94 research outputs found

    A preliminary evaluation of a client-centred prompting tool for supporting everyday activities in individuals with mild to moderate levels of cognitive impairment due to dementia

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    Objectives: Technology-based prompting has the potential to support people with dementia to complete multistep tasks in the home. However, these devices can be complex to use. This paper reports a feasibility trial of a personalised touchscreen digital prompter designed for home use. Methodology: A tablet-based prompter suitable for people living with dementia was developed, along with a detailed guidance manual. Carers loaded instructions for completing the task onto the prompter, and the person with dementia then used the tablet independently to complete a task. Eleven couples used the prompter ā€˜out-of-the-boxā€™ with no support other than a guidance manual. Results: The majority of participants with dementia could follow the steps on the prompter, and carers were able to breakdown and load tasks onto the prompter. Eight couples used the prompter successfully to complete goals that they had identified in advance. These included preparing simple snacks and using a TV remote control. Successfully achieving goals was associated with more frequent use of the prompting screen on more days, but not higher levels of editing or previewing of tasks. Conclusion: The study provides the preliminary evidence that family caregivers can use a touchscreen tablet, software and manual package to identify specific tasks and break these down into steps and that people living with dementia can then follow the prompts to complete the tasks. This potentially represents an important advance in dementia care. Further testing is required to establish efficacy and to identify any factors that impact on outcomes

    Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review

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    Background Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science & Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58%) reported postintervention improvements in outcomes. Conclusions Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M

    Involvement of People With Dementia in the Development of Technology-Based Interventions: Narrative Synthesis Review and Best Practice Guidelines

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    Background: Technology can be helpful in supporting people with dementia in their daily lives. However, people with dementia are often not fully involved in the development process of new technology. This lack of involvement of people with dementia in developing technology-based interventions can lead to the implementation of faulty and less suitable technology.Objective: This systematic review aims to evaluate current approaches and create best practice guidelines for involving people with dementia in developing technology-based interventions.Methods: A systematic search was conducted in January 2019 in the following databases: EMBASE (Excerpta Medica database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulated Index to Nursing and Allied Health Literature), and Web of Science. The search strategy included search terms in 3 categories: dementia, technology, and involvement in development. Narrative synthesis wove the evidence together in a structured approach.Results: A total of 21 studies met the inclusion criteria. Most studies involved people with dementia in a single phase, such as development (n=10), feasibility and piloting (n=7), or evaluation (n=1). Only 3 studies described involvement in multiple phases. Frequently used methods for assessing involvement included focus groups, interviews, observations, and user tests.Conclusions: Most studies concluded that it was both necessary and feasible to involve people with dementia, which can be optimized by having the right prerequisites in place, ensuring that technology meets standards of reliability and stability, and providing a positive research experience for participants. Best practice guidelines for the involvement of people with dementia in developing technology-based interventions are described

    Impact of assistive technologies in supporting people with dementia.

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    In recent decades, many Assistive Technologies (ATs) have been developed to promote independence among people with dementia (PWD). Although there is a high rate of AT abandonment, only a handful of studies have focused on AT usability evaluation from the user point of view. The aim of this thesis is to empirically investigate the usability of ATs from the PWD and to measure its impacts on their lives. Following the Multi-methods research approach, the first part of the thesis uses secondary research methods including literature review and systematic mapping studies. The second part uses primary research methods including interviews (N=20) and questionnaire (N=327) based surveys for data collection and requirements elicitation. The third part is based on the design, development, and testing of an assistive software application through case studies (N=8). The first mapping study categorised existing general ATs into five major categories: robotics, monitoring, reminders, communication, and software. The second mapping study categorised software-based ATs into nine categories: cognitive help, reminders, health/activity monitoring, socialization, leisure, travel help, dementia detection, dementia prevention, and rehabilitation. The qualitative results showed that most of the PWD use ATs for socialization, and highlighted user interface efficacy, tailoring individual needs, and simplified functions as the major limitations of existing ATs. The quantitative results identified eleven factors for ATs usage: operational support, physical support, psychological support, social support, cultural match, reduced external help, affordability, travel help, compatibility, effectiveness, and retention. The statistical analysis showed that improved (social, psychological and travel) support and reduced need of external help for operating ATs, greatly impact AT effectiveness and retention. Based on PWD requirements, an assistive software application named E-Community for Dementia (ECD) was developed and tested through case studies involving 8 PWD and 40 volunteers. The participants were able to get their daily needed items in less time and with a friendlier manner through the help of their neighbours. The involvement of the caregivers for medication, meals, prayers etc. reduced significantly. The painting function helped evoke their memories, and encouraged them to perform activities from their youth. The news and weather functions kept them updated about the world around them. The travel tutor guided them in safe travel outside home and made sure that they got back home independently. The enhanced interaction between the PWD and their neighbours significantly reduced their social isolation. The results support the idea to create dementia-friendly communities at street levels, which is a cost-effective and reliable solution. The major outcomes from this thesis are AT categorization, evaluation of user experiences, factor identification and ranking, user requirements elicitation, assistive software application development, and case studies. This thesis helps considerably towards empirical investigation of the impact of ATs in supporting the PWD. The implementation of the ECD contributes towards the wellbeing of the PWD and saves costs spent on caregivers and carer companies. In future, the same study could be conducted in other settings to analyse the role of culture in AT acceptance

