Assistive Technologies to Address Capabilities of People with Dementia: From Research to Practice

Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions

PURPOSE

Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function.

METHODS

In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users.

RESULTS

The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs' potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders' engagement, skills and teamwork.

Autonomy, independence, and participation of nursing home habitants addressed by assistive technology: a scoping review

CONTEXT

Assistive technologies have been identified by researchers and public policies of the Western world to be promising tools to face the challenge of maintaining quality of life of older people, and especially for nursing home habitants. Independence, autonomy, and participation are major determinants of quality of life of nursing homes habitants. Maintaining quality of life is nowadays a priority for public health policies and institutions of the where the population is growing older every year.

METHOD

This PRISMA-ScR review aims to determine which assistive technologies are used to promote autonomy, independence, and social participation of nursing home habitants. An electronic search was conducted for English, French articles to identify research studies using CINAHL, PubMed, Cochrane Library, PsycINFO, and Googlescholar.

RESULTS

12 papers published between 2009 and 2023 described 6 assistive technologies: technologies integrated into the environment, monitoring technologies, surveillance technologies, information and communication technology, social assistance robots, virtual reality. Six types of AT are currently used worldwide to maintain autonomy, independence and participation of people living in nursing homes. Their use is mainly perceived as positive by habitants, care and non-care staff, next of kin, and experts despite some concerns regarding ethical, financial, consideration.

DISCUSSION

Nevertheless, their impact on habitant's autonomy, independence and participation still needs to be measured using suitable tools to understand their real impact on the quality of life of the elderly.

Virtual reality-based dementia educational programmes for formal and informal caregivers of people with dementia: A scoping review

AIM

To map evidence of the existing virtual reality-based dementia educational programmes and the effects of these educational programmes on dementia formal and informal caregivers.

DESIGN

A scoping review.

METHODS

A comprehensive search of nine databases was conducted to find studies from the inception of the databases to October 2023. Two authors independently screened the titles and abstracts related to the eligibility criteria. Full texts of potentially relevant studies were read by one author and checked by a second. Data extraction and synthesis using NVivo 12 were undertaken by one author and checked by two other authors.

RESULTS

Nineteen studies published between 2002 and 2022. The four randomised controlled studies and five qualitative studies were of moderate to good methodological quality. The 10 quasi-experimental studies were of weak to moderate quality. Fifteen virtual reality-based educational programmes had a positive influence on formal and informal caregivers, including improving caregivers' perceptions changing attitudes towards people with dementia, while the nursing competence of formal caregivers did not improve in short term. Educational programmes that covered dementia-related information and care strategies better improved the knowledge level of dementia formal and informal caregivers.

CONCLUSIONS

The qualitative and quantitative studies of moderate to good quality included in this study support the idea that virtual reality-based dementia educational programmes may be a safe and effective way and have potential benefits for improving knowledge, perceptions, attitudes and nursing competence.

IMPACT

This scoping review will provide an emerging teaching model for formal and informal caregivers of people with dementia and help them better understand the types and the influence of virtual reality-based dementia educational programmes.

REPORTING METHOD

PRISMA-ScR.

NO PATIENT OR PUBLIC CONTRIBUTION

Not required as this review in accordance with the aim to map existing literature from the dementia formal and informal caregivers' perspective.

Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations

OBJECTIVES

To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs).

METHODS

Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context.

RESULTS

Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually.

CONCLUSION

Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.

Daily time management in dementia: qualitative interviews with persons with dementia and their significant others

BACKGROUND

Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.

METHOD

Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.

RESULTS

A main category "Support by significant others is always part of daily time management", and three categories "Facing new challenges", "Using strategies to handle changes", and "Time assistive technology in daily life" illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.

CONCLUSIONS

Time-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

Remote Monitoring of Physiology in People Living With Dementia: An Observational Cohort Study

BACKGROUND

Internet of Things (IoT) technology enables physiological measurements to be recorded at home from people living with dementia and monitored remotely. However, measurements from people with dementia in this context have not been previously studied. We report on the distribution of physiological measurements from 82 people with dementia over approximately 2 years.

