Using touchscreen tablets to support social connections and reduce responsive behaviours among people with dementia in care settings: A scoping review

Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study

BACKGROUND

Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout.

OBJECTIVE

This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden.

METHODS

In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs.

RESULTS

Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]).

CONCLUSIONS

COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions.

Personalized Tablets for Residents in Long-Term Care to Support Recreation and Mitigate Isolation

OBJECTIVES

There is a digital divide in long-term care homes (LTCHs), with few residents having regular access to internet-connected devices. In this study, we provided long-term care residents with personalized and adapted tablets. We aimed to understand what factors influenced tablet use and the impact of tablet access on opportunities for social connection and recreation.

DESIGN

A pragmatic, mixed-methods multicenter, open-label, uncontrolled interventional study with assessment of outcomes at baseline and 3 months.

SETTING AND PARTICIPANTS

A total of 58 resident-care partner dyads were recruited across 7 LTCHs in Ontario, Canada. The main inclusion criterion was having a care partner willing to participate, and we excluded residents who already had an internet-connected device.

METHODS

Resident demographics, functional status assessments, and recreational engagement were captured using items from the Resident Assessment Instrument/Minimum Data Set. Care partners completed a questionnaire about relational closeness and site leads assessed resident quality of life before and approximately 3 months after tablet distribution. Interviews with 23 care partners and 7 residents post-implementation were completed and analyzed.

RESULTS

The median tablet use by participants was 7 minutes (interquartile range 27) per day on average over the study period. Predictors of higher tablet use were younger age, higher cognitive functioning, absence of hearing impairment, and having a care partner who lives farther away. There was no improvement on quantitative measures of quality of life, recreation, or relational closeness. In interviews, participants identified many different opportunities afforded by access to personalized tablets.

CONCLUSIONS AND IMPLICATIONS

Some LTCH residents without current access to the internet benefit from being provided a personal tablet and use it in a variety of ways to enrich their lives. There is a critical need to bridge the digital divide for this population.

Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers

PURPOSE

People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiver's experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same.

MATERIALS AND METHODS

People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis.

RESULTS

The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness.

CONCLUSIONS

The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers.

Impact of digital assistive technologies on the quality of life for people with dementia: a scoping review

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.

Factors that influence the implementation of innovation in aged care: a scoping review

OBJECTIVE

The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care.

INTRODUCTION

Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care.

INCLUSION CRITERIA

This review included studies of any design, that examined the implementation of innovations in aged care settings.

METHODS

Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops.

RESULTS

Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies.

CONCLUSIONS

Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.

Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map

Background

Social isolation and loneliness are more common in older adults and are associated with a serious impact on their well-being, mental health, physical health, and longevity. They are a public health concern highlighted by the COVID-19 pandemic restrictions, hence the need for digital technology tools to enable remotely delivered interventions to alleviate the impact of social isolation and loneliness during the COVID-19 restrictions.

Objectives

To map available evidence on the effects of digital interventions to mitigate social isolation and/or loneliness in older adults in all settings except hospital settings.

Search Methods

We searched the following databases from inception to May 16, 2021, with no language restrictions. Ovid MEDLINE, Embase, APA PsycInfo via Ovid, CINAHL via EBSCO, Web of Science via Clarivate, ProQuest (all databases), International Bibliography of the Social Sciences (IBSS) via ProQuest, EBSCO (all databases except CINAHL), Global Index Medicus, and Epistemonikos.

Selection Criteria

Titles and abstracts and full text of potentially eligible articles were independently screened in duplicate following the eligibility criteria.

Data Collection and Analysis

We developed and pilot tested a data extraction code set in Eppi-Reviewer and data were individually extracted and coded based on an intervention-outcome framework which was also used to define the dimensions of the evidence and gap map.

