Improving caregivers' well-being by using technology to manage nighttime activity in persons with dementia

Implementation of smart supportive dementia technology in a hospital transitional care setting using human-centred design

Supportive smart home technology, for older adults living with dementia and their informal care partners, has shown some benefits in private homes. In this study, a supportive smart home system is being implemented in a hospital alternative level of care setting. This case report describes how a team of researchers and healthcare managers are navigating the complexities of a hospital setting, using human-centred design and implementation strategies, to facilitate the implementation and adoption of the technology.

Sleep Interventions for Informal Caregivers of Persons with Dementia: A Systematic Review

We conducted a systematic review on the state of the science related to sleep interventions for informal caregivers of persons with Alzheimer's disease or related dementia (ADRD). This review included English-written, peer-reviewed articles that studied the effect of an intervention on sleep health outcomes for informal caregivers of persons with ADRD. Our search yielded 15 articles that met our a priori inclusion criteria. We categorized interventions into four categories: environmental, physical, cognitive, and collaborative. Intervention effects were heterogeneous, with most yielding nonsignificant sleep health effects. There is a need for theoretically sound and robust sleep health interventions for informal caregiver samples. Future research in this area could benefit from the use of more controlled, pragmatic, and adaptive research designs, and the use of objective measures that conceptually represent the multiple domains of sleep health to enhance intervention quality.

New assistive technologies in dementia and mild cognitive impairment care: A PubMed review

INTRODUCTION

Dementia is characterized by global cognitive dysfunction, which can cause difficulties in performing Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), leaving people with dementia (PwD) who do not have the proper support extremely vulnerable. Dementia management should involve preventative methods, including during the stage of mild cognitive impairment (MCI). Lay-caregivers are found to have poorer health in all three domains of the biopsychosocial model, as a result of the burden of care. New assistive technologies (ATs) have been designed to help care for PwD. ATs aim to be more affordable and widely available than human workers, achieving greater health equity and quality of life for all.

METHODS

To identify relevant articles, a literature search using PubMed was undertaken by one independent reviewer: S.L.C. The keywords of "dementia", "technology", and "management" were used, with no date of publication limitations, which revealed 571 results.

RESULTS

44 articles were included in this review. Articles regarding new technologies to diagnose dementia or MCI were not included. ATs aim to help facilitate aging-in-place, reduce medical costs, and rates of caregiver burnout, by helping maintain patient functioning.

DISCUSSION

Legal issues in the form of workplace safety laws, data privacy laws and regulations, and health care ethics are major barriers to implementation that need to be resolved. The hope is that artificial intelligence (AI) systems may be able to advance what they are able to perceive and help uncover new knowledge and management options for dementia and MCI.

Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks

Background

Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions.

Methods

Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined.

Results

Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others.

Conclusions

Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants’ needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.

Development and Validation of a Community Assessment Survey for Diverse Rural Family Caregivers of People With Alzheimer Disease and Related Dementias

Many individuals with Alzheimer disease and related dementias receive care from family members and friends. Rurality adds increased complexity to care, especially for diverse caregivers. This study details the development and content validation process for a community assessment survey for rural white, Latinx, and American Indian/Alaska Native Alzheimer disease and related dementias caregivers. Foundational survey items were based upon instruments validated with diverse rural caregivers. A modified Delphi process (2 rounds) was used to refine items. The process concluded when 75%+ of experts agreed that the survey was (1) inclusive of different cultural groups; (2) respectful of cultural values and norms; (3) comprehensive with respect to needs, assets, and resources, and (4) relevant to the experiences of diverse rural caregivers. Round 1 of the process (N = 9 panelists) resulted in the elimination of 2 survey sections, a greater focus on issues including transportation and roles of extended family members, and the inclusion of open-ended questions. Round 2 (N = 6 panelists) resulted in further improvements, particularly to the sections about cultural customs, beliefs, and traditions and interactions with health care and other providers. Benefits of the process included raising awareness about rural caregiving issues and maximizing data quality. Challenges included honoring the diversity of respondents' opinions and balancing research rigor with community utility. This community assessment survey may help researchers better understand the needs and culturally-based strengths of diverse rural family caregivers.

Carers' experience of using assistive technology for dementia care at home: a qualitative study

OBJECTIVE

Assistive technology (AT) can help carers (family, friends and neighbours) and people with dementia to stay well and safely at home. There are important gaps in what we know about experience of using AT from the perspective of carers of persons with dementia. This study investigates carers' experience of using AT in supporting and caring for persons with dementia who live at home.

DESIGN

Qualitative phenomenological study with semi-structured interviews to achieve data saturation and thematic analysis to identify key themes.

SETTING

Community-based within the UK.

