Supporting ethical use of electronic monitoring for people living with dementia: Social work's role in assessment, decision-making, and review

Using passive surveillance technology for overdose prevention: Key ethical and implementation issues

Passive surveillance technology has the potential to increase safety through monitoring spaces where people are at risk of overdose. One key opportunity for the use of passive surveillance technology to prevent overdose fatality is in bathrooms where people may be using drugs. However, uncertainty remains with regards to how to attain informed consent, implications for data storage and privacy and potential negative socio-legal ramifications for people who use drugs. In addition, there are issues regarding responsibility and liability for the devices. Transparency with regards to data privacy and security may also be needed before bathroom users will feel comfortable with such solutions. In this article, we discuss these issues and offer recommendations to provide a foundation for future research and policy development.

Electronic tracking devices in dementia care: A systematic review of argument-based ethics literature

BACKGROUND

Wandering is a behavioral symptom of dementia that often results in patients eloping from home or care facilities, leading to high-risk situations for injury or death. To mitigate this serious problem, caregivers use electronic tracking devices (ETDs) to manage wandering. As these devices can track, record, and monitor wearers, profound ethical questions are raised related to their use in this vulnerable population. The objective of this review was to identify the ethical frames, concepts, and arguments used in the normative literature that focused on ETDs in dementia care.

METHODS

We conducted a systematic literature review of normative literature that focused on ETDs in dementia care.

RESULTS

Twenty-two articles met the inclusion requirements. The majority of articles utilized a principlist approach, with arguments concerning ETDs largely falling under the four principles of biomedical ethics: respect for autonomy, non-maleficence, beneficence, and justice. Privacy and informed consent were specifically emphasized. The normative literature recognizes that ETDs may have a dual effect, potentially bolstering or eroding the values connected to each principle.

CONCLUSIONS

The prevailing use of principlism in the normative literature on ETDs indicates that there is a need to pursue new ethical approaches and expand upon the few non-principlist approaches already in use. In addition, many of the ethical issues around ETD use involve value-laden questions present during their design. Therefore, future ethical orientations or frameworks should account for ethical questions that exist along the design continuum on the use of ETDs.

Acceptance, adoption, and usability of information and communication technologies for people living with dementia and their care partners: a systematic review

PURPOSE

This review aims to examine the instruments, approaches, scales, or assessment tools used to evaluate technology acceptance, technology adoption, and usability of information and communication technologies (ICTs) for people living with dementia and their care partners.

METHODS

A systematic literature review was conducted. Studies that explored the use of instruments, approaches, scales, or assessment tools to evaluate the technology acceptance and usability of ICTs for people living with dementia and their care partners were identified through five databases: Medline, EMBASE, CINAHL, Web of Science, and Scopus.

RESULTS

We included 74 out of 2182 papers. The most common scales used included the System Usability Scale (SUS) (11%), the ISONORM 9241/10 Questionnaire (4%), and the Post-Study System Usability Questionnaire (PSSUQ) (4%). Most (59%) of the included approaches, however, were bespoke (i.e., created by the authors for a particular study) and were not named. The approaches or tools used to assess technology acceptance, technology adoption, and usability of ICTs that applied to people living with dementia had an average of 15 items and used an average of 5.23 scale points.

CONCLUSION

There is no clear, standardised approach for assessing the technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners. The findings of this review may be used by academics to design and implement improved and more consistent assessment tools to assess technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners.IMPLICATIONS FOR REHABILITATIONThe number of ICTs for people with dementia and their care partners that can be used for rehabilitation is increasingThe most commonly recognized assessment tools used in this study were the SUS, ISONORM 9241/10, and PSSUQ questionnaires.For the custom assessment tools, the average number of items included in this study was 15 with five-point bidirectional labelling.There is no clear, standardized approach for assessing the technology acceptance, technology adoption, or usability of ICTs for people with dementia and their care partners.

Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review

Background

The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia.

Methods

The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5^th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3^rd of May 2019.

Results

A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted.

Conclusions

Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation.

Systematic Review Registration

PROSPERO, identifier CRD42019134313.

What are the perceptions of people living with dementia, family carers, professionals and other potential stakeholders to the use of global positioning systems to promote safer outdoor walking?: a qualitative literature review

OBJECTIVE

Walking outdoors has many benefits which can improve quality of life for people living with dementia. However, due to the risk of getting lost, many people with dementia are denied the opportunity to be outdoors. There has been increased interest in using global positioning systems (GPS) to facilitate independent outdoor mobility for people with dementia, but this interest has been accompanied by ethical debate focussing on the rights of an individual with dementia to maintain privacy and autonomy. The objective was to establish what people, those with dementia, those who provide support for people with dementia and wider society perceive to be the issues around GPS use.

Method: An adapted qualitative systematic review was conducted between November 2018 and December 2018. Medical, social and technological databases were searched for papers with no date restriction. Initial search terms displayed nine hundred and sixty citations. Titles and if necessary abstracts were read to determine which studies might be potentially relevant. Forty papers were identified as potentially relevant and their abstracts and references examined. This produced a further four potential studies. Following application of the exclusion criteria thirty papers were eliminated.Fourteen were accepted, appraised and thematically analyzed.

Results: The ethical debate was reflected in the opinions of the study respondents. There was a willingness to relinquish some privacy for safety but people with dementia were not prepared to sacrifice their autonomy-believing they alone should decide whether GPS was appropriate.

Conclusion: GPS was felt to have the potential to facilitate independent outdoor walking, but systems need to be tailored to the individual. There is also a need to contradict negative societal perceptions of the ability of people with dementia to live a fulfilled life which is in danger of diminishing GPS's potential to improve quality of life for people with dementia.Implications for RehabilitationWhilst dementia is a disabling and incurable disease, taking advantage of technological developments such as GPS can diminish its negative impact.Appropriate development and use of GPSs offers the potential to enable people with dementia to explore the outdoors independently with subsequent improvement in self-confidence, independence and autonomy.Professionals working with people with dementia need to be aware of the GPS technology available and the ethical issues involved to support the use of GPS.

User experience and clinical effectiveness with two wearable global positioning system devices in home dementia care

INTRODUCTION

The user experience and clinical effectiveness with wearable global positioning system (GPS) devices for persons with dementia (PwDs) and caregivers (CGs) remain unclear although many are available.

METHODS

Using a crossover design, 20 dyads tested two similar commercial GPS watches (products A and B) at home for 4 weeks each. Usability, product functions, design features and product satisfaction at home and the clinic were investigated. Caregiver burden and quality of life assessed clinical effectiveness.

RESULTS

The final 17 dyads rated the usability, telephone function, overall design features, font, buttons, and battery life of B significantly better than A. PwDs rated the overall design features and buttons of A significantly better than CGs. Product satisfaction with both products was significantly lower at home. Clinical effectiveness was not found.

DISCUSSION

User experience can be improved by optimizing specific product details. This might translate to clinical effectiveness. Social desirability bias may explain different product satisfaction ratings.