Main Results

We included 200 articles (103 primary studies and 97 systematic reviews) that assessed the effects of digital interventions to reduce social isolation and/or loneliness in older adults. Most of the systematic reviews (72%) were classified as critically low quality, only 2% as high quality and 25% were published since the COVID-19 pandemic. The evidence is unevenly distributed with clusters predominantly in high-income countries and none in low-income countries. The most common interventions identified are digital interventions to enhance social interactions with family and friends and the community via videoconferencing and telephone calls. Digital interventions to enhance social support, particularly socially assistive robots, and virtual pets were also common. Most interventions focused on reducing loneliness and depression and improving quality of life of older adults. Major gaps were identified in community level outcomes and process indicators. No included studies or reviews assessed affordability or digital divide although the value of accessibility and barriers caused by digital divide were discussed in three primary studies and three reviews. Adverse effects were reported in only two studies and six reviews. No study or review included participants from the LGBTQIA2S+ community and only one study restricted participants to 80 years and older. Very few described how at-risk populations were recruited or conducted any equity analysis to assess differences in effects for populations experiencing inequities across PROGRESS-Plus categories.

Authors' Conclusions

The restrictions placed on people during the pandemic have shone a spotlight onto social isolation and loneliness, particularly for older adults. This evidence and gap map shows available evidence on the effectiveness of digital interventions for reducing social isolation or loneliness in older adults. Although the evidence is relatively large and recent, it is unevenly distributed and there is need for more high-quality research. This map can guide researchers and funders to consider areas of major gaps as priorities for further research.

Lessons learnt from a community-driven digital social connection pilot program for people living with dementia: A qualitative interview study with key stakeholders

INTRODUCTION

In response to COVID-19 and mandated physical distancing, a new digital social connection program was developed and implemented by the local community in a large regional town in western Victoria, Australia. This pilot program, the Digital Inclusion-Social Connections (DI-SC) program, aimed to support people living with dementia to use a digital device to access social connection activities.

OBJECTIVE

The objective of this study is to inform the local community implementing the DI-SC program of key stakeholder experience of DI-SC process and outcomes to support future development and potential translation of digital social connections programs for people living with dementia.

DESIGN

Three semi-structured focus groups and two interviews were conducted with a total of fifteen participants. Data was transcribed verbatim and thematically analysed.

FINDINGS

Three main themes were identified describing factors as influencing the process and outcomes of the DI-SC program: understanding dementia; personal choice and control; and service planning and coordination. Six sub-themes were identified: matching capability; establishing a relationship; creating opportunities for different interactions; ownership of the device, program coordination and defining the volunteer digital mentor role.

CONCLUSION

Key stakeholders perceived the DI-SC program as an acceptable way of supporting people living with dementia to engage in activities they found enjoyable promoting social connection with care partners and others. DI-SC program outcomes were impacted by inappropriate training and a lack of program coordination. The findings of this study may inform future development and implementation of digital social connection programs for vulnerable populations at risk of social isolation.

Technology for activity participation in older people with mild cognitive impairment or dementia: expert perspectives and a scoping review

PURPOSE

This two-phased study aimed to collate, summarize and characterize - through the lens of an occupation-based, person-centred framework - ongoing research and practice featuring activity participation-supportive digital health technology (DHT) for direct use by older persons with mild cognitive impairment or Alzheimer's disease and related dementias (PwMCI/ADRD).

MATERIALS AND METHODS

Phase 1: Using scoping review procedures, PubMed, MEDLINE and PsycInfo were searched to identify primary research studies. Phase 2: Semi-structured interviews were completed with MCI/ADRD expert stakeholders identified through publicly available biographies and snowball referral. Thematic analysis was used to identify, synthesize and cross-compare emergent themes from both data sources that were subsequently organized into core facets of the Human Activity Assistive Technology (HAAT) model.

RESULTS

The scoping review resulted in 28 studies, which were primarily feasibility work with small sample sizes. Interviewed experts (N = 17) had 4+ years of MCI/ADRD experience, came from a variety of settings, and held myriad roles. Real world and research-based use of DHTs held some commonalities, particularly around support for social participation and instrumental activities of daily engagement. No DHT for sleep or work/volunteerism were noted in either phase. People with milder MCI/ADRD conditions were most often targeted users. Soft technology strategies facilitating implementation centred on product design (e.g., prompting software, customisability, multimedia/multisensory experiences), instructional methods and technology partner involvement.

