First steps in designing an all-in-one ICT-based device for persons with cognitive impairment: evaluation of the first mock-up

A systematic review of reminder and guidance systems for Alzheimer's Disease and Related Dementias patients: context, barriers and facilitators

PURPOSE

To present the latest available research assessing the actual impact of reminder and guidance technologies for daily activities in Alzheimer's Disease and Related Dementia's patients, outlining design implications for these technologies.

MATERIALS AND METHODS

The search was conducted in the ACM Digital Library, IEEExplore, ScienceDirect, PubMed, Cochrane Library, Sage Journal, ResearchGate, and SemanticScholar. An iteratively-developed Boolean search string was built including up to 18 AND/OR terms across Four categories (Memory Aids, Technology, Daily Activities, Memory Impairment). We qualitatively analyzed the findings and discussions of the findings reported in 40 studies in our corpus to determine common barriers to, and facilitators of, effective intervention implementation and adoption.

RESULTS

Forty studies fulfilled the inclusion and exclusion criteria. In existing studies, individuals with Alzheimer's Disease and Related Dementias understand the usefulness of different functions that can be provided within an app to assist with everyday tasks. There was a high level of heterogeneity regarding the studies' location, duration, and evaluation methodology.

CONCLUSIONS

There is a need for assistive reminder and guidance technologies to be tailored towards autonomy, identity and personalization. Future work should include motivating features to aid during mood changes and feelings of insecurity.

Improving the Acceptability and Implementation of Information and Communication Technology-Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders

BACKGROUND

The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups.

OBJECTIVE

Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union-funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs.

METHODS

The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied.

RESULTS

This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process.

CONCLUSIONS

The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users' needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/22463.

Telecaregiving for Dementia: A Mapping Review of Technological and Nontechnological Interventions

BACKGROUND AND OBJECTIVES

Informal (or family) caregivers to older adults with Alzheimer's disease or other related dementias (ADRD) could greatly benefit from innovative telecaregiving systems that support caregiving from a distance. The objective of this review is to better understand (a) who is involved in telecaregiving and their experiences; (b) the interventions currently available to support ADRD telecaregiving; and (c) the outcomes measured to assess the effects of ADRD telecaregiving interventions.

RESEARCH DESIGN AND METHODS

A mapping review was conducted by systematically searching MEDLINE, CINAHL, Embase, and PsycINFO for all works published in English from 2002 to 2022. References of included publications were searched to identify additional empirical publications for inclusion.

RESULTS

Sixty-one publications (describing 48 studies and 5 nonstudy sources) were included in the review. Currently available information on the demographics, experiences, challenges, and benefits of ADRD telecaregivers is summarized. We found that interventions to support telecaregiving could be classified into 7 categories of technological interventions and 3 categories of nontechnological interventions. Empirical studies on ADRD telecaregiving interventions investigated a variety of outcomes, the most prevalent being user experience.

DISCUSSION AND IMPLICATIONS

We conclude that (a) the paucity of literature on telecaregiving does not allow for a comprehensive understanding of the needs and day-to-day activities of ADRD telecaregivers; (b) interventions developed to support ADRD telecaregiving may not fully meet the needs of caregivers or care recipients; and (c) there is insufficient rigorous research establishing the effects of telecaregiving interventions on key ADRD-related outcomes.

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.

Partnering a Compensatory Application with Activity-Aware Prompting to Improve Use in Individuals with Amnestic Mild Cognitive Impairment: A Randomized Controlled Pilot Clinical Trial

BACKGROUND

Compensatory aids can help mitigate the impact of progressive cognitive impairment on daily living.

OBJECTIVE

We evaluate whether the learning and sustained use of an Electronic Memory and Management Aid (EMMA) application can be augmented through a partnership with real-time, activity-aware transition-based prompting delivered by a smart home.

METHODS

Thirty-two adults who met criteria for amnestic mild cognitive impairment (aMCI) were randomized to learn to use the EMMA app on its own (N = 17) or when partnered with smart home prompting (N = 15). The four-week, five-session manualized EMMA training was conducted individually in participant homes by trained clinicians. Monthly questionnaires were completed by phone with trained personnel blind to study hypotheses. EMMA data metrics were collected continuously for four months. For the partnered condition, activity-aware prompting was on during training and post-training months 1 and 3, and off during post-training month 2.

