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Köhler S, Perry J, Biernetzky OA, Kirste T, Teipel SJ. Ethics, design, and implementation criteria of digital assistive technologies for people with dementia from a multiple stakeholder perspective: a qualitative study. BMC Med Ethics 2024; 25:84. [PMID: 39068472 PMCID: PMC11282641 DOI: 10.1186/s12910-024-01080-6] [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: 05/25/2023] [Accepted: 07/04/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Dementia impairs the ability of people with dementia to be autonomous and independent. They need support from third parties, who should ideally respect their autonomy and independence as much as possible. Supporting people with dementia can be very burdensome for caregivers and numbers of patients increase while numbers of potential caregivers decline. Digital assistive technologies (DATs) that directly support patients or their caregivers may help bridging the increasing gap between need of support and available resources. DATs have the potential to preserve the autonomy and independence of people with dementia and promote their abilities, if they are properly designed in close interaction with future users. In our study, we focused on ethical concerns, technological requirements, and implementation criteria for DAT in general and specifically to support outdoor mobility of people with dementia. METHODS We applied a qualitative approach and conducted a World Café (2 tables, n = 7) and an online focus group (n = 6) with people with dementia, relatives, healthcare professionals, scientists, ethics experts, and experts for digitally-assisted medical care. We descriptively analyzed the data using a content analysis approach. RESULTS The participants reported technological (e.g., lack of Wi-Fi), financial (e.g., expensive devices or lack of budget for DATs), political (e.g., legal hurdles such as the European Medical Device Law or data protection regulations) as well as user-related hurdles (e.g., lack of digital competence) for the implementation of DAT in dementia care. Among the issues discussed were the importance of autonomy, independence, safety, privacy, and questions of decision making capacity in DAT's use. Participants identified opportunities and benefits in self-learning, situation-aware DATs and wished for dementia-friendly communities. They emphasized the value of personal interaction that should not be replaced, but rather supported by DAT. CONCLUSION The results revealed multiple hurdles and ethical concerns for DAT use and provided recommendations for designing and implementing DATs. Further investigations are needed on the impact of DAT on personal interactions in caregiving and the role of DAT in dementia-friendly communities.
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Affiliation(s)
- Stefanie Köhler
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Site Rostock/Greifswald, Gehlsheimer Str. 20, Rostock, 18147, Germany.
| | - Julia Perry
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Olga A Biernetzky
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Site Rostock/Greifswald, Gehlsheimer Str. 20, Rostock, 18147, Germany
| | - Thomas Kirste
- Faculty of Informatics and Electrical Engineering, Institute for Visual & Analytic Computing, Faculty of Informatics and Electrical Engineering, University of Rostock, Rostock, Germany
| | - Stefan J Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen, Site Rostock/Greifswald, Gehlsheimer Str. 20, Rostock, 18147, Germany
- Section for Gerontopsychosomatic and Dementia Diseases, University Medical Center Rostock, Rostock, Germany
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Howes J, Denier Y, Gastmans C. Electronic Tracking Devices for People With Dementia: Content Analysis of Company Websites. JMIR Aging 2022; 5:e38865. [DOI: 10.2196/38865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Electronic tracking devices, also known as locators, monitors, or surveillance devices, are increasingly being used to manage dementia-related wandering and, subsequently, raising various ethical questions. Despite the known importance technology design has on the ethics of technologies, little research has focused on the companies responsible for the design and development of electronic tracking devices. This paper is the first to perform a qualitative analysis of the ethically related content of the websites of companies that design and develop electronic tracking devices.
Objective
The aim of this study was to understand how companies that design, develop, and market electronic tracking devices for dementia care frame, through textual marketing content, the vulnerabilities and needs of persons with dementia and caregivers, the way in which electronic tracking devices respond to these vulnerabilities and needs, and the ethical issues and values at stake.