OBJECTIVE

Our objective was to characterize the physiology of people with dementia when measured in the context of their own homes. We also wanted to explore the possible use of an alerts-based system for detecting health deterioration and discuss the potential applications and limitations of this kind of system.

METHODS

We performed a longitudinal community-based cohort study of people with dementia using "Minder," our IoT remote monitoring platform. All people with dementia received a blood pressure machine for systolic and diastolic blood pressure, a pulse oximeter measuring oxygen saturation and heart rate, body weight scales, and a thermometer, and were asked to use each device once a day at any time. Timings, distributions, and abnormalities in measurements were examined, including the rate of significant abnormalities ("alerts") defined by various standardized criteria. We used our own study criteria for alerts and compared them with the National Early Warning Score 2 criteria.

RESULTS

A total of 82 people with dementia, with a mean age of 80.4 (SD 7.8) years, recorded 147,203 measurements over 958,000 participant-hours. The median percentage of days when any participant took any measurements (ie, any device) was 56.2% (IQR 33.2%-83.7%, range 2.3%-100%). Reassuringly, engagement of people with dementia with the system did not wane with time, reflected in there being no change in the weekly number of measurements with respect to time (1-sample t-test on slopes of linear fit, P=.45). A total of 45% of people with dementia met criteria for hypertension. People with dementia with α-synuclein-related dementia had lower systolic blood pressure; 30% had clinically significant weight loss. Depending on the criteria used, 3.03%-9.46% of measurements generated alerts, at 0.066-0.233 per day per person with dementia. We also report 4 case studies, highlighting the potential benefits and challenges of remote physiological monitoring in people with dementia. These include case studies of people with dementia developing acute infections and one of a person with dementia developing symptomatic bradycardia while taking donepezil.

CONCLUSIONS

We present findings from a study of the physiology of people with dementia recorded remotely on a large scale. People with dementia and their carers showed acceptable compliance throughout, supporting the feasibility of the system. Our findings inform the development of technologies, care pathways, and policies for IoT-based remote monitoring. We show how IoT-based monitoring could improve the management of acute and chronic comorbidities in this clinically vulnerable group. Future randomized trials are required to establish if a system like this has measurable long-term benefits on health and quality of life outcomes.

Using digital technologies to facilitate social inclusion during the COVID-19 pandemic: Experiences of co-resident and non-co-resident family carers of people with dementia from DETERMIND-C19

BACKGROUND

The COVID-19 pandemic triggered rapid and unprecedented changes in the use of digital technologies to support people's social inclusion. We examined whether and how co-resident and non-co-resident family carers of people with dementia engaged with digital technologies during this period.

METHODS

Throughout November 2020-February 2021, we interviewed 42 family carers of people with dementia from our DETERMIND-C19 cohort. Preliminary analysis was conducted through Framework analysis, followed by an inductive thematic analysis.

FINDINGS

Digital technologies served as a Facilitator for social inclusion by enabling carers to counter the effects of the differing restrictions imposed on them so they could remain socially connected and form a sense of solidarity, access resources and information, engage in social and cultural activities and provide support and independence in their caring role. However, these experiences were not universal as carers discussed some Challenges for tech inclusion, which included preferences for face-to-face contact, lack of technological literacy and issues associated with the accessibility of the technology.

CONCLUSION

Many of the carers engaged with Information and Communication Technologies, and to a lesser extent Assistive Technologies, during the pandemic. Whilst carers experienced different challenges due to where they lived, broadly the use of these devices helped them realise important facets of social inclusion as well as facilitated the support they provided to the person with dementia. However, to reduce the 'digital divide' and support the social inclusion of all dementia carers, our findings suggest it is essential that services are attuned to their preferences, needs and technological abilities.

