Stakeholder Requirements for an Ethical Framework to Sustain Multiple Research Projects in an Emerging Living Lab Involving Older Adults

How to deal with the consent of adults with cognitive impairment involved in European geriatric living labs?

BACKGROUND

Living labs are realistic environments designed to create links between technology developers and end-users (i.e. mostly older adults). Research in LLH (Living labs in health) covers a wide range of studies from non-interventional studies to CT (clinical trials) and should involve patients with neurocognitive disorders. However, the ethical issues raised by the design, development, and implementation of research and development projects in LLH have been the subject of only little interest thus far.

OBJECTIVE

Our aim was to determine a pragmatic, ethical and regulatory correct approach to seek the informed consent of patients with neurocognitive disorders according to the different types of studies carried out in European LLH, with a focus on the French context.

METHODS

A narrative review of regulatory texts and clinical articles was conducted, and a pragmatic procedure to determine the decision-making capacity of older adults in LLH was proposed.

RESULTS

Individuals must be adequately informed and freely agree to participate in CT. The capacity to consent should be assessed in CT including cognitively impaired older adults. We propose the following steps: first to assess for delirium using the 4 'A's Test (4AT) or the 3-min Diagnostic interview for Confusion Assessment Method (3D-CAM), second to search for medical history of major neurocognitive disorder, and third to assess the decision capacity using the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC).

CONCLUSIONS

Including individuals with neurocognitive disorders in research implies using an efficient and pragmatic strategy to inform participants and obtain their consent. The tool we offer here may be useful in the routine operation of LLH but can also be extended to all CT with this population.

Living Senior Labs, ecosistemas de co-creación e innovación abierta con personas mayores: revisión sistemática de la literatura en Ciencias Sociales

Los Living Labs son experiencias colaborativas que buscan implicar a la ciudadanía en la gobernanza científica y la evaluación de tecnologías. A pesar de su interés, se sabe muy poco sobre estas comunidades, su funcionamiento, tipología y características. Por ello, se realizó una revisión sistemática de la literatura sobre de un tipo particular de Living Lab, orientado hacia las personas mayores: los Living Senior Labs. A partir de una búsqueda general en las principales bases de datos científicas (WOS y Scopus), y de la aplicación de criterios de inclusión preestablecidos tras la primera selección quedaron finalmente seleccionados 19 estudios sobre Senior Labs (2010 y 2021). Los resultados proporcionan un mejor conocimiento de este tipo de ecosistemas y crean una base firme para avanzar en el conocimiento de este campo.