Methods
Electronic tracking device company websites were identified via a Google search, 2 device recommendation lists (Alzheimer’s Los Angeles and the Canadian Agency for Drugs and Technologies in Health), and the 2 recent reviews of wander management technology by Neubauer et al and Ray et al. To be included, websites must be official representations of companies (not market or third-party websites) developing and selling electronic tracking devices for use in dementia care. The search was conducted on December 22, 2020, returning 199 websites excluding duplicates. Data synthesis and analysis were conducted on the textual content of the included websites using a modified form of the Qualitative Analysis Guide of Leuven.
Results
In total, 29 websites met the inclusion criteria. Most (15/29, 52%) companies were in the United States. The target audience of the websites was largely caregivers. A range of intertwined vulnerabilities facing persons with dementia and their caregivers were identified, and the companies addressed these via care tools that centered on certain values such as providing information while preserving privacy. Life after device implementation was characterized as a world aspired to that sees increased safety for persons with dementia and peace of mind for caregivers.
Conclusions
The way electronic tracking device content is currently conveyed excludes persons with dementia as a target audience. In presenting their products as a response to vulnerabilities, particular values are linked to design elements. A limitation of the results is the opaque nature of website content origins. How or when values arise in the process of design, development, and marketing is unknown. Therefore, further research should explore the process companies use to identify vulnerabilities, how values are decided upon and integrated into the design of products, and the perceptions of developers regarding the ethics of electronic tracking devices.
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Neubauer N, Spenrath C, Philip S, Daum C, Liu L, Miguel-Cruz A. Identifying adoption and usability factors of locator devices for persons living with dementia. DEMENTIA 2021; 21:862-881. [PMID: 34964391 PMCID: PMC8996292 DOI: 10.1177/14713012211065381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A growing number of Canadians live with dementia. Strategies to reduce the risks of
getting lost include physical barriers, restraints and medications. However, these
strategies can restrict one’s participation in meaningful activities and reduce quality of
life. Locator devices can be used to manage safety risks while also supporting engagement
and independence among persons living with dementia. As more locator devices become
available on the market, adoption rates would be affected by certain factors. There is no
clear, standardized approach to identify the factors that have an influence on the
acceptance and usability of locator devices for persons with dementia and their care
partners. This project aimed to identify factors related to acceptance and usability of
locator devices that are important to individuals with dementia, their care partners,
service providers and technology developers. Qualitative description and conventional
content analysis guided our approach. We conducted 5 focus groups with 21 participants.
Trustworthiness strategies included multiple data sources, data verification for accuracy
and peer debrief. Five overarching factors emerged as critical aspects in the acceptance
and usability of locator devices. These factors were inclusivity, simplicity, features,
physical properties and ethics. Participants thought that locator devices do not
adequately consider privacy and stigma. Therefore, the acceptance and usability of locator
devices could be enhanced if privacy and stigma are addressed. The factors identified will
inform the creation of an acceptance and usability scale for locator devices used by
persons living with dementia, their care partners and service providers.
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Affiliation(s)
- Noelannah Neubauer
- 8430University of Waterloo, Canada.,Department of Occupational Therapy, 70412University of Alberta, Canada
| | - Christa Spenrath
- Department of Occupational Therapy, 70412University of Alberta, Canada
| | | | - Christine Daum
- 8430University of Waterloo, Canada.,Department of Occupational Therapy, 70412University of Alberta, Canada
| | - Lili Liu
- 8430University of Waterloo, Canada
| | - Antonio Miguel-Cruz
- 8430University of Waterloo, Canada.,Department of Occupational Therapy, 70412University of Alberta, Canada.,Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, 60351Glenrose Rehabilitation Hospital, Canada
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Howes J, Gastmans C. Electronic tracking devices in dementia care: A systematic review of argument-based ethics literature. Arch Gerontol Geriatr 2021; 95:104419. [PMID: 33964706 DOI: 10.1016/j.archger.2021.104419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/20/2021] [Accepted: 04/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Wandering is a behavioral symptom of dementia that often results in patients eloping from home or care facilities, leading to high-risk situations for injury or death. To mitigate this serious problem, caregivers use electronic tracking devices (ETDs) to manage wandering. As these devices can track, record, and monitor wearers, profound ethical questions are raised related to their use in this vulnerable population. The objective of this review was to identify the ethical frames, concepts, and arguments used in the normative literature that focused on ETDs in dementia care. METHODS We conducted a systematic literature review of normative literature that focused on ETDs in dementia care. RESULTS Twenty-two articles met the inclusion requirements. The majority of articles utilized a principlist approach, with arguments concerning ETDs largely falling under the four principles of biomedical ethics: respect for autonomy, non-maleficence, beneficence, and justice. Privacy and informed consent were specifically emphasized. The normative literature recognizes that ETDs may have a dual effect, potentially bolstering or eroding the values connected to each principle. CONCLUSIONS The prevailing use of principlism in the normative literature on ETDs indicates that there is a need to pursue new ethical approaches and expand upon the few non-principlist approaches already in use. In addition, many of the ethical issues around ETD use involve value-laden questions present during their design. Therefore, future ethical orientations or frameworks should account for ethical questions that exist along the design continuum on the use of ETDs.