Care home practitioners’ perceptions of the barriers and facilitators for using off-the-shelf gaming technology with people with dementia

Background: Off-the-shelf digital gaming technology has been shown to support the well-being of people with dementia. Yet, to date, it is rarely adopted within dementia care practice, particularly within care homes. Drawing on a descriptive, qualitative approach, this is the first study that has sought to explore care home practitioners’ perceptions of the barriers and facilitators for using gaming technology within their workplace. Method: Data were collected across eight focus groups in the south of England with a total of 39 care home workers. These were analysed inductively following the 6-stage thematic process as outlined by Braun and Clarke (2006). Findings: Three themes, constructed from the data suggested, the care environment, staff knowledge and skills for inclusive gaming, and staff perceptions about capabilities (their own and those of people with dementia) inhibited or facilitated the use of gaming technology in care homes. The findings were interpreted through a combination of the Capability, Opportunity, Motivation and Behaviour model and the Theoretical Domains Framework to provide theory-based insights into the mechanisms for supporting behaviour change and implementation within the care home context. Conclusions: We argue for the need to target wider institutional barriers alongside providing inclusive training for care staff on incorporating gaming technology within their person-centred care approaches. Through these mechanisms, they can be provided with the capabilities, opportunities and motivation to integrate gaming technology within their practice, and thus facilitate the process of culture change within care homes.

Exploring Adoption and Satisfaction with Self-Service Health Technology in Older Age: Perspectives of Healthcare Professionals and Older People

(1) Background. A range of self-service technologies (SST) have been adapted to support the health of older people. Factors involved in older people’s and health professionals’ perceptions of SST in older age were investigated. (2) Methods. Customer Dominant Logic guided this prospective mixed-methods study, including surveys with people 70 years and over and health professionals and individual semi-structured interviews in a sample of survey respondents. Survey data were descriptively analysed, while interview themes were derived inductively. (3) Results. Surveyed (n = 12) people 70 years and over placed higher value, expressed more positive user experience, were more satisfied and had greater recognition of the benefits of SST, compared with (n = 10) health professionals (p = 0.001), who considered them to be inferior to traditional healthcare. All seven interviewees agreed that despite accessibility issues and complexity, they valued SST support of older people’s health, thereby confirming the relevance of Customer Dominant Logic in SST offerings. (4) Conclusions. Since older participants were positive and satisfied in using SSTs that are health-supporting, health professionals have a role in encouraging and assisting older people in their use. This requires targeted SST education for health professionals, and more accessible, user-friendly SST and technological support for older people.

Personal and complex: The needs and experiences related to technology use for people living with dementia

BACKGROUND

With increasing focus on living well with dementia, technology has been identified as having potential benefits for safety, independence and wellbeing. Despite a large growth in specialised technology development, there has been limited uptake. There is a need to understand the current use and needs related to technology for people living with dementia and their care partners (informal carers).

METHODS

As part of a participatory design study, a qualitative inquiry into technology experiences and needs was undertaken within an interpretive description approach. A cross-disciplinary team including living experience experts (people living with dementia, unpaid care partners) was involved. Semi-structured interviews, including sharing technology locations and supports, were conducted, audio-recorded and transcribed. Key aspects of the technology use experience were constructed.

FINDINGS

Thirteen people living with dementia and 21 care partners participated in the study. Two core aspects of technology use were identified: Lots of moving parts: the complex context, and A technology cycle: the use and non-use. The findings indicated that the context involved an individual configuration of multiple factors including the user, their technology identity, their supporters, the technology and the environment. The experience is underpinned by shifting foundations created by constantly changing technologies and user characteristics. The cycle of use and non-use identified the processes required to maintain technology engagement.

CONCLUSION

The use of technology for people living with dementia is complex and personal. Future technology development, policies and practices need to consider this complexity and the effort required to keep using technology to realise the benefits.

Remind Me To Remember: A pilot study of a novel smartphone reminder application for older adults with dementia and mild cognitive impairment

