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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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Schneider C, Nißen M, Kowatsch T, Vinay R. Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review. BMJ Open 2024; 14:e080545. [PMID: 38341210 PMCID: PMC10862336 DOI: 10.1136/bmjopen-2023-080545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Digital assistive technologies (DATs) have emerged as promising tools to support the daily life of people with dementia (PWD). Current research tends to concentrate either on specific categories of DATs or provide a generic view. Therefore, it is of essence to provide a review of different kinds of DATs and how they contribute to improving quality of life (QOL) for PWD. DESIGN Scoping review using the framework proposed by Arksey and O'Malley and recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. DATA SOURCES Cochrane, Embase, PubMed, Scopus and Web of Science (January 2013 to May 2023). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Completed scientific literature with a primary focus on DATs for PWD, perspectives of caregivers, family members or healthcare workers in relation to a PWD, people living in diverse settings and all severities of dementia. DATA EXTRACTION AND SYNTHESIS Screening and data extraction were conducted, followed by quantitative and qualitative analyses using thematic analysis principles and Digital Therapeutics Alliance categories for DAT grouping. RESULTS The literature search identified 6083 records, with 1056 duplicates. After screening, 4560 full texts were excluded, yielding 122 studies of different designs. The DATs were categorised into digital therapeutics (n=109), patient monitoring (n=30), digital diagnostics (n=2), care support (n=2) and health system clinical software (n=1). These categories were identified to impact various aspects of QOL: preserving autonomy, engagement, and social interaction, health monitoring and promotion, improving activities of daily living, improving cognition, maintaining dignity, managing behavioural and psychological symptoms of dementia and safety/surveillance. CONCLUSIONS Various DATs offer extensive support, elevating the QOL of PWD. Digital therapeutics are predominantly used for ageing-in-place and independent living through assistance with daily tasks. Future research should focus on less-represented digital health technology categories, such as care support, health & wellness or software solutions. Observing ongoing DAT developments and their long-term effects on QOL remains essential.
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Affiliation(s)
- Charlotte Schneider
- Department of Management, Technology and Economics, ETH Zürich, Zurich, Switzerland
| | - Marcia Nißen
- University of St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Department of Management, Technology and Economics, ETH Zürich, Zurich, Switzerland
- Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Rasita Vinay
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Barbosa A, Ferreira AR, Smits C, Hegerath FM, Vollmar HC, Fernandes L, Craven MP, Innes A, Casey D, Sezgin D, Hopper L, Øksnebjerg L. Use and uptake of technology by people with dementia and their supporters during the COVID-19 pandemic. Aging Ment Health 2024; 28:83-94. [PMID: 36650751 DOI: 10.1080/13607863.2022.2163375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This rapid review aims to identify the types of technologies used by people with dementia and their supporters during the COVID-19 pandemic, and the issues which influenced technology adoption within their usual care routines. METHODS PubMed, PsychInfo, Scopus, and Cochrane COVID reviews were searched to identify peer-review studies published since 2020. A total of 18 studies were included and synthesised thematically. RESULTS Of these, most were conducted in the community (n = 15) with people with dementia only (n = 11) and involved qualitative methods (n = 11). The majority (n = 12) focused on digital off-the-shelf and low-cost solutions, such as free video conferencing platforms, to access care, socialise or take part in interventions. Whilst often well-accepted and associated with positive outcomes (such as improved social connectedness), lack of digital literacy or support to use technologies, limited access to appropriate technology, individuals' physical, cognitive, or sensory difficulties, were highlighted and likely to threaten the adoption of these solutions. The quality of the evidence was mixed, neither very robust nor easily generalisable which may be attributed to the challenges of conducting research during the pandemic or the need to rapidly adapt to a new reality. CONCLUSION While COVID-19 has fast-tracked the adoption of technology, its use is likely to continue beyond the pandemic. We need to ensure this technology can leverage dementia support and care and that people with dementia are enabled and empowered to use it.
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Affiliation(s)
- Ana Barbosa
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Ana Rita Ferreira
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carolien Smits
- Dutch Centre of Expertise on Health Disparities, Pharos Expertise Centre on Health Disparities, Utrecht, Netherlands
| | - Flora-Marie Hegerath
- Institute of General Practice and Family Medicine, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Michael P Craven
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Anthea Innes
- Department Health, Aging and Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Dympna Casey
- School of Nursing and Midwifery, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Laila Øksnebjerg
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Hill JR, Min EE, Abebe E, Holden RJ. Telecaregiving for Dementia: A Mapping Review of Technological and Nontechnological Interventions. THE GERONTOLOGIST 2024; 64:gnad026. [PMID: 36919597 PMCID: PMC10733214 DOI: 10.1093/geront/gnad026] [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: 08/29/2022] [Indexed: 03/16/2023] Open
Abstract
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.
