks to the diverse experiences and activities of each participant, the discussions on Ethics are of high quality.

PROSPECTIVES

As a place of shared discussions/thoughts, these ethical workshops could constitute a reference to be used when making decisions in complex situations. Other than the importance of the ethical questions that are raised, it should encourage open-minded attitudes and enrich the actions of each of us by making us more aware of the ethical concerns in daily situations. Finally, these workshops could be a field of research for theses, dissertations and answer the training and research needs of a memory centre.