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Affiliation(s)
- Jared Howes
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Box 7001, 3000 Leuven, Belgium.
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Box 7001, 3000 Leuven, Belgium
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Shu S, Woo BKP. Use of technology and social media in dementia care: Current and future directions. World J Psychiatry 2021; 11:109-123. [PMID: 33889536 PMCID: PMC8040150 DOI: 10.5498/wjp.v11.i4.109] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
As the population across the globe continues to dramatically increase, the prevalence of cognitive impairment and dementia will inevitably increase as well, placing increasing burden on families and health care systems. Technological advancements over the past decade provide potential benefit in not only relieving caregiver burden of caring for a loved one with dementia, but also enables individuals with dementia to age in place. Technological devices have served to improve functioning, tracking and mobility. Similarly, smartphones, tablets and the ubiquitous world wide web have facilitated the dissemination of health information to previously hard to reach populations largely through use of various social media platforms. In this review, we discuss the current and future uses of technology via devices and social media to promote healthy aging in individuals with dementia, and also limitations and challenges to consider in the future.
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Affiliation(s)
- Sara Shu
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, United States
| | - Benjamin KP Woo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA) Medical Center, Sylmar, CA 91104, United States
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Grigorovich A, Kontos P. Towards Responsible Implementation of Monitoring Technologies in Institutional Care. THE GERONTOLOGIST 2021; 60:1194-1201. [PMID: 31958118 PMCID: PMC7491435 DOI: 10.1093/geront/gnz190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Increasing awareness of errors and harms in institutional care settings, combined with rapid advancements in artificial intelligence, have resulted in a widespread push for implementing monitoring technologies in institutional settings. There has been limited critical reflection in gerontology regarding the ethical, social, and policy implications of using these technologies. We critically review current scholarship regarding use of monitoring technology in institutional care, and identify key gaps in knowledge and important avenues for future research and development.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Ávila-Tomás JF, Mayer-Pujadas MA, Quesada-Varela VJ. [Artificial intelligence and its applications in medicine II: Current importance and practical applications]. Aten Primaria 2021; 53:81-88. [PMID: 32571595 PMCID: PMC7752970 DOI: 10.1016/j.aprim.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Technology and medicine follow a parallel path during the last decades. Technological advances are changing the concept of health and health needs are influencing the development of technology. Artificial intelligence (AI) is made up of a series of sufficiently trained logical algorithms from which machines are capable of making decisions for specific cases based on general rules. This technology has applications in the diagnosis and follow-up of patients with an individualized prognostic evaluation of them. Furthermore, if we combine this technology with robotics, we can create intelligent machines that make more efficient diagnostic proposals in their work. Therefore, AI is going to be a technology present in our daily work through machines or computer programs, which in a more or less transparent way for the user, will become a daily reality in health processes. Health professionals have to know this technology, its advantages and disadvantages, because it will be an integral part of our work. In these two articles we intend to give a basic vision of this technology adapted to doctors with a review of its history and evolution, its real applications at the present time and a vision of a future in which AI and Big Data will shape the personalized medicine that will characterize the 21st century.