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Affiliation(s)
- Jordan R Hill
- Department of Health & Wellness Design, Indiana University School of Public Health—Bloomington, Bloomington, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute Inc., Indianapolis, Indiana, USA
| | - Elissa E Min
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
| | - Ephrem Abebe
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Richard J Holden
- Department of Health & Wellness Design, Indiana University School of Public Health—Bloomington, Bloomington, Indiana, USA
- Indiana University Center for Aging Research, Regenstrief Institute Inc., Indianapolis, Indiana, USA
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Gris F, D’Amen B, Lamura G, Paciaroni L, Socci M, Melchiorre MG. Personalized Technological Support for Informal Caregivers of Older People with Dementia: A Co-Design Approach Involving Potential End Users and Healthcare Professionals in Three Focus Groups in Italy. Healthcare (Basel) 2023; 11:2640. [PMID: 37830677 PMCID: PMC10572801 DOI: 10.3390/healthcare11192640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Informal/family caregivers (ICs) of older people with dementia (PwD) can suffer from depression and burnout. However, digital solutions can potentially provide innovative ways to facilitate care provision. The aim of this study was to analyze the opinions of end users (EUs), i.e., PwD aged 65 years and over and their ICs and healthcare professionals (HPs), on the use of digital technology to support care activities. Qualitative data were collected during the co-design phase of the European project "DemiCare-Personalized support for informal caregivers of people with dementia". This study focused on the Italian context and included two PwD, three ICs, and seven HPs. Three focus groups were held in April-June 2022. Qualitative data were analyzed using MaxQDA 2020 software. Seven thematic areas were identified: daily activities, care tasks, information needs, support received, relationship with and expectations from technology, functionality of the DemiCare integrated system, and ethical issues. Smart devices seemed to be received positively by ICs and HPs, although older PwD seemed to have difficulty accepting the technology. Overall, despite the low number of participants, it seems important and potentially effective to consider the needs and preferences of PwD during exploratory co-design to allow social interactions with them. This study was not registered.
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Affiliation(s)
- Francesca Gris
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Barbara D’Amen
- Italian National Institute of Statistics—ISTAT, Via Cesare Balbo 39, 00184 Rome, Italy
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Lucia Paciaroni
- Neurology Unit, Centre for Cognitive Disorders and Dementias, IRCCS INRCA—National Institute of Health and Science on Ageing, 60129 Ancona, Italy;
| | - Marco Socci
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
| | - Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, 60124 Ancona, Italy; (F.G.); (G.L.); (M.G.M.)
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Ardelean A, Redolat R. Supporting Behavioral and Psychological Challenges in Alzheimer Using Technology: A Systematic Review. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2172900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- A. Ardelean
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
| | - R. Redolat
- Department of Psychobiology, Faculty of Psychology and Logopedy, Universitat de València, Valencia, Spain
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Sohn M, Yang J, Sohn J, Lee JH. Digital healthcare for dementia and cognitive impairment: A scoping review. Int J Nurs Stud 2022; 140:104413. [PMID: 36821951 DOI: 10.1016/j.ijnurstu.2022.104413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cognitive disorders, such as Alzheimer's disease, are a global health problem. Digital healthcare technology is an innovative management tool for delaying the progression of dementia and mild cognitive impairment. Thanks to digital technology, the possibility of safe and effective care for patients at home and in the community is increasing, even in situations that threaten the continuity of care, such as the COVID-19 pandemic. However, it is difficult to select appropriate technology and alternatives due to the lack of comprehensive reviews on the types and characteristics of digital technology for cognitive impairment, including their effects and limitations. OBJECTIVE This study aims to identify the types of digital healthcare technology for dementia and mild cognitive impairment and comprehensively examine how its outcome measures were constructed in line with each technology's purpose. METHODS According to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines, a literature search was conducted in August 2021 using Medline (Ovid), EMBASE, and Cochrane library. The search terms were constructed based on Population-Concept-Context mnemonic: 'dementia', 'cognitive impairment', and 'cognitive decline'; digital healthcare technology, such as big data, artificial intelligence, virtual reality, robots, applications, and so on; and the outcomes of digital technology, such as accuracy of diagnosis and physical, mental, and social health. After grasping overall research trends, the literature was classified and analysed in terms of the type of service users and technology. RESULTS In total, 135 articles were selected. Since 2015, an increase in literature has been observed, and various digital healthcare technologies were identified. For people with mild cognitive impairment, technology for predicting and diagnosing the onset of dementia was studied, and for people with dementia, intervention technology to prevent the deterioration of health and induce significant improvement was considered. Regarding caregivers, many studies were conducted on monitoring and daily living assistive technologies that reduce the burden of care. However, problems such as data collection, storage, safety, and the digital divide persisted at different intensities for each technology type. CONCLUSIONS This study revealed that appropriate technology options and considerations may differ depending on the characteristics of users. It also emphasises the role of humans in designing and managing technology to apply digital healthcare technology more effectively.
