The experience of using prompting technology from the perspective of people with Dementia and their primary carers

OBJECTIVES

People who are living with dementia typically experience difficulties in completing multi-step, everyday tasks. However, digital technology such as touchscreen tablets provide a means of delivering concise personalised prompts that combine audio, text and pictures. This study was one component of a broader, mixed methods study that tested how an application (app) -based prompter running on a touchscreen tablet computer could support everyday activities in individuals with mild to moderate dementia. In this study we set out to understand the experiences of people living with dementia and their primary carer in using the prompter over a four-week period.

METHOD

We collected qualitative data using semi-structured interviews from 26 dyads, composed of a person living with dementia and their carer. Dyads were interviewed at the start and end of this period. Transcripts were then analysed using thematic analysis.

RESULTS

The study identified three overarching themes related to: participants' attitudes towards the technology; their judgements about how useful the prompter would be; and the emotional impact of using it.

CONCLUSION

Consistent with the Technology Acceptance Model, carers and participants were influenced by their approaches to technology and determined the usefulness of the prompter according to whether it worked for them and fitted into their routines. In addition, participants' decisions about using the prompter were also determined by the extent to which doing so would impact on their self-identity.

Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol

INTRODUCTION

Older people with multimorbidities frequently access 999 ambulance services. When multimorbidities include dementia, the risk of ambulance use, accident and emergency (A&E) attendance and hospital admission are all increased, even when a condition is treatable in the community. People with dementia tend to do poorly in the acute hospital setting and hospital admission can result in adverse outcomes. This study aims to provide an evidence-based understanding of how older people living with dementia and other multimorbidities are using emergency ambulance services. It will also provide evidence of how paramedics make decisions about taking this group of patients to hospital, and what resources would allow them to make more person-focused decisions to enable optimal patient care. METHODS AND ANALYSIS: Phase 1: retrospective data analysis: quantitative analysis of ambulance service data will investigate: how often paramedics are called to older people with dementia; the amount of time paramedics spend on scene and the frequency with which these patients are transported to hospital. Phase 2: observational case studies: detailed case studies will be compiled using qualitative methods, including non-participant observation of paramedic decision-making, to understand why older people with multimorbidities including dementia are conveyed to A&E when they could be treated at home or in the community. Phase 3: needs analysis: nominal groups with paramedics will investigate and prioritise the resources that would allow emergency, urgent and out of hours care to be effectively delivered to these patients at home or in a community setting.

ETHICS AND DISSEMINATION

Approval for the study has been obtained from the Health Research Authority (HRA) with National Health Service (NHS) Research Ethics Committee approval for phase 2 (16/NW/0803). The dissemination strategy will include publishing findings in appropriate journals, at conferences and in newsletters. We will pay particular attention to dissemination to the public, dementia organisations and ambulance services.

'Coming out' with Alzheimer's disease: changes in awareness during a psychotherapy group for people with dementia

This paper forms part of the second phase of a project looking at those changes that occurred for participants during a series of time-limited psychotherapy groups for people with dementia. Using the Assimilation of Problematic Experiences Scale (APES), the accounts of one participant (Robert) are analyzed across the course of the group. Robert moves from a position in which he wards off awareness that he has dementia of the Alzheimer's type, to being able to joke about having brain changes that are symptomatic of the illness. This change in his discourse about Alzheimer's disease was accompanied by an increase in Robert's levels of affect. However, reflecting on the changes that had occurred for him, Robert commented that before he came to the group he had been frightened, thinking that 'I'm going crazy?...?what am I going to be like in another five years?'. For Robert, coming to the group had meant that this fear had been replaced by the knowledge that he was not alone. In the light of the move towards early diagnosis, the importance of this model of change in awareness as a means of increasing understanding of the process of emotional development is discussed.'...?but I think that a lot of people who I have met who have come out about Alzheimer's were quite shocked because I said that. It did help, it may not have helped others, but I suppose that it helps overcome a feeling of being different.'Janet, session six.

Group psychotherapy and people with dementia

Psychotherapy and counselling approaches are being used increasingly with people with dementia, but there has been little structured research into the effectiveness of such work. This research reports findings from the evaluation of six, ten-week long psychotherapy groups for people with dementia in the south of England. Measures of depression and anxiety were taken independently of the clinical work at four time points: six weeks before the group began, at the start of the group, at the end of the group and at follow-up after a gap of ten-weeks. Forty-two participants entered the project at different points, of whom 19 completed the baseline, intervention and follow-up phases of the project. Analysis of the data for depression and anxiety levels using a repeated measures ANOVA showed a statistically significant treatment effect for Cornell depression scores which was maintained at follow-up and a similar reduction in anxiety as measured by the rating for anxiety in dementia (RAID) which was borderline for significance. Although not all people with dementia would be suitable for group psychotherapy, nevertheless this research provides some of the first clear evidence that group psychotherapy may have a role to play in reducing levels of depression and anxiety of people with mild and moderate levels of dementia.

Brains, minds and selves: changing conceptions of the losses involved in dementia

Until the last 10 years or so, dementia research had been dominated by the psychiatric or medical approach to dementia. However, increasing numbers of new psychological and social psychological approaches to dementia have begun to emerge. Consequently, there has been a significant change in the descriptions of the losses involved in the dementing process: from being represented in terms of brain functioning, they have become repositioned as occurring within both personal and social contexts. We elaborate these frameworks and apply them to three phenomena associated with dementia--depressions, delusions and denial. While these conceptualizations are limited by a number of difficulties, they nevertheless represent a significant change in approaches to dementia care and allow the potential for positive change through psychological as well as chemical means. The emergence of these new accounts of the losses involved in dementia needs to be matched by the equivalent development of effective psychosocial interventions to maintain individuals within their own homes.

Psychotherapeutic work with people with dementia: a review of the literature

Until recently, psychotherapy and counselling techniques have rarely been used with people with dementia. However, the change in emphasis within dementia care towards a person-centred approach has meant that there is a growing clinical interest in their use. This paper reviews the published literature in this area which bears on psychotherapy assessment, intervention and evaluation. Although there is a developing clinical literature on intervention techniques drawn from all the main psychotherapeutic approaches, there has been little research into the effectiveness of this work and such research as does exist often uses methodologies that are inappropriate for such an early stage of clinical development. It is argued that clinical research should adopt case study or single-case designs that are more appropriate than group designs for evaluating new clinical developments.