CONCLUSIONS

This study demonstrates that although DHT supportive of activity participation is being studied and integrated into the lives of PwMCI/ADRD, there are still key opportunities for growth to meet the needs of diverse MCI/ADRD end users.Implications for rehabilitationMainstream digital health technologies (DHTs) are being utilized by persons with mild cognitive impairment and Alzheimer's disease and related dementias (PwMCI/ADRD) in everyday life, in limited capacities, to support social participation, leisure, health management and instrumental activities of daily living (IADL).Innovative research-based technologies to be used directly by PwMCI/ADRD are under development, particularly to facilitate management of ADL, social participation and IADL in persons with mild-to-moderate forms of cognitive impairment.Soft technology strategies to support technology implementation with MCI/ADRD target users include close attention to design of the technology (e.g., customisability, sensory stimulators and prompting features), instructional strategies that promote learning and motivation and involvement of technology partners to facilitate engagement with the technology.Future studies will require more robust research designs with transparent reports of participant characteristics and facilitative instructional methods to expand DHT's potential to account for and better meet the needs of diverse MCI/ADRD communities in real-world contexts.

Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review

Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.

Co-design of a digital app "WhatMatters" to support person-centred care: A critical reflection

BACKGROUND

People with dementia often do not receive optimal person-centred care (PCC) in care settings. Family members can play a vital role as care partners to support the person with dementia with their psychosocial needs. Participatory research that includes the perspectives of those with lived experience is essential for developing high-quality dementia care and practices.

OBJECTIVE

Throughout 2021-2022, a mobile app, called WhatMatters, was co-developed to provide easy-to-access and personalised support for people with dementia in hospitals and long-term care homes, with input from patients/residents, family partners and healthcare staff. This article discusses and critically reflects on the experiences of patients/residents, family partners, and healthcare staff involved in the co-design process.

METHODS

For the app development, we applied a participatory co-design approach, guided by a User Experience (UX) model. The process involved co-design workshops and user testing sessions with users (patients/residents, family partners, healthcare staff) to co-develop the WhatMatters prototype. We also conducted focus groups and one on one interviews with staff and caregiver participants to explore their experiences. Our research team, which also included patient partners, took part in regular team meetings during the app's development, where we discussed and reflected on the co-design process. Reflexive thematic analysis was performed to identify themes that represent the challenges and rewarding experiences of the users involved in the co-design process, which guided our overall reflective process.

FINDINGS

Our reflective analysis identified five themes (1) clarifying the co-design process, (2) ensuring inclusive collaborations of various users, and (3) supporting expression of emotion in a virtual environment, (4) feeling a sense of achievement and (5) feeling valued.

IMPLICATIONS

WhatMatters offers potential for providing personally relevant and engaging resources in dementia care. Including the voices of relevant users is crucial to ensure meaningful benefits for patients/residents. We offer insights and lessons learned about the co-design process, and explore the challenges of involving people with lived experiences of dementia in co-design work, particularly during the pandemic.

Connecting Today: Feasibility and acceptability of a remote visiting program for people living with dementia in long-term care homes

OBJECTIVES

Social isolation and loneliness affect the quality of life of people living with dementia, yet few interventions have been developed for this population. The purpose of this study was to assess the feasibility and acceptability of 'Connecting Today', a remote visiting program designed for use with care home residents living with dementia.

METHODS

This was a feasibility study to assess whether Connecting Today can be delivered in care homes, and was acceptable to family and friends and people living with dementia. We used a single-group before/after design and included residents ≥ 65 years old with a dementia diagnosis from two care homes in Alberta, Canada. Connecting Today involved up to 60 min per week of facilitated remote visits for 6 weeks. To understand feasibility, we assessed rates and reasons for non-enrollment, withdrawal and missing data. We assessed acceptability with the Observed Emotion Rating Scale (residents) and a Treatment Perception and Preferences Questionnaire (family and friends). Data were analyzed with descriptive statistics.

RESULTS

Of 122 eligible residents, 19.7% (n = 24) enrolled (mean age = 87.9 years, 70.8% females). Three residents withdrew from the study before the first week of calls. Among 21 remaining residents, 62%-90% completed at least 1 call each week. All the calls were completed by videoconference, rather than by phone. Alertness and pleasure were observed for ≥92% of residents during calls. The 24 contacts rated Connecting Today as logical, effective and low risk.