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Affiliation(s)
- Minsung Sohn
- Division of Health and Medical Sciences, The Cyber University of Korea, Seoul, Republic of Korea
| | - JungYeon Yang
- Transdisciplinary Major in Learning Health Systems, Department of Public Health Science, Graduate School, Korea University, Republic of Korea
| | - Junyoung Sohn
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea
| | - Jun-Hyup Lee
- Department of Health Policy and Management, College of Health Sciences, Korea University, Republic of Korea.
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The effect of COVID-19 on the home behaviours of people affected by dementia. NPJ Digit Med 2022; 5:154. [PMID: 36253530 PMCID: PMC9575641 DOI: 10.1038/s41746-022-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has dramatically altered the behaviour of most of the world’s population, particularly affecting the elderly, including people living with dementia (PLwD). Here we use remote home monitoring technology deployed into 31 homes of PLwD living in the UK to investigate the effects of COVID-19 on behaviour within the home, including social isolation. The home activity was monitored continuously using unobtrusive sensors for 498 days from 1 December 2019 to 12 April 2021. This period included six distinct pandemic phases with differing public health measures, including three periods of home ‘lockdown’. Linear mixed-effects modelling is used to examine changes in the home activity of PLwD who lived alone or with others. An algorithm is developed to quantify time spent outside the home. Increased home activity is observed from very early in the pandemic, with a significant decrease in the time spent outside produced by the first lockdown. The study demonstrates the effects of COVID-19 lockdown on home behaviours in PLwD and shows how unobtrusive home monitoring can be used to track behaviours relevant to social isolation.
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Gatta FD, Fabrizi E, Giubilei F, Grau MD, Moret-Tatay C. Caregivers' Profiles Based on the Canadian Occupational Performance Measure for the Adoption of Assistive Technologies. SENSORS (BASEL, SWITZERLAND) 2022; 22:7500. [PMID: 36236598 PMCID: PMC9573476 DOI: 10.3390/s22197500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
The COPM (Canadian Occupational Performance Measure) is a tool that is based on the identification of self-perceived performance and satisfaction problems in the performance of occupations, allowing the creation of a hierarchy in the order of the interventions to be carried out, and speeding up the identification of the necessary AT (Assistive Technologies). Given the importance of the caregiver's perception about their own performance in the design of AT, this research examines the caregiver's profile through the COPM. A sample of 40 caregivers volunteered to participate in the study. A cluster analysis was carried out on the COPM scores. Two caregiver profiles were found in relation to the COPM measure, one with low scores on performance and satisfaction and another with high scores on both of these two variables. The main predictor was found to be the self-perception of performance. The structure was replicated through a hierarchical cluster analysis, where the role of caregivers was of interest. These results are relevant on both a theoretical and practical level.
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Affiliation(s)
- Francesco Della Gatta
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain
| | - Elisa Fabrizi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - María Dolores Grau
- Faculty of Psychology, Universidad Católica de Valencia San Vicente Mártir, 46100 Burjassot, Spain
| | - Carmen Moret-Tatay
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Faculty of Psychology, Universidad Católica de Valencia San Vicente Mártir, 46100 Burjassot, Spain
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State-of-the-Art Sensors Research in Ireland. SENSORS 2022; 22:s22020629. [PMID: 35062590 PMCID: PMC8780755 DOI: 10.3390/s22020629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022]
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