PARTICIPANTS

Twenty-three (14 women, 9 men) adult carers of persons with dementia who have used at least one AT device.

RESULTS

All participants reported benefiting to varying degrees from using AT. There were 5 themes and 18 subthemes that highlighted reasons for using AT and use of AT over time. Providing care for a person with dementia, motivation for using AT, changes to roles and routines, carer knowledge and skills for using AT and social, environmental and ethical considerations were the main themes. This study showed that AT can provide reassurance and support for carers of persons with dementia but there are difficulties with acquiring and continued use of AT as dementia progresses.

CONCLUSIONS

Carers consider AT as an adjunct to care they provided in caring for a person with dementia. Use of AT should be considered in the personal, social and environmental context of persons with dementia and their carers. Further research and policy interventions are needed to address best use of resources and guidance on data sharing and data protection while using AT.

Informal carers' experience of assistive technology use in dementia care at home: a systematic review

Background

Dementia is a health and care priority globally. Caring for persons with dementia is a challenge and can lead to negative psychological, physiological and financial consequences for informal carers. Advances in technology have the potential to assist persons with dementia and their carers, through assistive technology devices such as electronic medication dispensers, robotic devices trackers and motion detectors. However, little is known about carers’ experience and the impact of these technologies on them. This review aims to investigate the outcomes and experience of carers of persons with dementia, who live at home and use assistive technology.

Methods

A systematic search in seven databases and manual searches were carried out using pre-defined inclusion and exclusion criteria to identify studies on carers of persons with dementia involving the use of assistive technology. The search identified 56 publications with quantitative, qualitative and mixed-method designs.

Results

The studies reported positive and negative findings and focused on a wide variety of assistive technology devices. There were large differences in the uses of assistive technology, outcome measures used and the quality of studies. Knowledge and acceptance, competence to use and ethical issues when using assistive technology were themes that emerged from the studies. Carers generally appreciated using assistive technology and their experience of use varied.

Conclusions

The intention of this systematic review is to list and classify the various types of assistive technology used by carers of persons with dementia and explores the positive and negative aspects, knowledge, acceptance and ethical issues in the use of assistive technology by carers of persons with dementia. We recommend the use of a standard and person-centred system of classifying and naming assistive technology devices and systems and for future research efforts in assistive technology to incorporate a family/carer centred model.

Systematic review registration

PROSPERO - CRD42017082268.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1169-0) contains supplementary material, which is available to authorized users.

Ethical Implications of User Perceptions of Wearable Devices

Health Wearable Devices enhance the quality of life, promote positive lifestyle changes and save time and money in medical appointments. However, Wearable Devices store large amounts of personal information that is accessed by third parties without user consent. This creates ethical issues regarding privacy, security and informed consent. This paper aims to demonstrate users' ethical perceptions of the use of Wearable Devices in the health sector. The impact of ethics is determined by an online survey which was conducted from patients and users with random female and male division. Results from this survey demonstrate that Wearable Device users are highly concerned regarding privacy issues and consider informed consent as "very important" when sharing information with third parties. However, users do not appear to relate privacy issues with informed consent. Additionally, users expressed the need for having shorter privacy policies that are easier to read, a more understandable informed consent form that involves regulatory authorities and there should be legal consequences the violation or misuse of health information provided to Wearable Devices. The survey results present an ethical framework that will enhance the ethical development of Wearable Technology.

The Concept of Missing Incidents in Persons with Dementia

Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model. Examining the evidence base, specific factors within each category of the model were further described, reviewed and modified until consensus was reached regarding the final model. The model begins to explain in particular the variety of antecedents that are related to missing incidents. The model presented in this paper is designed to be heuristic and may be used to stimulate discussion and the development of effective preventative and response strategies for missing incidents among persons with dementia.

Sleep Quality in Family Caregivers of Individuals With Dementia

Poor sleep quality in family caregivers may impact their health status and cause quality of life to decline. Nurses are conducting an increasing number of studies that use sleep quality or related concepts as a main indicator to assess caregiver’s sleep. Therefore, a clear understanding of sleep quality and how it is different from other relevant sleep domains is essential. This article aimed to analyze the concept of sleep quality using the steps outlined by Walker and Avant. Findings include (a) attributes of sleep quality including subjective perception of sleep, sleep hours, and evaluation of activity after awaking; (b) antecedents of sleep quality including the ability to get naturally into the sleep cycle and status of conscious state; and (c) consequences of sleep quality including bio-psycho-social and global dimensions of health. This article intends to help clinicians and researchers better understand and define sleep quality in dementia caregivers.

Aging society and gerontechnology: a solution for an independent living?