RESULTS

The analyzed aMCI sample included 15 EMMA-only and 14 partnered. Compared to the EMMA-only condition, by week four of training, participants in the partnered condition were engaging with EMMA more times daily and using more basic and advanced features. These advantages were maintained throughout the post-training phase with less loss of EMMA app use over time. There was little differential impact of the intervention on self-report primary (everyday functioning, quality of life) and secondary (coping, satisfaction with life) outcomes.

CONCLUSION

Activity-aware prompting technology enhanced acquisition, habit formation and long-term use of a digital device by individuals with aMCI. (ClinicalTrials.gov NCT03453554).

An interactive digital calendar with mobile phone reminders (RemindMe) for people with cognitive impairment: a pilot randomized controlled trial

BACKGROUND

People with cognitive impairment often need support to perform everyday-life activities. Interventions are available, but evidence-based interventions are lacking.

AIM

This pilot RCT aimed to investigate use of an intervention with an interactive digital calendar with mobile phone reminders (RemindMe) in relation to change in outcomes and impact on occupational performance, independence, health-related quality of life, and psychosocial impact of the support for people with cognitive impairment.

METHOD

The study design was a multi-centre parallel-group pilot RCT [ClinicalTrails.gov, identifier: NCT04470219]. Fifteen participants from primary rehabilitation centres in Sweden were recruited and randomly assigned to intervention group (n = 8) receiving the intervention with RemindMe, or control group (n = 7) receiving usual treatment by an occupational therapist. Data were collected at baseline, after two- and four months, and analysed using descriptive and non-parametric statistics.

RESULT

The Canadian Occupational Performance Measure (COPM), and the Functional Independence Measure (FIM item n-r) showed significant differences. There were no significant differences in health-related quality of life nor in the psychosocial impact of the used support.

CONCLUSION

Plausible changes in outcome measures were found in COPM and FIM (items n-r). These instruments indicate change in outcome measures and impact on occupational performance and independence.

Lack of time and dependence on significant others: Occupational therapists´ experiences of prescribing time assistive technology for persons with dementia

Background: There is lack of knowledge on how occupational therapists (OTs) assess daily time management (DTM) for persons with dementia (PwDs) and on which aspects affect prescription of time assistive technology (AT).Aim: To explore OTs' experiences of assessing the need for and prescribing time AT for PwDs.Material and methods: Focus group interviews with OTs that prescribe time AT for PwDs analyzed via qualitative content analysis.Results: A main category and four categories were identified. The categories illustrated a complex and time-consuming prescription process, which was facilitated if the PwD was supported by a significant other (SO). Support from a SO was especially important during implementation and follow-up. OTs had to take individual responsibility for staying informed about time AT. Organizational limitations and time constraints were barriers for OTs striving to work according to national prescription guidelines.Conclusions and significance: High demands are made on SO's participation during the prescription process. PwDs with no support from SOs are at risk not receiving or fully benefitting from time AT. To avoid inequalities, specific forms of support need to be developed and targeted at PwDs without SOs to ensure that they have sufficient opportunities to access and use time AT.

Feasibility of an Intervention for Patients with Cognitive Impairment Using an Interactive Digital Calendar with Mobile Phone Reminders (RemindMe) to Improve the Performance of Activities in Everyday Life

The aim of this study is to increase evidence-based interventions by investigating the feasibility of an intervention using an interactive digital calendar with mobile phone reminders (RemindMe) as support in everyday life. Qualitative and quantitative data were collected from participating patients (n = 8) and occupational therapists (n = 7) from three rehabilitation clinics in Sweden. The intervention consisted of delivering the interactive digital calendar RemindMe, receiving an individualized introduction, a written manual, and individual weekly conversations for two months with follow-up assessments after two and four months. Feasibility areas of acceptability, demand, implementation, practicality, and integration were examined. Patients expressed their interest and intention to use RemindMe and reported a need for reminders and individualized support. By using reminders in activities in everyday life their autonomy was supported. The study also demonstrated the importance of confirming reminders and the possible role of habit-forming. Occupational therapists perceived the intervention to be useful at the rehabilitation clinics and the weekly support conversations enabled successful implementation. This study confirmed the importance of basing and tailoring the intervention to patients' needs and thus being person-centered.

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.

Factors Influencing the Adoption of Smart Health Technologies for People With Dementia and Their Informal Caregivers: Scoping Review and Design Framework

Background

Smart Health technologies (s-Health technologies) are being developed to support people with dementia (PwD) and their informal caregivers at home, to improve care and reduce the levels of burden and stress they experience. However, although s-Health technologies have the potential to facilitate this, the factors influencing a successful implementation in this population are still unknown.

Objective

The aim of this study was to review existing literature to explore the factors influencing PwD and their informal caregivers’ adoption of s-Health technologies for home care.