The SmartPrompt is a smartphone-based reminder application informed by a neuropsychological model of functional disability. This laboratory-based pilot study examined the SmartPrompt feasibility, efficacy, and subjective usability using a within-participant, counterbalanced, cross-over design. Ten participants (M age = 80.3 + 8.2; M education = 15.7 + 2.5; 60% female) with mild cognitive impairment or mild dementia completed the Remember to Drink Test, which required preparing a glass of water at four predetermined times, in a SmartPrompt (SP) and Unprompted condition (UP). Written cues and a clock were available in both conditions; however, in the SP, the smartphone presented auditory alarms and visual reminders to obtain the water at specified times and required photo logging. In a separate session, caregivers were trained and tested on configuring the SmartPrompt. Overall, caregivers and participants learned to effectively use the SmartPrompt. Caregivers achieved near-perfect scores on the configuration quiz and responded well to training. Participants completed significantly more Remember to Drink tasks in the SP (93%) than UP (56%); checking the cues/clock decreased by 87% in the SP. Usability ratings were excellent among caregivers and fair among participants. Results indicate that the SmartPrompt holds promise for reducing functional disability in older adults with cognitive difficulties in at-home contexts.

Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks

Background

Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions.

Methods

Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined.

Results

Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others.

Conclusions

Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants’ needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.

Empowerment for people living with dementia: An integrative literature review

BACKGROUND AND OBJECTIVES

Although the concept of empowerment seems useful for good care and support for people living with dementia, there is a lack of understanding of the process of empowerment. Therefore, more insight is needed into the concept of empowerment, and the environment's role in the empowerment process.

RESEARCH DESIGN AND METHODS

We performed an integrative literature review (PubMed, CINAHL, PsychINFO), including studies that addressed empowerment for people living with dementia in their title or abstract. Using qualitative data analysis software ATLAS.ti, we applied open codes to describe all relevant aspects of included articles. Common themes and categories were identified using inductive reasoning and constant comparison.

RESULTS

Sixty-nine articles were included. We identified four themes: (1) description of the state of being empowered, (2) the process of empowerment, (3) contribution of the environment to the empowerment process, and (4) effects on other variables. We combined these results with the conceptual framework of our previous qualitative study on the definition of empowerment for people living with dementia based on stakeholders' perspectives. Subsequently, the combined information of both studies was visualized in a revised conceptual framework.

DISCUSSION AND IMPLICATIONS

This literature review provides more details as to the role of the environment for empowerment of people living with dementia and suggests that empowerment can be considered a dynamic process, taking place through interaction between the person living with dementia and their environment. Our revised conceptual framework of empowerment can serve as a basis for future studies on empowerment for people living with dementia, and to support (in)formal caregivers in the empowerment process.

Towards a Human Capabilities Conscious Enterprise Architecture

This conceptual paper argues that enterprise architecture (EA) should move towards a conscious human-centered conception of the enterprise. Employing the conceptual methodological approach of theory synthesis and drawing on the extant literature in enterprise architecture as well as pertinent social and organizational theories, we suggested foundational propositions that could holistically serve as a theoretical lens for (re)viewing the foundations of EA within a progressive conscious enterprise agenda. The novel contribution of the paper is the introduction of human capabilities approach (HCA) as a method theory, to supplement systems and stakeholder theories, for design and evaluation of enterprise architecture in the modern enterprise. The paper concludes by showing the implications of the propositions for practitioners and researchers.

Developing practice standards for engaging people living with dementia in product design, testing, and commercialization - a case study

 AbstractTo successfully create assistive technologies for persons with dementia, product developers must understand the capacity of people with dementia to use these technologies. Capacity assessment is typically done through user experience research. However, the published literature is bereft of guidelines to conduct optimal user experience research in samples of persons with dementia.We recruited persons with dementia from community-based organizations and private partners to participate in user experience research for an assistive technology platform. After a testing session, we used semi-structured interviews to ask participants about their involvement in the user experience process. We employed an inductive thematic approach to analyze the interview transcripts and draft guidelines to meaningfully engage persons with dementia in user experience research in the future.Ten participants with mild to moderate dementia (6 females, 4 males) participated in the study. Nine participants had previous experience with mobile devices. Thematic analysis yielded three overarching themes: 1) the techniques, approaches and attributes of the interviewer; 2) participants' views on being part of the user experience research process; and 3) specific items to optimize the research process. Resulting guidelines were divided into recommendations for the interviewer specifically, and for the broader research process.