CONCLUSIONS

Facilitated, remote visits are feasible and highly acceptable to residents and their family and friend contacts. Connecting Today shows promise to address social isolation and loneliness for people living with moderate to severe dementia because it can promote positive engagement in meaningful interactions with their family and friends while they are living in a care home. Future studies will test effectiveness of Connecting Today in a large sample.

How tablets/applications enhance social connections and social support in people with dementia: A qualitative systematic review

The 2020 Lancet issue identified social isolation as one of 12 modifiable risk factors for dementia and revealed that enhanced social connections and social support can effectively reduce the incidence of social isolation. During the COVID-19 pandemic, technology attracted an increasing amount of attention, and it is necessary to synthesize ideas from existing evidence. First, we explored how people with dementia experienced changes in social connection and social support due to tablet/app use. Second, we explored the attitudes of people with dementia towards tablets and mobile applications. Third, we explored the feasibility of using tablets and mobile applications to enhance social connection and social support among people with dementia. We systematically searched the PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang, and VIP databases. Two reviewers independently screened the titles and abstracts of studies, extracted the data and performed critical appraisals of each included study. The data synthesis was conducted using thematic analysis. A total of nine studies were included. Eight studies used mobile applications via tablets, and one study collected textual data from Twitter for analysis. Four themes were synthesized: (1) change from the perspective of caregivers; (2) growth of nonsingle aspects; (3) emotional feeling of belonging; and (4) feasibility of using digital technology. Tablet- and mobile application-based interventions can enhance both online and offline social connections and provide multiple types of social support among people with dementia. People with dementia have positive attitudes towards tablets and mobile applications. Overall, it is feasible for people with dementia to use technology.

Application of the Person-Centered Care to Manage Responsive Behaviors in Clients with Major Neurocognitive Disorders: A Qualitative Single Case Study

OBJECTIVES

Our study aimed to describe "how" and "why" the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders.

METHODS

A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environment, and accessing documents available on the LTC community's public website. A thematic content analysis was used for data analysis.

RESULTS

The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in meaningful activities, and d) empowering care providers by offering essential resources.

CONCLUSIONS

Applying and implementing the PCC approach within an LTC community to manage clients' RBs is a long-term multi-dimensional process that requires a solid foundation.

CLINICAL IMPLICATIONS

These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.

Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions

Challenging behaviours are one of the most serious sequelae after a traumatic brain injury (TBI). These chronic behaviours must be managed to reduce the associated burden for caregivers, and people with TBI. Though technology-based interventions have shown potential for managing challenging behaviours, no review has synthesised evidence of technology aided behaviour management in the TBI population. The objective of this scoping review was to explore what technology-based interventions are being used to manage challenging behaviours in people with TBI. Two independent reviewers analysed 3505 studies conducted between 2000 and 2023. Studies were selected from five databases using search strategies developed in collaboration with a university librarian. Sixteen studies were selected. Most studies used biofeedback and mobile applications, primarily targeting emotional dysregulation. These technologies were tested in a variety of settings. Two interventions involved both people with TBI and their family caregivers. This review found that technology-based interventions have the potential to support behavioural management, though research and technology development is at an early stage. Future research is needed to further develop technology-based interventions that target diverse challenging behaviours, and to document their effectiveness and acceptability for use by people with TBI and their families.

The use of technology for arts-based activities in older adults living with mild cognitive impairment or dementia: A scoping review

For older adults living with mild cognitive impairment or dementia, creative arts-based activities can offer many benefits from enjoyment as leisure/recreation to an avenue to maintain cognitive, social and emotional wellbeing. With growing interest and recognition that technology could have potential to assist in delivering these activities in more accessible and personalised ways, a scoping review was undertaken to systematically examine the scientific literature for technology-assisted creative arts activities for older adults living with dementia. We searched PubMed, PsychINFO, Web of Science, Scopus and ACM Digital Library databases using keywords centering on population with dementia, an intervention using technology, and a context of creative arts, with no restrictions on the type of outcome measured. We retrieved 3739 records, with an additional 22 from hand-searching. 51 full-text articles met the inclusion and exclusion criteria. Findings of the review indicate technologies principally being designed for music activities (listening, and music-making), as well as storytelling and visual arts. The majority of devices were custom-made, with studies mainly reporting on validating the success of the device/intervention. This suggests most work in the field is currently at prototyping stage, although a few devices are now commercially available. Recommendations for future research includes involvement of participants reporting on their previous experiences in the arts and how this influences co-design choices, and inclusion of different severities of dementia in the participant/co-design group. Furthering device development past prototyping stage as well as collaboration between teams would enable comparisons to be made across different types of devices used for the same activity, and comparisons across arts-based activities that could lead to cross-disciplinary outcomes for the design of creative arts-based assistive technologies.

