Older Adults and Assistive Technology to Facilitate Occupation and Participation: A complex intervention

OsloMet Avhandling 2020 nr 31, av Torhild Holthe. Thesis submitted for the degree of Philosophiae Doctor (PhD). Department of Occupational Therapy, Prosthetics and Orthotics. Faculty of Health Sciences. OsloMet – Oslo Metropolitan University. Autumn 2020 ISSN 2535-471X (trykket) / ISSN 2535-5454 (online) ISBN 978-82-8364-276-6 (trykket) / ISBN 978-82-8364-287-2 (online

Digital Assistive Technology to Support Everyday Living in Community-Dwelling Older Adults with Mild Cognitive Impairment and Dementia

Objective: The objective of this review was to explore whether knowledge about and practice of technology for older adults with mild cognitive impairment (MCI) and dementia (D) had developed since our 2017 review. Furthermore, we wanted to explore the usability and acceptability of technology in the newer trials, and how these may impact quality of life, occupational performance and human dignity. Materials and Methods: We searched for primary studies published between 2017 and 2020 reusing medical subject heading (MeSH) terms in five databases – Medline, PsycINFO, Embase, Amed and Cinahl – and obtained 1452 titles. The titles were divided in six piles, two for each of the three authors. The titles were sorted utilizing the Rayyan web tool. Fourteen studies were included in this review. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies examined. Results: This review included almost twice as many participants as in the 2007– 2017 review. Since 2017, a shift seems to have occurred toward technologies that can be worn on the body to monitor body functions and report states, or imbalances. Moreover, research interest is now focused on mobile phone apps and wearables providing reminders and timely support, rather than on separate devices at home. Conclusion: The studies conducted since 2017 report on wearable and environmental digital assistive technologies and often with multiple purposes. Three strategies for support seem evident: prompting and reminding people with dementia, monitoring people with dementia at home using environmental sensors and biosensors and providing safety outdoors. Thus, there is still a need for further research on the impact of technologies promoting occupational performance, quality of life, and human dignity for independent living.publishedVersio

Matching user needs to technology in dementia care: experiences with the Alma Supervisor Educational Program

The number of individuals with dementia in Norway is more than 78,000, and, as in all other European countries, this figure is expected to rise over the coming decades. The Norwegian Health Directorate encourages municipalities to make use of ‘welfare technology’ in order to contribute to independent living and quality of life in older adults, to increase the quality of community health care, to save time when providing community health services and to reduce costs, e.g. admission to a nursing home. Introducing welfare technology to care recipients requires innovation on the part of the community health care service with regard to increasing the competency of the staff in the operation of the technologies, as well as in establishing an infrastructure for ‘digital communication’. Research has shown that access to assistive technology may support individuals with mild cognitive impairments, as well as in an early phase of dementia. However, it is crucial that the technology addresses an identified need, and that the device is tailored to the person’s preferences and context. Therefore, it is important to train health professionals to assess the user’s needs and preferences and to identify resources and limitations in the particular context. Alma’s House in Oslo is a demonstration site and education center for welfare technologies. The education program for the certification of Alma supervisors has become an important strategy in educating occupational therapists (OTs) and nurses on how to assess user needs, identify appropriate technology and implement this into the care recipient’s home

Velferdsteknologi som kommunal tjeneste til personer med kognitiv svikt/demens

SAMMENDRAG Et pilotprosjekt i Drammen kommune i 2014−2015 undersøkte hvorvidt velferdsteknologi kunne støtte opp om mestring og selvstendighet og trygge omgivelsene slik at personer med kognitiv svikt/tidlig fase av demens kunne bo lenger hjemme, med hjemmetjenester. Fem hjemmeboende personer med kognitiv svikt/ demens og deres pårørende ble rekruttert fra to hjemmetjenestedistrikt. Ulike typer velferdsteknologi ble implementert, og evaluert av to forskere hver annen/tredje måned. Pilotprosjektet varte i 12 måneder. Medarbeidere fra hjemmetjenesten deltok i refleksjonsgrupper der målet var kunnskapsutveksling. Ved avslutningen av prosjektet deltok seks medarbeidere fra de to hjemmetjenestedistriktene i fokusgruppeintervju. En tema-analyse fant at med arbeidere som hadde deltatt i refleksjonsgrupper mente at informasjon og refleksjon om velferdsteknologiske tiltak økte deres bevissthet knyttet til hensikt og praktisk bruk av teknologi. Det å følge opp teknologien hjemme hos deltakerne og se den i praksis gav verdifull læring. Lærdommen fra prosjektet er at det er behov for å utbedre dagens praksis, spesielt knyttet til opplæring både av medarbeidere og tjenestemottakere. Tverrfaglig samarbeid og effektiv formidling kan forbedres slik at velferdsteknologiske løsninger blir relevante tidlige tiltak som er tilpasset brukernes behov

Digital Assistive Technology to Support Everyday Living in Community-Dwelling Older Adults with Mild Cognitive Impairment and Dementia