Recent studies report that the majority of older adults wish to live in their own homes, for as long as possible. This creates a growing interest in technologies to enable older people to remain living independently at home. The purpose of this article is to provide a narrative review of current technology appropriate for older adults' home use. The key research questions were as follow: 1- What is the evidence demonstrating that gerontechnologies are effective in enabling independent living? 2- What are devices designed specifically for frail elderly persons ? Several publications were identified about devices targeting social isolation (videophonic communication, affective orthotic devices or companion-type robots, personal emergency response systems [security]), autonomy loss (technologies for maintenance of autonomy in the activities of daily living) and cognitive disorders (cognitive orthotics, wandering management systems, telemonitoring). Very few articles dealt specifically with the frail older person. In particular, there was extremely limited evidence on use and efficacy of these devices within this population. There is a need to obtain a consensus on definition of the technologies, and also to revisit work strategies and develop innovative business models. To meet this goal, we need to create a network of technological companies, aging services organizations, end-users, academics, and government representatives to explore the real needs of the frail older population and to develop and validate new devices promoting aging at home.

Nurse entrepreneurs, arise!: improving lives of older adults by bringing your ideas to market

Many functions that nurses carry out require the use of various technologies, yet nurses are rarely involved in the development and/or testing of technology. The purpose of this article is to provide an introduction to the world of technology development to help nurses understand how to become involved in this endeavor. An illustration of a newly developed technology will be used to further clarify the steps.

Users' and professionals' contributions in the process of designing an easy-to-use videophone for people with dementia

PURPOSE

To develop a design concept for an easy-to-use videophone for people with dementia and to evaluate the design and need of such a product.

METHOD

In this project, we have used an inclusive design approach that includes the target users in the design process. In an earlier study, the need of a videophone was examined and a requirement specification was developed. In this study, a preliminary design concept was developed. Five focus groups of people with dementia, significant others and occupational therapists working with people with dementia were formed to capture their experiences, expectations and thoughts concerning the videophone and the design concept. Data were analysed using a grounded theory approach.

FINDINGS

The participants pointed out that the design of the videophone should be flexible in order to meet the needs of people with dementia, be easy-to-use and not look like assistive technology. In order to facilitate learning, the videophone should be introduced in an early stage of the disease.

CONCLUSIONS

A videophone has potentials to enable videophone calls without assistance, add quality in communication and provide possibilities for monitoring. Further work will focus on developing a prototype to be empirically tested by people with dementia and significant others.

IMPLICATIONS FOR REHABILITATION

An easy-to-use videophone was viewed as an important device that could support people with dementia in making videophone calls without assistance. It was also viewed as a product that significant others could use for monitoring the person with dementia, for example to judge the well-being of the person. But monitoring should be used with caution and not without the consent of the person with dementia. It was viewed as important that the videophone be introduced in an early stage of the disease in order to facilitate learning, so that the person can get used to the new way of making telephone calls and incorporate the new habit in his/her routines. In order to motivate people with dementia to start using a videophone, it was recommended that the videophone should be introduced as a product which is a pleasure to use, and not as a compensation for impairment or to solve a problem.

Missing incidents in community-dwelling people with dementia: understanding how these dangerous events differ from dementia-related ‘wandering’ is critical to assessment, intervention, and prevention

OVERVIEW

At every stage of dementia, people with the condition are at risk for both missing incidents, in which they are unattended and unable to navigate a safe return to their caregiver, and "wandering," a term often used to describe repetitive locomotion with patterns such as lapping or pacing. By understanding the differences between these two phenomena, nurses can teach caregivers how to anticipate and prevent missing incidents, which are not necessarily related to wandering. The authors differentiate missing incidents from wandering, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents.

Comparing dementia patients' nighttime objective movement indicators with staff observations

BACKGROUND

Pharmacological and non-pharmacological approaches are commonly used to treat patients' institutionalised for nighttime wandering. Actigraphy and other scales have been used to evaluate the efficacy of these treatments. However, in clinical settings, nursing records are often the sole source of daily observation of nighttime wandering. Thus, physicians rely on nursing records to evaluate pharmacological and non-pharmacological treatments. This study examined nighttime movements of patients with dementia, comparing the results of integrated circuit tag monitoring with hourly nighttime nursing records. We tested which factors were associated with agreement rates between the two data sources.

METHODS

The study hospital was a general hospital in Osaka, Japan. Monitoring was conducted in a closed 60-bed dementia care unit. An integrated circuit tag monitoring system was used to monitor the movement of institutionalised dementia patients for over half a year. The distance moved per hour by subjects was measured using the monitoring system, and the data were compared with hourly nighttime nursing records. Agreement rates were calculated between the two data sources.

