Wearables for residents of nursing homes with dementia and challenging behaviour: Values, attitudes, and needs

Abstract

Background: Challenging Behaviour (CB) occurs in up to 80% of nursing home residents with dementia. Identifying stressors causing CB is difficult (as residents themselves cannot indicate what is experienced as stressful), thereby hampering the psychosocial approach. Nowadays, stress-related biomedical variables, such as (aberrant) physical activity, skin temperature, heart activity, and skin conductance, can be measured continuously and relatively easily using wearable sensors. Next to validation of algorithms (i.e. the relationship between wearable data and CB), it is of utmost importance to consider the different values, attitudes, and needs of all stakeholders involved to successfully develop, apply and implement this technology. Objective: To identify the values, needs, and attitudes of multiple stakeholders regarding wearables in the care of people with dementia and CB. Method: A qualitative study was conducted, in which a real-life context was created in a Dutch nursing home. Two residents with CB wore the Empatica E4 wristband for three half-days. Multiple stakeholders (i.e., eight involved nurses and eight informal caregivers) were interviewed. Subsequently, results were used for designing two focus groups. The first focus group included formal (n=6) and informal (n=6) caregivers. The second focus group consisted of community-dwelling people with dementia (n=7) and their informal caregivers (n=5) and case managers (n=2). Results: Stakeholders accepted the wearable as a supportive technology in the care of people with dementia and CB. Expected value, user comfort, need for information, and design (including customizability and stigmatization) were important themes. During the focus groups, explicit recommendations were given by the participants with respect to the wearables’ design. Conclusion: In order to enhance the adoption of wearable sensors in CB and dementia on an individual level, information about the technology and the design of the wearable deserves more explicit attention in clinical practice and future research.