Assistive technology for memory support in dementia

Review question

We wanted to find out from a review of the evidence whether Assistive Technology can help people with dementia overcome some of the effects of their memory problems.

Background

Dementia causes memory problems that make it increasingly difficult to carry out everyday activities, for example cooking, remembering appointments, taking medication. The memory problems experienced can have a large negative impact on people with dementia, and may cause confusion, anxiety, embarrassment, or depression. This decreasing ability to carry out daily activities can cause stress to family carers who worry about the person’s safety and well-being. A range of electronic devices — most commonly referred to as Assistive Technology (AT – used throughout this review), and sometimes as Electronic Assistive Technology (EAT) — have been developed to support people with dementia. The devices can be divided into four categories offering support with general and personal information (e.g. digital social charts); practical support with problems caused by the symptoms of dementia, especially memory loss (e.g. electronic pill dispenser boxes, electronic diaries); support with social contact and company (e.g. picture phones, interactive ‘pet’ robots); and support with perceived risks to health and safety (e.g. tracking devices, fall sensors). In this review, we concentrated on devices intended to help people manage their memory problems. We wanted to find our whether AT is effective at helping people who have memory problems due to dementia carry out their daily activities, and whether it makes them less dependent on others, improves their quality of life or has an effect on admission to institutional care. We also wanted to find out if it has any impact on family and paid carers.

Study characteristics

We searched systematically for all research studies that had evaluated AT by allocating people with dementia at random to an AT device or to 'usual care' or a non-technological solution to support memory and then comparing outcomes. Our search included all the evidence available up to 10 November 2016.

Key results

We found no studies that met our criteria.

Quality of the evidence

The review identified a lot of literature on the development of AT, including reports of researchers working with people with dementia and their carers to determine the type and design of AT which might be useful. There was also a lot of guidance written for health professionals and potential users of AT. We found some small studies that had tested the effectiveness of selected AT devices, but the methods used were not of a high enough quality to meet the review criteria. Therefore we cannot be sure at the moment whether or not AT can really help people with dementia manage their memory problems. We believe more research should be done in this area.

Authors' conclusions: 

This review highlights the current lack of high-quality evidence to determine whether AT is effective in supporting people with dementia to manage their memory problems.

Read the full abstract...
Background: 

The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. Also the low costs and wide availability of electronic devices make it more feasible to use electronic devices for the benefit of disabled persons. Information Communication Technology (ICT) devices designed to support people with dementia are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT). By using AT in this review we refer to electronic assistive devices. A range of AT devices has been developed to support people with dementia and their carers to manage their daily activities and to enhance safety, for example electronic pill boxes, picture phones, or mobile tracking devices. Many are commercially available. However, the usefulness and user-friendliness of these devices are often poorly evaluated. Although reviews of (electronic) memory aids do exist, a systematic review of studies focusing on the efficacy of AT for memory support in people with dementia is lacking. Such a review would guide people with dementia and their informal and professional carers in selecting appropriate AT devices.

Objectives: 

Primary objective

To assess the efficacy of AT for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living (ADL), level of dependency, and admission to long-term care.

Secondary objective

To assess the impact of AT on: users (autonomy, usefulness and user-friendliness, adoption of AT); cognitive function and neuropsychiatric symptoms; need for informal and formal care; perceived quality of life; informal carer burden, self-esteem and feelings of competence; formal carer work satisfaction, workload and feelings of competence; and adverse events.

Search strategy: 

We searched ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), on 10 November 2016. ALOIS is maintained by the Information Specialists of the CDCIG and contains studies in the areas of dementia prevention, dementia treatment and cognitive enhancement in healthy people. We also searched the following list of databases, adapting the search strategy as necessary: Centre for Reviews and Dissemination (CRD) Databases, up to May 2016; The Collection of Computer Science Bibliographies; DBLP Computer Science Bibliography; HCI Bibliography: Human-Computer Interaction Resources; and AgeInfo, all to June 2016; PiCarta; Inspec; Springer Link Lecture Notes; Social Care Online; and IEEE Computer Society Digital Library, all to October 2016; J-STAGE: Japan Science and Technology Information Aggregator, Electronic; and Networked Computer Science Technical Reference Library (NCSTRL), both to November 2016; Computing Research Repository (CoRR) up to December 2016; and OT seeker; and ADEAR, both to February 2017. In addition, we searched Google Scholar and OpenSIGLE for grey literature.

Selection criteria: 

We intended to review randomised controlled trials (RCTs) and clustered randomised trials with blinded assessment of outcomes that evaluated an electronic assistive device used with the single aim of supporting memory function in people diagnosed with dementia. The control interventions could either be 'care (or treatment) as usual' or non-technological psychosocial interventions (including interventions that use non-electronic assistive devices) also specifically aimed at supporting memory. Outcome measures included activities of daily living, level of dependency, clinical and care-related outcomes (for example admission to long-term care), perceived quality of life and well-being, and adverse events resulting from the use of AT; as well as the effects of AT on carers.

Data collection and analysis: 

Two review authors independently screened all titles and abstracts identified by the search.

Main results: 

We identified no studies which met the inclusion criteria.

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