Taking ‘A walk through dementia’: exploring care home practitioners’ experiences of using a virtual reality tool to support dementia awareness

Emerging research has outlined the possibility for virtual reality (VR) experiences, which situate users into the perspective of someone living with dementia, to enhance dementia awareness. Currently, there is limited VR research that engages care home practitioners. It is imperative this population has high levels of dementia education given their requirements to provide care and support to residents, many of whom will be living with the condition. This paper reports on an exploratory qualitative study designed to elicit the experiences of care home practitioners who engaged with the VR application: ‘A walk through dementia’. Twenty practitioners, across four care homes in the United Kingdom, watched the VR scenarios and provided their views on the experience and the potential for the VR tool to be developed into a wider training programme to support dementia awareness. Data were collected via focus group discussions. Following an inductive thematic analysis, we constructed three themes. These suggested participants perceived the VR application offered them a convincing and immersive experience that was insightful and evocative, and provided ‘next-level’ dementia-awareness training that enabled them to reflect on care practices. Although the findings highlight important challenges for practitioners and developers wishing to use VR within dementia care, they suggest this application may be an engaging experiential learning tool that can provide care home staff with deeper cognitive and emotional awareness of living with dementia. Further work, drawing on these preliminary insights, is required to ensure the VR tool can be incorporated into a training programme that can positively contribute to the ‘dementia-friendly communities’ agenda.

Comprehensible instructions from assistive robots for older adults with or without cognitive impairment

The purpose of this study was to reveal comprehensible instructions from an assistive robot for older adults, across cognitive levels and characteristics. Participants included 19 older adults with or without cognitive impairment. We administered cognitive tests assessing all major domains (e.g., memory and attention). Participants were required to listen to robot instructions carefully, and perform three activities of daily living (e.g., taking medicine) with three different types of instructions. In instruction pattern 1 (IP1), the robot informed seniors of the task in one sentence, while in instruction patterns 2 and 3 (IP2 and IP3), the steps of each activity were split into two and three sentences, respectively. Participants with lower cognitive level showed lower task performance with IP1, whereas almost all participants completed tasks with IP2 and IP3. Cognitive domains such as working memory significantly affected task performances. Participants with lower attention made mistakes in taking their medicine. The results imply that step-by-step instructions should be used for older people with lower levels of cognitive function, especially working memory, and repeated instructions may be required for lower attention. Types of instruction should be selected depending on cognitive characteristics.

Self-management and cognitive rehabilitation in early stage dementia - merging methods to promote coping and adoption of assistive technology. A pilot study

Objectives: It is essential to develop interventions that meet individual needs for coping and self-management of people with dementia. This study explored the feasibility and applicability of an intervention merging methods of cognitive rehabilitation and self-management groups for people with early stage dementia. The potential of this intervention to promote adoption of assistive technology was also explored.Method: People with early stage Alzheimer's disease (N = 19) participated in the programme comprising both individual and group sessions. Caregivers were involved in the individual session and a separate group meeting. The intervention both addressed individual goals and more general self-management approaches. In addition, both participants and caregivers were introduced to the ReACT app, a holistic solution tailormade to meet self-management needs of people with early stage dementia.Results: There was significant improvement in the participants' attainment of individual goals and satisfaction with goal attainment from pre- to post-intervention. Participants and caregivers generally reported a positive attitude towards the intervention, attendance rate was high, and all participants completed the intervention. Qualitative results also indicated that the intervention promoted awareness, acceptance and coping among participants. The specific benefits of using the ReACT app for self-management were also emphasised. Forty-two percent of the participants adopted the app and continued using it after completing the intervention.Conclusion: Results from this pilot study indicated that the intervention is both feasible and applicable and can be an effective method to promote coping and adoption of assistive technology among people with early stage dementia.

Prioritizing Benefits: A Content Analysis of the Ethics in Dementia Technology Policies

BACKGROUND

As the global prevalence of dementia rises, care costs impose a large burden on healthcare systems. Technology solutions in dementia care have the potential to ease this burden. While policies exist to guide and govern the use of dementia care technologies, little is known about how ethical considerations are incorporated into these documents.

OBJECTIVE

The goal of this study was to examine ethics-related content in dementia care technology policies.

