Shirley Evans

Technologies to support community-dwelling persons with dementia: a position paper on issues regarding development, usability, effectiveness and cost-effectiveness, deployment, and ethics

Background With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

Framing outcomes of post-diagnostic psychosocial interventions in dementia: the Adaptation-Coping Model and adjusting to change

Purpose The purpose of this paper is to describe the Adaptation-Coping Model developed by Droes in the Netherlands to frame the process of optimal adjustment for people diagnosed with dementia. This model is not well-known in English-speaking countries, but appears to have much to offer practitioners and researchers. As part of a large EU research project (MeetingDem) the authors translated and utilised this model in piloting the Dutch Meeting Centre Support Programme in the UK. This is a local community place-based approach to post-diagnostic psychosocial support. It is aimed at people diagnosed with dementia alongside their families and has proven benefits. Design/methodology/approach The Adaptation-Coping Model underpins the support provided by the Meeting Centre Programme. The model and its translation into the UK context are described. Focus groups were undertaken with people living with dementia (n=9) and family carers (n=6) at the UK Meeting Centre pilot. Examples from these focus groups are provided in order to illustrate different aspects of the model. Findings The translated Adaptation-Coping (adjusting to change) Model provides a way for service users (people with dementia and families) to conceptualise their journey with dementia post-diagnosis, and potentially provides service providers and researchers with aims for treatment and support. Research limitations/implications These are initial observations based on a UK pilot service. Originality/value Ways of conceptualising psychosocial support for people living with dementia often do not get translated between countries. This model has been successfully utilised within the Netherlands for many years. This paper highlights the opportunity to build on this in English-speaking countries.

Using a Virtual Learning Environment to deliver transitional skills at the Royal National College for the Blind

This paper reviews how a Virtual Learning Environment (VLE) was used as an Innovative way to deliver transitional skills to 16 to 19 year-old students at the Royal National College for the Blind in Hereford. Focusing on the pilot phase, it examines the choice of delivery, describes the planning and process, and refiects on this from the perspectives of tutors, students and a learning technalogist, A major consideration was the accessibility and usability of the technology and whether it would be feasible to introduce a VLE as a cross-college initiative. This pilot was a success in respect of its primary objective and has been the springboard for wider use of VLEs in college and further quantitative and qualitative research.

FACTORS INFLUENCING ADAPTIVE IMPLEMENTATION OF THE MEETING CENTRES SUPPORT PROGRAMME IN FOUR EUROPEAN COUNTRIES: RESULTS OF THE MEETINGDEM PROJECT

English care homes. We compared ratings and investigated whether staff, family carer and resident characteristics were associated with ratings of staff and family proxy QoL using multilevel modelling. Results: There was a significant difference between staff and family DEMQOL proxy mean scores (104 and 101 respectively), (Z 1⁄4 -7.15, p 1⁄40.00). The correlation between scores was low (0.35). Family proxy raters were more likely than staff to rate QoL as “Poor” (X2 1⁄4 55.91, p 1⁄4 0.00). Exploratory analysis looking at different factors associated with ratings will be presented. Conclusions: Staff and family proxy raters think differently about the QoL of somebody living with dementia in care homes. We need to consider carefully what we are measuring when QoL is rated via a proxy in a care home and who the proxy rater is. Investigating further the factors associated with different perspectives of QoL can inform our evaluation of existing interventions and inform the development of future interventions to improve QoL for people with dementia living in care homes.