Abstract
BackgroundWith 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.ObjectiveThe 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.MethodsReviews 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.ResultsAccording 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.ConclusionsBased 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.
Highlights
Conditions during foetal life and the first two years after birth are important for determining final brain size
In the course of this review, to inform health promotion and disease prevention strategies, we have examined critically the evidence for the existence of modifiable risk factors for dementia
In summarising the evidence for modifiable risk factors, we have considered this separately for exposures that are assessed in midlife and late-life (Tables 6.1)
Summary
Conditions during foetal life and the first two years after birth are important for determining final brain size. Some studies have found a discrepancy between the degree of brain pathology and the clinical symptomatology of Alzheimer’s disease (AD). The brain and skull grow rapidly, with 95% of growth achieved by the age of six years. Dementia is a syndrome caused by a number of progressive illnesses that affect memory, thinking, behaviour and the ability to perform everyday activities. It mainly affects older people but 2 to 10% of all cases are estimated to start before the age of 65 years. Dementia syndrome is linked to a large number of underlying brain pathologies. Alzheimer’s disease (AD), vascular dementia (VaD), dementia with Lewy bodies and frontotemporal dementia are the most common (Table 1.1)
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