Digital healthcare for dementia and cognitive impairment: A scoping review

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.

Experiences of residents of long-term-care homes with the use of socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to explore the experiences of residents of long-term-care homes using socially assistive technologies and the effectiveness of these technologies in relation to depression, loneliness, and social interaction.

INTRODUCTION

Research related to the experiences of residents of long-term-care homes with socially assistive technologies, and their effectiveness, is limited. This population of older adults is projected to steeply increase in the future, as will the need for services, such as long-term care. Older adults (≥65 years) in long-term care are at increased risk of depression, loneliness, and social isolation. Therefore, there is a need to explore the experiences of long-term-care residents with the use of socially assistive technologies and to determine the effectiveness of these technologies in relation to depression, loneliness, and social interaction.

INCLUSION CRITERIA

This review will include studies about the experiences of older adults in long-term care using socially assistive technologies, and the effectiveness of these technologies. Older adults are defined as people 65 years of age and above. We will consider human-to-human socially assistive technologies, such as computers, smart phones, tablets, and associated applications. We will review quantitative, qualitative, and mixed methods studies.

METHODS

A JBI mixed methods convergent segregated approach will be used. Select databases and gray literature will be searched for published and unpublished studies, with no date or language limits. Titles, abstracts, and full texts of included studies will be screened by at least two reviewers, and undergo quality appraisal, data extraction, and synthesis of quantitative and qualitative data followed by integration of the two types of evidence.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021279015.

Usability and acceptability of internet-based interventions for family carers of people living with dementia: systematic review

Objectives: Internet-based interventions can help carers of people living with dementia to cope with care-related challenges and can help improve their wellbeing. This systematic review aimed at investigating the criteria of usability and acceptability of self-guided internet-based interventions for family carers of people living with dementia. Method: Searches were conducted on PubMed, Virtual Health Library Regional Portal (Americas), MEDLINE, PsycINFO, Scopus, and Cochrane. Studies published up to December 2019, in English, Portuguese, or Spanish, were eligible. We followed the definition/criteria from ISO ISO-9241-11 for usability (efficiency, effectiveness, and satisfaction) and acceptability (barriers for using and utility). Methodological quality was evaluated using specific tools according to each study design. Results: Ten studies were included, all of which had high methodological quality. Carers of people living with dementia indicated that internet-based interventions were mostly effective, efficient, and satisfactory. They considered these to be informative, relevant, and functional, highlighting the utility and intention of using the resource in the future. The high heterogeneity in the terms and methods used to evaluate usability and acceptability hindered cross-study comparisons, however internet-based interventions were considered useful and acceptable by most carers. Conclusion: Future research should consider expanding the criteria of usability and acceptability to better reflect the needs of this population.

Expert appraisal and prioritization of barriers to mHealth use for older adults living with Alzheimer's disease and related Dementias: A Delphi study

INTRODUCTION

Older adults living with Alzheimer's disease and related dementias (ADRD) can benefit from mHealth innovations in (daily) care. However, successful implementation and adoption of such innovations can be hindered by a lack of inclusive design. Inclusive design can be challenging, due to the variety of ADRD- and aging-related symptoms that can pose barriers to using mHealth. Previously, a literature-based model with 53 barriers to mHealth use for this population has been developed ("MHealth for OLder adults living with DEMentia - USability" or MOLDEM-US). In this study, we aim to prioritize these through a Delphi study with ADRD experts (case managers, informal caregivers, hospital healthcare professionals, district nurses, and researchers).

METHODS

In the first round, participant characteristics and potentially new insights into barriers to mHealth use for older adults living with ADRD were gathered. The consensus questionnaire was submitted in the second round, containing barriers to mHealth use for this population (from MOLDEM-US) with questions inquiring its impact and frequency. In the third round, participants rejudged those barriers for which no consensus (<51 %) or minor consensus (51 % - 60 %) was reached.