Objective: The objective of this review was to explore whether knowledge about and practice of technology for older adults with mild cognitive impairment (MCI) and dementia (D) had developed since our 2017 review. Furthermore, we wanted to explore the usability and acceptability of technology in the newer trials, and how these may impact quality of life, occupational performance and human dignity. Materials and Methods: We searched for primary studies published between 2017 and 2020 reusing medical subject heading (MeSH) terms in five databases – Medline, PsycINFO, Embase, Amed and Cinahl – and obtained 1452 titles. The titles were divided in six piles, two for each of the three authors. The titles were sorted utilizing the Rayyan web tool. Fourteen studies were included in this review. The Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the studies examined. Results: This review included almost twice as many participants as in the 2007–2017 review. Since 2017, a shift seems to have occurred toward technologies that can be worn on the body to monitor body functions and report states, or imbalances. Moreover, research interest is now focused on mobile phone apps and wearables providing reminders and timely support, rather than on separate devices at home. Conclusion: The studies conducted since 2017 report on wearable and environmental digital assistive technologies and often with multiple purposes. Three strategies for support seem evident: prompting and reminding people with dementia, monitoring people with dementia at home using environmental sensors and biosensors and providing safety outdoors. Thus, there is still a need for further research on the impact of technologies promoting occupational performance, quality of life, and human dignity for independent living

A critical occupational perspective on user engagement of older adults in an assisted living facility in technology research over three years

Digital assistive technology has potential for supporting older adults who depend upon community healthcare services. To boost the efficiency of those services, technological devices are often installed for care recipients as part of governed practice. However, the varying adoption of technology risks widening the digital divide. In response, the Assisted Living project engaged older adults in co-creating knowledge about users’ needs, to guide the development of technological solutions designed to support everyday living. This study sought to investigate how eight older adults in an assisted living facility in Norway, aged 81–92 years, evaluated user inclusion in a 3-year technology-oriented research project. Individual interviews, dialogue cafés, interventions with environmental sensors, and a final focus group discussion constituted sites for co-creation of knowledge. Participants’ answers to standardised questionnaires and statements during dialogue café meetings were collated into tables and the focus group discussion was thematically analyzed, with three themes identified: motivation for project engagement, experiencing and understanding participation in the project, and mixed feelings towards environmental sensors at home. The project revealed that older adults with impairments could nevertheless meaningfully contribute opinions about their needs. Applying a critical occupational perspective raised awareness regarding sociocultural assumptions about older adults in assisted living as frail and unable to participate, which may reinforce ageist and ableist stereotypes, as well as promote occupational injustice

Usability and acceptability of technology for community-dwelling older adults with mild cognitive impairment and dementia: A systematic literature review

Background: The objective of this review was to obtain an overview of the technologies that have been explored with older adults with mild cognitive impairment and dementia (MCI/D), current knowledge on the usability and acceptability of such technologies, and how people with MCI/D and their family carers (FCs) were involved in these studies. Materials and methods: Primary studies published between 2007 and 2017 that explored the use of technologies for community-dwelling people with MCI/D were identified through five databases: MEDLINE, PsycINFO, Embase, AMED, and CINAHL. Twenty-nine out of 359 papers met the criteria for eligibility. We used the Mixed Methods Appraisal Tool for quality assessment. Results: A wide range of technologies was presented in the 29 studies, sorted into four domains: 1) safe walking indoors and outdoors; 2) safe living; 3) independent living; and 4) entertainment and social communication. The current state of knowledge regarding usability and acceptability reveals that even if researchers are aware of these concepts and intend to measure usability and acceptability, they seem difficult to assess. Terms such as “user friendliness” and “acceptance” were used frequently. User participation in the 29 studies was high. Persons with MCI/D, FCs, and staff/other older adults were involved in focus groups, workshops, and interviews as part of the preimplementation process. Conclusion: Research regarding technologies to support people with MCI/D seems optimistic, and a wide range of technologies has been evaluated in homes with people with MCI/D and their FCs. A major finding was the importance of including people with MCI/D and their FCs in research, in order to learn about required design features to enhance usability and acceptability. Surprisingly, very few studies reported on the consequences of technology use with regard to quality of life, occupational performance, or human dignity

Technological Care. Health Professionals’ Discourses on Technology in Home-Based Services Seen Through a Capability Approach

This article is a contribution to the reflection upon what forms of assistive technologies societies should provide to users of home-based services. The material is collected from five focus group interviews conducted in Oslo in 2016 as part of a research project into assistive technologies with the purpose to gain knowledge of how such technologies were used in the home-based services. The interviews are analyzed on the basis of Martha Nussbaum’s capability approach in order to see what forms of technologies influenced the users’ capabilities. Thereafter, the technologies are classified as either public or private technologies in order to see what forms of capabilities the public care for and which technologies that are in the domain of private initiative. Based on the focus groups, it seems that public technologies are targeted at bodily health and integrity, while private technologies on communication and infrastructure, with some notable exceptions. The paper ends with discussions on the seemingly paradoxical situation that publicly supported technologies aim at the private sphere while the privately acquired technologies focus on public activities