    Literature review: the cost effectiveness of assistive technology in supporting people with dementia

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    Despite much emphasis on the potential of assistive technologies of many varieties to deliver cost effective ways of supporting people with dementia, and clear indications of this potential, rigorous cost-effectiveness studies of these technologies for this group remain largely absent. The review includes consideration of the indicative evidence. This report describes the process and results of the literature review. Extensive searches identified a large literature, of which 59 items were systematically reviewed and quality assessed.We are indebted to the Dementia Services Development Trust who funded the study as part of the work of the Dementia Services Development Centre in Northern Ireland. This work is supported by the Atlantic Philanthropies and the Northern Ireland DHSSPH

    Progress in ambient assisted systems for independent living by the elderly

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    One of the challenges of the ageing population in many countries is the efficient delivery of health and care services, which is further complicated by the increase in neurological conditions among the elderly due to rising life expectancy. Personal care of the elderly is of concern to their relatives, in case they are alone in their homes and unforeseen circumstances occur, affecting their wellbeing. The alternative; i.e. care in nursing homes or hospitals is costly and increases further if specialized care is mobilized to patientsā€™ place of residence. Enabling technologies for independent living by the elderly such as the ambient assisted living systems (AALS) are seen as essential to enhancing care in a cost-effective manner. In light of significant advances in telecommunication, computing and sensor miniaturization, as well as the ubiquity of mobile and connected devices embodying the concept of the Internet of Things (IoT), end-to-end solutions for ambient assisted living have become a reality. The premise of such applications is the continuous and most often real-time monitoring of the environment and occupant behavior using an event-driven intelligent system, thereby providing a facility for monitoring and assessment, and triggering assistance as and when needed. As a growing area of research, it is essential to investigate the approaches for developing AALS in literature to identify current practices and directions for future research. This paper is, therefore, aimed at a comprehensive and critical review of the frameworks and sensor systems used in various ambient assisted living systems, as well as their objectives and relationships with care and clinical systems. Findings from our work suggest that most frameworks focused on activity monitoring for assessing immediate risks while the opportunities for integrating environmental factors for analytics and decision-making, in particular for the long-term care were often overlooked. The potential for wearable devices and sensors, as well as distributed storage and access (e.g. cloud) are yet to be fully appreciated. There is a distinct lack of strong supporting clinical evidence from the implemented technologies. Socio-cultural aspects such as divergence among groups, acceptability and usability of AALS were also overlooked. Future systems need to look into the issues of privacy and cyber security

    Training Parents to Implement the Picture Exchange Communication System Via Telehealth and Behavioural Skills Training

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    Research indicates that deficits in functional communication skills correlate with problem behaviour. Results from previous studies suggests that by teaching functional communication skills to an individual, it may be possible to replace problem behaviour with more socially appropriate means of communicating their needs and wishes. The primary aim of the current study was to investigate whether parents could be trained to implement the Picture Exchange Communication System (PECS) effectively with their adolescent son, Jack (pseudonym), who has an intellectual disability. The effectiveness of telehealth to administer PECS training was evaluated in conjunction with the use of behavioural skills training. Additionally, errors made by the parents in their use of PECS during training sessions where the researcher provided them with prompts were also examined. The secondary aim of the study was to investigate the effect of the aforementioned PECS training on the functional communication skills of Jack in the home environment. The most significant findings of the current study were that telehealth was a viable method of teaching PECS to parents, that parents made fewer errors for subsequent sessions within each phase, and that a greater number of errors were made in the role of communicative partner compared to physical prompter during Phase One. Results of the study also suggest that the intervention resulted in increased functional communication skills for Jack; namely the emergence of mands for particular toys and for making requests for the continuation of activities he enjoyed