RESULTS

Thirty-five patients were monitored. Between 10-30% of subjects moved at any given hour during the night. The overall agreement rate between sources of movement data was 39%. Agreement rates were significantly correlated with the interquartile of the distance moved, changes in medication, physical conditions, and behavioural and psychological symptoms of dementia measured during the day.

CONCLUSIONS

Although the agreement rate was low, staff appeared to pay more attention to patients associated with notable events during the day and patients exhibiting variability in distance moved.

Sleep in dementia caregivers and the effect of a nighttime monitoring system

PURPOSE

The purpose of this study was to determine if a nighttime home monitoring system, designed to track the movements of a care recipient with dementia, would relieve worry and improve sleep in caregivers of persons with dementia.

DESIGN AND METHODS

In this controlled clinical trial, 49 dementia caregivers were followed for up to 1 year. Sleep was measured for 7-day intervals at nine points in time using actigraphy and a sleep diary.

FINDINGS

Although the experimental caregivers generally reported that the system was "of great help" in relieving worry about nighttime activity, no significant group differences were found using multilevel modeling analyses. With regard to total sleep time, time awake after sleep onset, and sleep quality, multilevel models did not demonstrate any changes in sleep between groups, either averaged over time or for the interaction of group and time.

CONCLUSIONS

Since previous analysis of our qualitative data suggested improvements in caregiver worry and sleep, problems other than night awakenings may be perpetuating the sleep problem. Future studies should include testing of multimodal sleep interventions.

CLINICAL RELEVANCE

Caregivers have high amounts of unwanted wake time during the night and additional research is needed to identify effective interventions to improve their sleep.

What can low and high technologies do for late-life mental disorders?

PURPOSE OF REVIEW

To identify and review the latest research in the use of low and high technology in the areas of mood disorders, psychosis, normal ageing, mild cognitive impairment and dementia.

RECENT FINDINGS

Technology use varied in type and extent of use across the different areas that have been reviewed. Telepsychiatry, internet-delivered therapy programs and bright-light therapy were used in managing symptoms associated with depression. In psychosis, multisensory therapy, reminiscence and virtual cognitive stimulation showed some benefits. Navigation aids and computerized diaries assisted in maintaining independence in the normally ageing and mildly cognitively impaired, although the benefits of cognitive stimulation are yet to be consistently established. By far, dementia technology received the most research attention. Benefits in this population included reductions in behavioural and psychological symptoms and carer burden and increased independence, task engagement and safety.

SUMMARY

Research in the use of low and high technology in late-life mental disorders continues to evolve in its scope and innovation. To progress the accessibility and acceptability of technology, involvement of stakeholders and users in the design and application, as well as examination of cost-effectiveness and robust methodologically designed studies are necessary.

Non-pharmacological interventions for wandering of people with dementia in the domestic setting

BACKGROUND

A number of studies exist of interventions for wandering in the institutional setting, but much less work has been done on wandering in the domestic setting. The prevalence of wandering by people with dementia is difficult to assess; wandering is not a simple or static behaviour and the reasons why people wander remain unclear. In the absence of a theory of wandering and an agreed definition of wandering, it is difficult to discover effective strategies for managing wandering and difficult to design appropriate intervention strategies. Also, the same behaviour or type of wandering might occur for different reasons in different individuals; any theoretical formulation is going to have to allow for different triggers for the behaviour and so to get a 'one size fits all' kind of explanation is unlikely. Thus what we mostly encounter in this field is a 'trial and error' approach which does not always do justice to the complex interactions of personal and environmental factors that lead people with dementia to wander. While there seems to be a consensus in the literature that in the majority of cases non-pharmacological approaches may work as well as drug treatment and with fewer side effects, in practice clinicians often resort to drugs as the first line of treatment. This review reports the lack of evidence from RCTs and discusses the range of non-pharmacological interventions that have been carried out using other study designs.

OBJECTIVES

To evaluate the effectiveness and safety of non-pharmacological interventions in reducing wandering in the domestic setting by people with dementia. The secondary objective is to highlight the quality and quantity of research evidence available and to set an agenda for future research.

SEARCH STRATEGY

The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 11 May 2006 using the terms exit* or wander* or elopement or ambulat* or walk*. This Register contains records from all major healthcare databases and many ongoing trial databases and is updated regularly.

SELECTION CRITERIA

Randomised clinical trials comparing intervention with no intervention or usual treatment ('standard care') or another intervention.

DATA COLLECTION AND ANALYSIS

No suitable trials of non-pharmacological interventions for the prevention and management of wandering in the domestic setting were found.

MAIN RESULTS

As no randomised controlled trials were found, no results can be reported.

AUTHORS' CONCLUSIONS

There is an urgent need for randomised controlled trials of non-pharmacological interventions for wandering in the domestic setting.