METHODS

We used a two-step data mining approach to collect a sample of dementia technology policies. Policy documents were analyzed using emergent content analysis. Following the coding of the sample, thematic categories were organized using the principles of biomedical ethics as a framework.

RESULTS

A total of 23 policy documents from four Alzheimer associations in four countries were included in our analysis. General ethics considerations and themes related to beneficence were mentioned in 96% of the documents. Thematic categories related to justice were present in 74% of the sample, themes related to non-maleficence appeared in 52% of documents, and themes related to autonomy appeared in 43% of the sample.

CONCLUSION

While ethical considerations are present in existing policies for dementia care technology, these considerations revolve primarily around the benefit of the technologies. Further efforts are needed to provide formal guidance that incorporates both benefits and potential harms.

Evaluating the Facilitators, Barriers, and Medical Outcomes Commensurate with the Use of Assistive Technology to Support People with Dementia: A Systematic Review Literature

Background: Assistive technologies (AT) have been used to improve the daily living conditions of people living with dementia (PWD). Research supports the positive impact of the use of AT such as decreased burden on caregivers and behavioral support for people with dementia. Four reviews in the last six years have analyzed AT and PWD, but none have incorporated the dimension of medical outcomes. Objectives: The purpose of this review is to identify the facilitators, barriers, and medical outcomes commensurate with the use of AT with PWD. Method: This review queried The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, and PubMed databases for peer-reviewed publications in the last five years for facilitators, barriers, and medical outcomes commensurate with the use of AT with PWD. The study is reported and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Kruse Protocol for conducting a systematic review. Results: 48 studies were analyzed. Fourteen types of AT, 17 facilitators, 17 barriers, and 16 medical outcomes were identified in the literature. The two most frequently mentioned ATs were cognitive stimulators (9/48, 19%) and social robots (5/48, 10%). The two most frequently mentioned facilitators were caregivers want AT (8/68, 12%) and enables increased independence (7/68, 10%). The top two barriers were cost (8/75, 11%) and PWD reject AT (8/75, 11%). The top medical outcomes were improved cognitive abilities (6/69, 9%), increased activities of daily living (ADLs), and increased autonomy (each at 5/69, 7%): Zero negative outcomes were reported. Conclusion: The systematic review revealed the positive relations that occur when PWD and their caregivers use AT. Although many reservations surrounding the use of AT exist, a majority of the literature shows a positive effect of its use. Research supports a strong support for AT by caregivers due to many positive medical outcomes, but also a reticence to adopt by PWD. If ATs for PWD are a way to reduce stress on caregivers, barriers of cost and complexity need to be addressed through health policy or grants.

Do you observe what I perceive? The relationship between two perspectives on the ability of people with cognitive impairments to use everyday technology

Objectives: Everyday technologies (ETs) can be challenging to use, particularly for older adults with cognitive impairments. This study evaluated the relationship between the self-perceived ability to use ET and observable performance of self-chosen and familiar, but challenging ETs in people with mild cognitive impairment (MCI) or dementia.Method: A self-perceived report, the Everyday Technology Use Questionnaire (S-ETUQ), and a structured observational tool, the Management of Everyday Technology Assessment (META), assessing the perceived and observed ability to use ET, were used in 41 people with MCI and 38 people with dementia. Correlations were investigated with non-parametric statistical tests.Results: In the dementia group, self-perceived report and observational scores correlated on a significant medium level (R_s=0.44, p = 0.006). In the MCI group, no significant correlation was found.Conclusion: The findings of this study suggest the ability of older adults with cognitive impairments to use ETs can be depicted with self-perceived reports as well as with observations. However, the combination of both approaches is recommended to get a comprehensive picture. While the S-ETUQ provides a broad picture of the use, presence and relevance of technologies in an individual's life, the META describes a specific human-technology interaction in detail. Furthermore, the results suggest people with early dementia retain the ability and insight to accurately reflect on their own ability to use ET, emphasizing the need to include their experiences in research and clinical work.