RESULTS

Thirty-seven participants completed the three rounds of the study. Consensus was reached for eleven barriers after the second round, all having major impact and frequency: integration of functions during daily activities, perceived complexity, efficiency in seeing benefits, trust in own ability, restlessness and agitation, computer literacy, self confidence in using wearables, learnability, working memory, and visual acuity.

CONCLUSION

After round three, consensus was achieved for all 53 barriers. Twenty-six barriers are considered to majorly affect mHealth use, most of which relate to cognition and frame of mind. This study contributes to the development of mHealth design guidelines that take into account the progressive and diverse ADRD- and aging-related symptoms negatively affecting mHealth implementation and adoption.

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.

A tablet-based intervention for activating nursing home residents with dementia: results from a cluster-randomized controlled trial

OBJECTIVES

To investigate global and momentary effects of a tablet-based non-pharmacological intervention for nursing home residents living with dementia.

DESIGN

Cluster-randomized controlled trial.

SETTING

Ten nursing homes in Germany were randomly allocated to the tablet-based intervention (TBI, 5 units) or conventional activity sessions (CAS, 5 units).

PARTICIPANTS

N = 162 residents with dementia.

INTERVENTION

Participants received regular TBI (n = 80) with stimulating activities developed to engage people with dementia or CAS (n = 82) for 8 weeks.

MEASUREMENTS

Apathy Evaluation Scale (AES-I, primary outcome), Quality of Life in Alzheimer's Disease scale, QUALIDEM scale, Neuropsychiatric Inventory, Geriatric Depression Scale, and psychotropic medication (secondary outcomes). Momentary quality of life was assessed before and after each activity session. Participants and staff were blinded until the collection of baseline data was completed. Data were analyzed with linear mixed-effects models.

RESULTS

Levels of apathy decreased slightly in both groups (mean decrease in AES-I of .61 points, 95% CI -3.54, 2.33 for TBI and .36 points, 95% CI -3.27, 2.55 for CAS). Group difference in change of apathy was not statistically significant (β = .25; 95% CI 3.89, 4.38, p = .91). This corresponds to a standardized effect size (Cohen's d) of .02. A reduction of psychotropic medication was found for TBI compared to CAS. Further analyses revealed a post-intervention improvement in QUALIDEM scores across both groups and short-term improvements of momentary quality of life in the CAS group.

CONCLUSIONS

Our findings suggest that interventions involving tailored activities have a beneficial impact on global and momentary quality of life in nursing home residents with dementia. Although we found no clear advantage of TBI compared to CAS, tablet computers can support delivery of non-pharmacological interventions in nursing homes and facilitate regular assessments of fluctuating momentary states.

Family caregiver competence in managing behavioral and psychological symptoms of dementia: A concept synthesis

AIM

This study aimed to identify the attributes of "family caregiver competence in managing behavioral psychological symptoms of dementia".

METHODS

Six electronic databases were searched for studies published between January 1990 and June 2017 with the key words "dementia", "behavioral psychological symptoms of dementia", "caregiver", "coping (managing)", and "competence". From the final fully reviewed 26 articles, descriptions related to family caregiver's dealing with behavioral psychological symptoms of dementia were extracted first. Then, based on Walker and Avant's concept synthesis, the concept of "family caregiver competence in managing behavioral psychological symptoms of dementia" was explored.

RESULTS

Four attributes, namely "Judging", "Empathizing", "Adjusting", and "Reflecting", comprised of ten categories were identified as constituting the concept of family caregiver competence in managing the behavioral psychological symptoms of dementia. As a meta competence, "reflecting" may play a significant role in improving family caregiver competence by interacting with the other dimensions of competence in managing symptoms.

CONCLUSIONS

Based on the suggested conceptual model, education or training programs could be developed to improve family caregiver competence in managing behavioral psychological symptoms of dementia. To refine the attributes found in this study, field studies including observations of and interviews with family caregivers need to be conducted. Studies exploring the associations between these attributes are also of value.