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Affiliation(s)
- Jose Francisco Ávila-Tomás
- Medicina de Familia y Comunitaria, Centro de Salud Santa Isabel, Madrid, España; Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Móstoles, Madrid, España; Estrutura Organizativa de Xestión Integrada (EOXI), Vigo, Pontevedra, España.
| | - Miguel Angel Mayer-Pujadas
- Medicina de Familia y Comunitaria, Research Programme on Biomedical Informatics (GRIB), Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC
| | - Victor Julio Quesada-Varela
- Medicina de Familia y Comunitaria, Centro de Salud de A Guarda, A Guarda, Pontevedra, España; Estrutura Organizativa de Xestión Integrada (EOXI), Vigo, Pontevedra, España; Miembro del Grupo de Trabajo de Innovación Tecnológica y Sistemas de Información de la semFYC
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Hegde N, Muralidhara S, Ashoka D. A low-cost and autonomous tracking device for Alzheimer’s patients. JOURNAL OF ENABLING TECHNOLOGIES 2019. [DOI: 10.1108/jet-03-2019-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Alzheimer’s is the most commonly occurring neurodegenerative disease and progressive cognitive impairment is its major symptom due to which the patients tend to wander and get lost in unfamiliar places. This is a constant cause of worry for caretakers and a source of distress to the patients themselves. The paper aims to discuss this issue.
Design/methodology/approach
This paper presents a low-cost, autonomous, embedded systems-based wearable device for real-time location tracking using GPS and the concept of geo-fencing. The system provides real-time updates in the form of a text message sent to the mobile number of a family member or caregiver.
Findings
An alert is sent whenever the patient moves out of a certain “safe zone” area and sends subsequent updates after every 5 min of such an event. The system supports caregivers of patients with early and moderate Alzheimer’s disease.
Social implications
Alzheimer’s patients are prone to disorientation, confusion and tend to wander off. Since the device eliminates the need for the patients to operate it and is instead at the discretion of the system itself, the chances of it failing to help are minimized. Hence, with this project, the authors address the need for an autonomous device that can assist caretakers in tracking Alzheimer’s patients.
Originality/value
The various existing technologies that are in use now for tracking are often high in price, not tailored to Alzheimer’s and are non-autonomous. To overcome this, the authors utilized easily accessible technology into developing this system, which not only be affordable, but also addresses the major flaw in existing systems – which is that they rely on being operated by the patients themselves.
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9
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Tani Y, Suzuki N, Fujiwara T, Hanazato M, Kondo K. Neighborhood Food Environment and Dementia Incidence: the Japan Gerontological Evaluation Study Cohort Survey. Am J Prev Med 2019; 56:383-392. [PMID: 30777158 PMCID: PMC6375726 DOI: 10.1016/j.amepre.2018.10.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Interventions targeting built environmental factors may encourage older people to engage in favorable behaviors and decrease dementia risk, but epidemiologic evidence is limited. This study investigated the association between neighborhood food environment and dementia incidence. METHODS A 3-year follow-up (2010-2013) was conducted among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of older adults aged ≥65 years. Dementia incidence for 49,511 participants was assessed through the public long-term care insurance system. Availability of food stores (defined as the number of food stores selling fruits and vegetables within 500 meters or 1 kilometer of residence) was assessed for each participant using objective (GIS-based) and subjective (participant-reported) measurements. Data were analyzed from 2017 to 2018. RESULTS A total of 3,162 cases of dementia occurred during the follow-up. Compared with the highest quartile for objective availability of food stores, the hazard ratio adjusting for age and sex was 1.60 (95% CI=1.43, 1.78) for the second-lowest quartile. Compared with the highest subjective availability of food stores, the hazard ratio was 1.74 (95% CI=1.49, 2.04) for the lowest category. After successive adjustment for sociodemographic characteristics, health status, and other geographic neighborhood factors (availability of restaurants, convenience stores, and community centers), the hazard ratio remained statistically significant. CONCLUSIONS Lower food store availability was associated with increased dementia incidence. Given that food shopping is a routine activity and a main motive for going out among older adults, increasing the availability of food stores may contribute to dementia prevention.