    Dementia Care during a Healthcare Crisis

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    Living through the COVID-19 crisis, Dementia care in Healthcare Crisis project highlights existing challenges faced by dementia patients in the long-term care system. Through this study, the ļ¬eld of study is explored using foresight methods to better understand future care provisions in the event of impending pandemics. The project empathizes with patients in the Ontario system of long-term care while being cognizant of the dilemmas that emerge as a result of healthcare crisis. It reviews current literature and emerging forces of change to understand how things can develop in the future. With scientists assuring the occurrence of future pandemics as a result of globalization and migration, it is assumed the next pandemic will disturb the global environment 15 years into the future, in the year 2035. This project aims to develop alternative future scenarios that discover potential ideas which need to be further worked upon to provide the best form of care for dementia patients

    INFORMAL CAREGIVER IDENTITY: VOLUNTARY JOB FIT, TEAMWORK, AND TOOLS

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    According to the Family Caregiver Alliance, an informal or family caregiver is ā€œan unpaid individual . . . involved in assisting others with activities of daily living and/or medical tasks.ā€ As informal caregiving in the United States has increased, research on the topic has been published in a myriad of disciplines (e.g., sociology, nursing, social work, and medicine). The literature has defined informal caregivers (ICGs), described their role and its impacts, detailed the costs and benefits of informal caregiving, and evaluated interventions to assist ICGs. Scholars have also investigated more natural, less experimental use of informational and support resources for ICGs than, for example, interventions via informational websites or support groups, but they have not thoroughly explored their effects. This study used semistructured interviews with ICGs catering to care recipients (CRs) with various conditions and characteristics (e.g., ages) to explore ICGsā€™ authentic use of caregiving-related resources for providing care and for coping with the often complex and fluctuating demands of their role. Using a theoretical sample of 25 ICGs, this grounded theory study yielded a number of findings. Study participantsā€™ comments revealed that they conceived of informal caregiving as more akin to a volunteer job than to a career. Because the study sample contained primary, secondary, and other nonprimary caregivers, I observed that the participantā€™s position in the caregiving project team, in conjunction with overall team functioning, influenced their caregiving experience. The proportion of helpful resources relative to unhelpful resources, however, was not related to whether or not ICGs identified positive aspects of the job. The quality of relationships with other members of the formal and informal caregiving team proved to have more influence on whether or not ICGs identified any positive aspects of the job. In addition, the Internet proved to be a largely beneficial caregiving tool for those who used it. Although the Internet was most often used to seek information, it helped ICGs cope by enabling them to build personal coping resources and by offering social support by connecting users to similar others. These findings suggest the need for early identification of prospective caregiving team members to (1) optimize the calibration of caregiver abilities and (2) establish a division of labor to diminish the caregiving workload while building greater appreciation among team members for the contributions and capacities of the others

    Engaging older adults and people with dementia in the design of digital technologies

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    PhD ThesisImprovements in healthcare and nutrition have led to increased life expectancies for people around the world, and a growing need to support the larger numbers of older people living with chronic and age-related health conditions. Although the use of digital technologies is increasingly proposed for health and social care solutions, in practice the designers of these technologies are ill equipped to actively engage older people and in particular people with syndromes such as dementia. An examination of previous work on design for older people, and people with dementia, suggests that poor design arises from a gulf in knowledge and experience between the designers and their subjects. To address this divide the KITE participatory design method for engaging people with dementia in design is proposed. KITE facilitates engagement by structuring and scaffolding an empathic relationship between designers and their participants. The approach is elaborated and evaluated through an exercise to design a digital technology to help people with dementia have safe walking experiences. The analysis of this process leads to the formulation of the OASIS design method which is intended to apply to older people more generally. OASIS is evaluated and refined through a number of design studies for technologies to support healthy eating, day-to-day travelling needs and living safely within the community. Reflection on the application of the OASIS method highlights a number of key strategies that can be used to establish and maintain respectful, empathic, and productive participatory design relationships with older adults and people with dementia
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