Virtual team-based care planning with older persons in formal care settings: a scoping review protocol

INTRODUCTION

COVID-19 has necessitated greater adoption of virtual care (eg, telephone (audio), videoconference) delivery models. Virtual care provides opportunities for innovative practice in care planning with older persons and meaningful family engagement by synchronously involving multiple care providers. Nevertheless, there remains a paucity of summarising evidence regarding virtual team-based care planning for older persons. The purpose of this scoping review is to summarise evidence on the utilisation of virtual team-based care planning for older persons in formal care settings. Specifically, (1) what has been reported in the literature on the impact or outcomes of virtual team-based care planning? (2) What are the facilitators and barriers to implementation?

METHODS AND ANALYSIS

This scoping review will follow a rigorous and well-established methodology by the Joanna Briggs Institute, supplemented by the Arksey & O'Malley and Levac, Colquhoun, & O'Brien frameworks. A three-step search strategy will be used to conduct a search on virtual team-based care planning for older persons in formal care settings. Keywords and index terms will be identified from an initial search in PubMed and AgeLine, and used to conduct the full search in the databases PubMed, EMBASE, CINAHL, AgeLine, PsycInfo and Scopus. Reference lists of included articles and grey literature retrieved through Google and Google Scholar will also be reviewed. Three researchers will screen titles and abstracts, and will conduct full-text review for inclusion. Extracted data will be mapped in a table.

ETHICS AND DISSEMINATION

Research ethics approval is not required for data collection from publicly accessible information. Findings will be presented at conferences, submitted for open-access publication in a peer-reviewed journal and made accessible to multiple stakeholders. The scoping review will summarise the literature on virtual team-based care planning for the purpose of informing the implementation of a virtual PIECES™ intervention (Physical/Intellectual/Emotional health, Capabilities, Environment, and Social).

Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review

Background

The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult.

Objective

The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies.

Methods

Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings.

Results

We identified technologies designed to be used “by informal caregivers,” “by people with dementia,” and “with people with dementia.” Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time.

Conclusions

Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care.

Digital technologies to support people living with dementia in the care home setting to engage in meaningful occupations: protocol for a scoping review

BACKGROUND

People living with all stages of dementia should have the opportunity to participate in meaningful occupations. For those living in care homes, this may not always occur and residents may spend significant parts of the day unengaged, especially those living with more advanced dementia. Digital technologies are increasingly being used in health care and could provide opportunities for people living with dementia (PLWD) in care homes to engage in meaningful occupations and support care staff to provide these activities. With technology advancing at a rapid rate, the objective of this scoping review is to provide an up-to-date systematic map of the research on the diverse range of digital technologies that support engagement in meaningful occupations. In particular, focus will be given to barriers and facilitators to inform future intervention design and implementation strategies, which have not yet been clearly mapped across the full range of these digital technologies.

METHOD

A scoping review will be conducted to systematically search for published research using a comprehensive search strategy on thirteen databases. Published, peer-reviewed studies that focused on PLWD in the care home setting and assessed any form of digital technology that supported a meaningful occupation will be included. All methodologies which meet the criteria will be included. Data will be extracted and charted to report the range of digital technologies, underlying mechanisms of action, facilitators and barriers to implementation.

DISCUSSION

Mapping the range of technologies to support PLWD to engage in meaningful occupations will identify gaps in research. The systematic search will include a diverse range of technologies such as software to enhance care planning, tablets devices, smartphones, communication robots and social media platforms, rather than focussing on a specific design or interface. This will enable comparison between mechanisms of action, barriers and facilitators to implementation which will be useful for future research and intervention design.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/7UDM2.

Digital reminiscence app co-created by people living with dementia and carers: Usability and eye gaze analysis

BACKGROUND

This research reports on a pilot study that examined the usability of a reminiscence app called 'InspireD' using eye tracking technology. The InspireD app is a bespoke digital intervention aimed at supporting personalized reminiscence for people living with dementia and their carers. The app was developed and refined in two co-creation workshops and subsequently tested in a third workshop using eye tracking technology.

INTERVENTION

Eye tracking was used to gain insight into the user's cognition since our previous work showed that the think-aloud protocol can add to cognitive burden for people living with dementia while also making the test more unnatural.