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Affiliation(s)
- Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Norimichi Suzuki
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
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10
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Kwan RYC, Cheung DSK, Kor PPK. The use of smartphones for wayfinding by people with mild dementia. DEMENTIA 2018; 19:721-735. [PMID: 29973063 DOI: 10.1177/1471301218785461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to explore the acceptability, feasibility and usability of older people with mild dementia to use smartphone for wayfinding. Thirty cognitively normal older people and 16 people with mild dementia were recruited to participate in a wayfinding trial in the free-living environment. Five feasibility and three acceptability markers were compared between the groups. Content analysis on the video-recorded trial processes and individual interviews was employed to identify the usability issues. The results found that there were no significant between-group differences on the feasibility markers, except that the people with mild dementia needed significantly more time to complete the wayfinding trial and workshop; or on the acceptability items. Sensory/cognitive impairment and GPS signal reliability affected their usability. Mild dementia does not limit the older people to use smartphones for wayfinding in the free-living environment. Future studies should examine the efficacy and safety of smartphone to promote outdoor independence of the people with mild dementia.
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Affiliation(s)
- Rick Yiu Cho Kwan
- The Centre for Gerontological Nursing, School of Nursing, Hong Kong Polytechnic University, China
| | - Daphne Sze Ki Cheung
- The Centre for Gerontological Nursing, School of Nursing, Hong Kong Polytechnic University, China
| | - Patrick Pui-Kin Kor
- The Centre for Gerontological Nursing, School of Nursing, Hong Kong Polytechnic University, China
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MacAndrew M, Schnitker L, Shepherd N, Beattie E. People with dementia getting lost in Australia: Dementia-related missing person reports in the media. Australas J Ageing 2018; 37:E97-E103. [PMID: 29787630 DOI: 10.1111/ajag.12542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to understand the circumstances in which people with dementia become lost, and the outcomes of these incidents. METHODS A search was conducted of news articles published in Australia between 2011 and 2015 reporting a missing person with a diagnosis of dementia. RESULTS Over the five-year period, 130 missing person cases were reported. The average age of the missing person was 75 years with more men (74%) than women reported missing. Most missing persons travelled on foot (62%) and were last seen at home (66%). The newspaper reports described 92 (71%) of the individuals being found. Of these, 60% were found well, 20% were found injured, and 20% were deceased. CONCLUSIONS People with dementia are at risk of becoming lost from their homes or health-care settings, and this can have catastrophic outcomes. Care strategies need to focus on promoting autonomy while ensuring adverse outcomes are minimised.
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Affiliation(s)
- Margaret MacAndrew
- The Dementia Collaborative Research Centre: Carers and Consumers, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Linda Schnitker
- The Dementia Collaborative Research Centre: Carers and Consumers, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Shepherd
- The Dementia Collaborative Research Centre: Carers and Consumers, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- The Dementia Collaborative Research Centre: Carers and Consumers, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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12
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Young Y, Papenkov M, Nakashima T. Who Is Responsible? A Man With Dementia Wanders From Home, Is Hit by a Train, and Dies. J Am Med Dir Assoc 2018; 19:563-567. [PMID: 29602644 DOI: 10.1016/j.jamda.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/08/2018] [Accepted: 02/10/2018] [Indexed: 11/19/2022]
Abstract
The impact of dementia and Alzheimer's disease extends far beyond the healthcare needs of the person with dementia. As the disease progresses, individuals with dementia often require ongoing formal or informal care for their basic daily routine because of behavior changes and continuing loss of cognitive function. Most of the care for people with dementia takes place at home, and the unpaid, informal caregivers are often spouses or other relatives. Providing long-term informal care at home for someone with dementia is psychologically, physically, and financially draining. The tragedy described in this case elucidates the far-reaching societal impact of dementia care and the implicit health policy considerations. In 2007, a 91-year-old Japanese man with dementia was in the care of his wife when he wandered from home, was hit by a train, and died, immediately affecting the Central Japan Railway Company operations and, subsequently, legal practice as well as Japanese elder care policy. The railway sued the man's wife and son for negligence and lost revenue, winning both trials at the local and district courts. This ruling shocked families and caregivers in Japan, where care for elderly parents traditionally falls on the oldest son, and brought attention to the complex issues related to dementia care. A decade later, we revisit this case to provoke a renewed dialogue about the matrix of responsibilities and liabilities associated with caregiving; to illuminate the unmet needs of the person with dementia, as well as his or her informal caregivers; and the financial implications related to long-term care policy. We close with 2 practical suggestions which preserve the dignity of the individual and provide reassurance for caregivers.