Assistive technology designed to support self-management of people with dementia: user involvement, dissemination, and adoption. A scoping review

BACKGROUND

Assistive technology is advocated as a key solution to the need for support among people living with dementia. There is growing awareness of the benefits of user involvement in the design and test of these technologies and the need to identifying applicable and effective methods for implementation. The aim of this review was to explore and synthesize research addressing assistive technology designed to be used by people with dementia for self-management. Further research aims were to explore if and how user involvement, dissemination, and adoption of assistive technology were addressed.

METHOD

Electronic databases were searched using specified search terms. Key publications and grey literature sources were hand-searched. Materials published until year end 2018 were included. The results were summarized according to the research aims.

RESULTS

Eleven papers derived from eight studies were included. The studies presented data from prototype design and testing, and the review showed great variation in study scope, design, and methodology. User involvement varied from extensive involvement to no user involvement. Methods for adoption also varied widely and only targeted prototype testing. None of the studies addressed dissemination.

CONCLUSION

The results of this review underline the need for well-designed high-quality research into all the aspects that are essential to deliver applicable, effective, and sustainable assistive technology to support self-management of people with dementia. There is a need for evidence-based methods to promote and qualify user involvement, dissemination, and adoption. The results also point to the need for standardized outcome measures and standards for conducting and reporting research to improve its quality and impact.

People with dementia and carers online discussing surveillance

Purpose

This paper aims to interrogate online comments from consumers with dementia and family carers on surveillance technology products used by or for people with dementia.

Design/methodology/approach

A naturalistic, observational study of qualitative posts (N = 120) by people with dementia (n = 7) and family carers (n = 38) to discussion threads on surveillance technology (ST), hosted by an online dementia support forum in the Netherlands. Kozinet’s (2002) typology was used to describe respondent characteristics, and comments on features of ST products were analysed within a pre-existing framework.

Findings

Forum users were mainly “tourists” interested in ST, with some “insiders” interested in sharing experiences of ST use. They expressed a lack of trust in information from marketers and providers to the experience of being provided with poor information. Consumer-to-consumer comments on products triangulated with previous face-to-face qualitative studies. Carers prioritised “peace of mind” through location monitoring. In contrast, people with dementia prioritised user-friendliness (simple, with capability and compatible with daily routines).

Practical implications

Using online discussions of ST products provides a rapid approach to understanding current consumer needs and preferences in the ever-changing world of technology.

Originality/value

No previous study is known to have explored the views of carers and people with dementia in online discussions about ST.

A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns

Background

Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption.

Objective

This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention.

Methods

The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days.

Results

Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters.

Conclusions

For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.

Designing the ReACT App to Support Self-Management of People with Dementia: An Iterative User-Involving Process

BACKGROUND

Assistive technology (AT) has the potential to support and enhance self-management of people living with dementia. However, a range of special and heterogeneous needs must be considered when designing and deploying AT for people with dementia, and consequently the involvement of end-users throughout the design process is essential to provide usable and effective AT solutions.

OBJECTIVE

The ReACT study was conducted to investigate how a tailor-made app, the ReACT app, can be designed and deployed to meet the needs of people with dementia in relation to self-management.

METHODS

This paper presents 4 steps of an iterative user-involving app design process. In the first step, a pilot study was conducted to explore the potential benefits and challenges of using existing off-the-shelf apps to support self-management when living with early-stage dementias. In the second step, focus group interviews provided in-depth understanding of the perspectives and needs of potential end-users of the app. The third step was a product benchmarking process, which served to further qualify the design process. Finally, results from these first 3 steps were included in the fourth step where the ReACT app was designed through an iterative codesign process. In total, 28 people with dementia, 17 family caregivers, and 10 professional caregivers were involved through these 4 iterative steps.

RESULTS

The functionalities and the design of the ReACT app directly reflect the perspectives and needs of end-users in relation to self-management. Support of memory and structure in daily living were identified as main needs, and the ReACT app was designed as a holistic and adaptable solution with a tailor-made calendar as a key feature.

CONCLUSION

Based on this extensive iterative user-involving design process, the ReACT app has great potential to support and enhance self-management of people living with dementia. Further studies are needed to test and validate the usability and impact of the app, and methods for deployment and adoption of AT for people with dementia also need to be considered.

A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial

Background

It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement.

