Assistive technologies to address capabilities of people with dementia: from research to practice

Assistive technologies (AT) became pervasive and virtually present in all our life domains. They can be either an enabler or an obstacle leading to social exclusion. The Fondation Médéric Alzheimer gathered international experts of dementia care, with backgrounds in biomedical, human and social sciences, to analyse how AT can address the capabilities of people with dementia, on the basis of their needs. Discussion covered the unmet needs of people with dementia, the domains of daily life activities where AT can provide help to people with dementia, the enabling and empowering impact of technology to improve their safety and wellbeing, barriers and limits of use, technology assessment, ethical and legal issues. The capability approach (possible freedom) appears particularly relevant in person-centered dementia care and technology development. The focus is not on the solution, rather on what the person can do with it: seeing dementia as disability, with technology as an enabler to promote capabilities of the person, provides a useful framework for both research and practice. This article summarizes how these concepts took momentum in professional practice and public policies in the past fifteen years (2000-2015), discusses current issues in the design, development and economic model of AT for people with dementia, and covers how these technologies are being used and assessed

Pillar-structured microchannels for on-chip liquid chromatography: Evaluation of the permeability and separation performance

The chromatographic characteristics were determined for a set of microfabricated separation channels structured with cylindrical and diamond-shaped pillars with a characteristic size of 5 µm. Channels with different structures and porosities were etched in a silicon wafer using lithographic techniques. The permeability for flow of the channels was shown to increase strongly with the overall porosity. Diamond-shaped pillars appeared to yield a slightly higher permeability than cylindrical pillars at the same channel porosity. Compared to packed columns, permeabilities were higher by a factor of up to 5. Band dispersion in the channels was measured with an unretained fluorescent probe compound using a fluorescence microscope. A relatively large variation in the observed plate heights between channels was found, which was mainly attributed to the inaccurate geometry of the structure close to the side walls. Reduced plate heights between 0.2 and 1.0 were obtained. The lowest plate heights were found for channels with low porosity. The chromatographic impedances were calculated and compared to the values for the traditional chromatographic systems. For one of the structured microchannels the impedance was found to be more than ten times lower than for a column packed with nonporous spherical particles. With the data collected, predictions are given on the possibilities in terms of efficiency and speed offered by structured microchannels for pressure-driven separations, taking practical constraints into account

How do geriatricians evaluate decision-making ability for older adults with cognitive impairment? Results from an European survey

International audienceContext: The assessment of decision-making ability of older adults with cognitive impairment is a complex challenge that geriatricians often face in relation to risk-taking situations (driving, aging in place, financial decisions, etc.). However, there are no clear and consensual practice guidelines. An overview of current practices and needs seemed necessary. Methods: We co-created and conducted an online survey to describe practice and knowledge, among European geriatricians. The survey was structured in 3 parts: a description of the professional’s practice regarding cognitive impairment, a specific questionnaire about everyday risky decision-making evaluation and an investigation of the clinician’s knowledge about relevant ethical and legal recommendations. Each part consisted of both multiple choice and open questions, analyzed through descriptive statistics and qualitative analysis methods. Results: Based on the responses of 123 geriatricians across Europe, our survey showed that clinical interview is the cornerstone of geriatric assessment of decision-making ability of patients with mild to moderate dementia. When faced with risk-taking dilemma situations, geriatricians tend to favor a context of safety above autonomy, but they can support risky decision-making if it is consistent with the patient’s previous lifestyle, depending on the degree of risk to self and others, on the decision-making ability assessed, and if there is some form of shared decision-making. Conclusion: Assessing decision-making ability is challenging for geriatricians, who in our study relied more on their clinical interview and global cognitive tests than more in-depth evaluations. Supporting independent decision-making, when associated with risk-taking, requires better detection and anticipation shared with the patient environme