RESULTS

Results showed that there were no barriers to using a wearable eye tracker in this setting and participants were able to use the reminiscence app freely. However, some tasks required prompts from the observer when difficulties arose. While prompts are not normally used in usability testing (as some argue the prompting defeats the purpose of testing), we used 'prompt frequency' as a proxy for measuring the intuitiveness of the task. There was a correlation between task completion rates and prompt frequency. Results also showed that people living with dementia had fewer gaze fixations when compared to their carers. Carers had greater fixation and saccadic frequencies when compared to people living with dementia. This perhaps indicates that people living with dementia take more time to scan and consume information on an app. A number of identified usability issues are also discussed in the paper.

PATIENT OR PUBLIC CONTRIBUTION

The study presents findings from three workshops which looked at user needs analysis, feedback and an eye tracking usability test combined involving 14 participants, 9 of whom were people living with dementia and the remaining 5 were carers.

Identification and Reporting of Patient and Public Partner Authorship on Knowledge Syntheses: Rapid Review

BACKGROUND

Patient and public involvement (PPI) in health research is an area of growing interest. Several studies have examined the use and impact of PPI in knowledge syntheses (systematic, scoping, and related reviews); however, few studies have focused specifically on the patient or public coauthorship of such reviews.

OBJECTIVE

This study seeks to identify published systematic and scoping reviews coauthored by patient or public partners and examine the characteristics of these coauthored reviews, such as which journals publish them, geographic location of research teams, and terms used to describe patient or public partner authors in affiliations, abstracts, or article text.

METHODS

We searched CAB Direct, CINAHL, Cochrane Database of Systematic Reviews (Ovid), Embase (Ovid), MEDLINE (Ovid), and PsycInfo from 2011 to May 2019, with a supplementary search of several PPI-focused databases. We refined the Ovid MEDLINE search by examining frequently used words and phrases in relevant search results and searched Ovid MEDLINE using the modified search strategy in June 2020.

RESULTS

We screened 13,998 results and found 37 studies that met our inclusion criteria. In line with other PPI research, we found that a wide range of terms were used for patient and public authors in author affiliations. In some cases, partners were easy to identify with titles such as patient, caregiver or consumer representative, patient partner, expert by experience, citizen researcher, or public contributor. In 11% (n=4) of studies, they were identified as members of a panel or advisory council. In 27% (n=10) of articles, it was either impossible or difficult to tell whether an author was a partner solely from the affiliation, and confirmation was found elsewhere in the article. We also investigated where in the reviews the partner coauthors' roles were described, and when possible, what their specific roles were. Often, there was little or no information about which review tasks the partner coauthors contributed to. Furthermore, only 14% (5/37) of reviews mentioned patient or public involvement as authors in the abstract; involvement was often only indicated in the author affiliation field or in the review text (most often in the methods or contributions section).

CONCLUSIONS

Our findings add to the evidence that searching for coproduced research is difficult because of the diversity of terms used to describe patient and public partners, and the lack of consistent, detailed reporting about PPI. For better discoverability, we recommend ensuring that patient and public authorships are indicated in commonly searched database fields. When patient and public-authored research is easier to find, its impact will be easier to measure.

Understanding the impact of the COVID-19 pandemic on well-being and virtual care for people living with dementia and care partners living in the community

The COVID-19 pandemic has necessitated public health measures that have impacted the provision of care for people living with dementia and their families. Additionally, the isolation that results from social distancing may be harming well-being for families as formal and informal supports become less accessible. For those living with dementia and experiencing agitation, social distancing may be even harder to maintain, or social distancing could potentially aggravate dementia-related neuropsychiatric symptoms. To understand the lived experience of social and physical distancing during the COVID-19 pandemic in Canada, we remotely interviewed 21 participants who normally attend a dementia specialty clinic in Calgary, Alberta, during a period where essential businesses were closed and health care had abruptly transitioned to telemedicine. A reflexive thematic analysis was used to analyze the interview and field note data. The impacts of the public health measures in response to the pandemic emerged through iterative analysis in three main categories of experience: (1) personal, (2) health services, and (3) health status (of both persons living with dementia and care partner). Isolation and mental health needs emerged as important impacts to family experiences. This in-depth understanding of the needs and experiences of the pandemic for people living with dementia suggests that innovative means are urgently needed to facilitate provision of remote medicine and also social interaction and integration.