Objective

This study uses a pilot randomized controlled trial (RCT) design to evaluate the SSA. The objectives were to ascertain (1) the feasibility and utility of the SSA, (2) whether the outcomes of SSA use suggest potential benefits for persons living with memory loss and their care partners, and (3) how study design components could inform subsequent RCTs.

Methods

Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey.

Results

Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations.

Conclusions

There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation.

Trial Registration

ClinicalTrials.gov NCT03645694; https://clinicaltrials.gov/ct2/show/NCT03645694 (Archived by WebCite at http://www.webcitation.org/78dcVZIqq)

A neurological and philosophical perspective on the design of environments and technology for older people with dementia

Purpose

Older people with dementia (OPD) have specific housing and technology-related needs, for which various design principles exist. A model for designing environments and its constituting items for people with dementia that has a firm foundation in neurology may help guide designers in making design choices. The paper aims to discuss these issues.

Design/methodology/approach

A general design model is presented consisting of three principles for OPD, namely designing for ageing people; designing for a favourable state and designing for beautiful moments. The neurosciences as a whole give shape to an eminent framework explaining the behaviour of OPD. One of the objectives of this paper is to translate the design principles into design specifications and to show that these specifications can be translated in a design.

Findings

Philosophical concepts are introduced which are required to understand design for OPD. Four case studies from Dutch nursing homes are presented that show how the theory of modal aspects of the philosopher Dooyeweerd can be used to map design specifications in a systematic way.

Research limitations/implications

These examples of design solutions illustrate the applicability of the model developed in this article. It emphasises the importance of the environment for supporting the daily life of OPD.

Originality/value

There is a need for a design model for OPD. The environment and technology should initiate positive behaviours and meaningful experiences. In this paper, a general model for the designing of environments for OPD was developed that has a firm foundation in neurology and behavioural sciences. This model consists of six distinct steps and each step can be investigated empirically. In other words, this model may lay the foundation for an evidence-based design.

Technological Solutions for Older People with Alzheimer's Disease: Review

In the nineties, numerous studies began to highlight the problem of the increasing number of people with Alzheimer's disease in developed countries, especially in the context of demographic progress. At the same time, the 21st century is typical of the development of advanced technologies that penetrate all areas of human life. Digital devices, sensors, and intelligent applications are tools that can help seniors and allow better communication and control of their caregivers. The aim of the paper is to provide an up-to-date summary of the use of technological solutions for improving health and safety for people with Alzheimer's disease. Firstly, the problems and needs of senior citizens with Alzheimer's disease (AD) and their caregivers are specified. Secondly, a scoping review is performed regarding the technological solutions suggested to assist this specific group of patients. Works obtained from the following libraries are used in this scoping review: Web of Science, PubMed, Springer, ACM and IEEE Xplore. Four independent reviewers screened the identified records and selected relevant articles which were published in the period from 2007 to 2018. A total of 6,705 publications were selected. In all, 128 full papers were screened. Results obtained from the relevant studies were furthermore divided into the following categories according to the type and use of technologies: devices, processing, and activity recognition. The leading technological solution in the category of devices are wearables and ambient noninvasive sensors. The introduction and utilization of these technologies, however, bring about challenges in acceptability, durability, ease of use, communication, and power requirements. Furthermore, it needs to be pointed out that these technological solutions should be based on open standards.

A general neurologist's perspective on the urgent need to apply resilience thinking to the prevention and treatment of Alzheimer's disease

The goal of this article was to look at the problem of Alzheimer's disease (AD) through the lens of a socioecological resilience-thinking framework to help expand our view of the prevention and treatment of AD. This serious and complex public health problem requires a holistic systems approach. We present the view that resilience thinking, a theoretical framework that offers multidisciplinary approaches in ecology and natural resource management to solve environmental problems, can be applied to the prevention and treatment of AD. Resilience thinking explains a natural process that occurs in all complex systems in response to stressful challenges. The brain is a complex system, much like an ecosystem, and AD is a disturbance (allostatic overload) within the ecosystem of the brain. Resilience thinking gives us guidance, direction, and ideas about how to comprehensively prevent and treat AD and tackle the AD epidemic.