Methods

Following the Arksey and O’Malley methodology, this study is a scoping review providing a narrative description of the scientific literature on factors influencing s-Health technology adoption for PwD and their informal caregivers. A search was conducted using PubMed, the Cochrane library, the IEEE library, and Scopus. Publications screening was conducted by 2 researchers based on inclusion criteria, and full-text analysis was then conducted by 1 researcher. The included articles were thematically analyzed by 2 researchers to gain an insight into factors influencing adoption that PwD and their informal caregivers have to encounter when using s-Health technologies. Relevant information was identified and coded. Codes were later discussed between the researchers for developing and modifying them and for achieving a consensus, and the researchers organized the codes into broader themes.

Results

Emerging themes were built in a way that said something specific and meaningful about the research question, creating a list of factors influencing the adoption of s-Health technologies for PwD and their informal caregivers, including attitudinal aspects, ethical issues, technology-related challenges, condition-related challenges, and identified gaps. A design framework was created as a guide for future research and innovation in the area of s-Health technologies for PwD and their informal caregivers: DemDesCon for s-Health Technologies. DemDesCon for s-Health Technologies addresses 4 domains to consider for the design and development of s-Health technologies for this population: cognitive decline domain, physical decline domain, social domain, and development domain.

Conclusions

Although s-Health technologies have been used in health care scenarios, more work is needed for them to fully achieve their potential for use in dementia care. Researchers, businesses, and public governments need to collaborate to design and implement effective technology solutions for PwD and their informal caregivers, but the lack of clear design guidelines seems to be slowing the process. We believe that the DemDesCon framework will provide them with the guidance and assistance needed for creating meaningful devices for PwD home care and informal caregivers, filling a much-needed space in the present knowledge gap.

An Acoustic-Based Smart Home System for People Suffering from Dementia

Aging-in-place can reduce the progress of dementia syndrome and improve the quality of life of the sufferers and their families. Taking into consideration the fact that numerous neurological research results suggest the use of sound as a stimulus for empowering the memory of the sufferer, an innovative information home support system for people suffering from dementia is proposed. The innovation of the proposed system is found in its application, that is to integrate a home system for assisting with person recognition via a sound-based memory aid service. Furthermore, the system addresses the needs of people suffering from dementia to recognize their familiars and have better interaction and collaboration, without the need for training. The system offers a ubiquitous recognition system, using smart devices like smart-phones or smart-wristbands. When a familiar person is detected in the house, then a sound is reproduced on the smart speakers, in order to stimulate the sufferer’s memory. The system identified all users and reproduced the appropriate sound in 100% of the cases. To the best of the authors’ knowledge, this is the first system of its kind for assisting person recognition via sound ever reported in the literature.

Electronic memory aids for people with dementia experiencing prospective memory loss: A review of empirical studies

This paper details a review of the literature on the use of electronic aids for prospective memory for people with dementia. Key findings of the review are that: electronic memory aids show potential for supporting people’s prospective memory but the devices and software applications need further development in order to function reliably; sample sizes of studies are often very small, limiting the generalisability of their findings; few studies of devices are conducted in users’ home environments; and most of the studies focus on the effectiveness of the electronic memory aid, rather than outcomes for users, such as improved daily functioning, quality of life, or social connectedness. The review concludes that future studies with robust devices are required that explicitly focus on the varying needs and capacities of people with dementia, in order to generate additional evidence for the effectiveness of electronic memory aids for this cohort.

Sensor technology more than a support

BACKGROUND

This interview study is a part of a project that evaluated sensor technology as a support in everyday activities for patients with memory impairment.

AIM

To explore patients with memory impairment and their partners' experiences of using sensor technology in their homes.

METHODS AND MATERIAL

Five patients with memory impairment after stroke and three partners were interviewed. Individual semi-structured interviews were analyzed with qualitative content analysis.

RESULTS

Installing sensor technology with individually prerecorded voice reminders as memory support in the home had a broad impact on patients' and their families' lives. These effects were both positive and negative. The sensor technology not only supported activities but also influenced the patients by changing behavior, providing a sense of security, independence and increased self-confidence. For the partners, the sensor technology eased daily life, but also gave increased responsibility for maintenance. Technical problems led to frustration and stress for the patients.

CONCLUSION

The results indicate that sensor technology has potential to increase opportunities for persons with memory impairment to perform and participate in activities and to unburden their partners. The results may promote an understanding of how sensor technology can be used to support persons with memory impairment in their homes.