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Affiliation(s)
- Yuchi Young
- Department of Health Policy, Management, and Behavior School of Public Health, State University of New York, Rensselaer, NY.
| | - Maksim Papenkov
- Department of Economics, College of Arts and Sciences, State University of New York, Albany, NY
| | - Taeko Nakashima
- Department of Health Policy, Management, and Behavior School of Public Health, State University of New York, Rensselaer, NY; Department of Economics, Rutgers University, Camden, NJ
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13
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Kenigsberg PA, Aquino JP, Bérard A, Brémond F, Charras K, Dening T, Droës RM, Gzil F, Hicks B, Innes A, Nguyen SM, Nygård L, Pino M, Sacco G, Salmon E, van der Roest H, Villet H, Villez M, Robert P, Manera V. Assistive Technologies to Address Capabilities of People with Dementia: From Research to Practice. DEMENTIA 2017; 18:1568-1595. [PMID: 28699364 DOI: 10.1177/1471301217714093] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Assistive technologies became pervasive and virtually present in all our life domains. They can be either an enabler or an obstacle leading to social exclusion. The Fondation Médéric Alzheimer gathered international experts of dementia care, with backgrounds in biomedical, human and social sciences, to analyze how assistive technologies can address the capabilities of people with dementia, on the basis of their needs. Discussion covered the unmet needs of people with dementia, the domains of daily life activities where assistive technologies can provide help to people with dementia, the enabling and empowering impact of technology to improve their safety and wellbeing, barriers and limits of use, technology assessment, ethical and legal issues. The capability approach (possible freedom) appears particularly relevant in person-centered dementia care and technology development. The focus is not on the solution, rather on what the person can do with it: seeing dementia as disability, with technology as an enabler to promote capabilities of the person, provides a useful framework for both research and practice. This article summarizes how these concepts took momentum in professional practice and public policies in the past 15 years (2000-2015), discusses current issues in the design, development and economic model of assistive technologies for people with dementia, and covers how these technologies are being used and assessed.
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Affiliation(s)
| | | | | | | | | | - Tom Dening
- Institute of Mental Health, University of Nottingham, UK
| | - Rose-Marie Droës
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ben Hicks
- Bournemouth University Dementia Institute, UK
| | - Anthea Innes
- Salford Institute for Dementia University of Salford, Salford, United Kingdom
| | - Sao-Mai Nguyen
- Lab-STICC, Institut Mines-Télécom Bretagne, Brest, France
| | - Louise Nygård
- Department of Neurobiology, Care sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Maribel Pino
- Laboratoire Lusage, Hôpital Broca, Assistance publique-Hôpitaux de Paris, France
| | - Guillaume Sacco
- Centre Mémoire de Ressources et de Recherche, CHU de Nice; Université Côte-d'Azur, CoBTeK, Nice, France
| | - Eric Salmon
- Department of Neurology, Liège University Hospital, Belgium
| | - Henriëtte van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdaù Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marion Villez
- Laboratoire LIRTES, Université Paris-Est-Val de Marne, Créteil, France
| | - Philippe Robert
- Université Côte-d'Azur, CoBTeK, & Innovation Alzheimer Association, Nice, France
| | - Valeria Manera
- Université Côte-d'Azur, INRIA STARS & CoBTeK, Nice, France
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