Assistive technologies for demented elderly: a systematic review

Maia, Juliana Cunha; Coutinho, Janaína Fonseca Victor; Sousa, Caroline Ribeiro de; Barbosa, Rachel Gabriel Bastos; Mota, Fernanda Rochelly do Nascimento; Marques, Marília Braga; Silva, Rávida da Rocha Lima; Lima, Rayanne Branco dos Santos

doi:10.1590/1982-0194201800089

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Acta Paulista de Enfermagem

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Systematic Review • Acta Paul Enferm 31 (6) • Nov-Dec 2018 • https://doi.org/10.1590/1982-0194201800089 copy

Assistive technologies for demented elderly: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Analyze intervention studies using assistive technologies to help demented elderly with the execution of Basic and Instrumental Activities of Daily Living.

Methods

A survey was undertaken in the databases CINAHL, MEDLINE/PubMed, LILACS, SCOPUS, Scielo, Cochrane and Web of Science . The descriptors used were dementia /demência, aged /idoso, self-help devices /equipamentos de autoajuda. The methodological quality of the selected articles was analyzed by means of the Physiotherapy Evidence Database (PEDro) assessment tool.

Results

Four clinical trials were reviewed. The classification of the studies’ methodological quality ranged from low to moderate. The effects of the nighttime monitoring system and voice command technologies on the Basic and Instrumental Activities of Daily Living were assessed better.

Conclusion

The application of these technological devices offers positive results to support elderly people and caregivers in performing their daily activities. The use of simple voice prompts is cheaper, easier to manage and more efficient for demented elderly to perform Instrumental Activities of Daily Living.ene menor costo, manejo simplificado y mayor eficiencia para realizar las Actividades Instrumentales de la Vida Diaria de los ancianos con demencia.

Aged; Dementia; Self-help devices; Activities of daily living; Health of the elderly

Articles	References	Countries	Samples	Inclusion criteria	Assistive technologies	Activities of daily living	Usage periods
A1. ⁽¹⁴14. Rowe MA , Kelly A , Horne C , Lane S , Campbell J , Lehman B , et al . Reducing dangerous nighttime events in persons with dementia by using a nighttime monitoring system . Alzheimers Dement . 2009 ; 5 ( 5 ): 419 – 26 .⁾	Rowe MA, Kelly A, Horne C, Lane S, Campbell J, Lehman B, et al. [Reducing Dangerous Nighttime Events in Persons with Dementia Using a Nighttime Monitoring System]. Alzheimers Dement. 2009; 5(5):419-26.	United States.	EG= 26 elderly and caregivers. GC= 27 elderly and caregivers.	Being primary caregiver as from 21 years of age; no physical impairment; not being under treatment for sleep disorders; speaking and reading in English and no cognitive impairment. For the elderly: dementia diagnosis, MMSE score < 23 and history of nocturnal awakenings.	Nighttime monitoring system.	Mobilization.	12 months.
A2. ⁽¹⁵15. Thomas KR , Marsiske M . Verbal prompting to improve everyday cognition in MCI and unimpaired older adults . Neuropsychology . 2014 Jan ; 28 ( 1 ): 123 – 34 .⁾	Thomas KR, Marsiske M. [Verbal Prompting to Improve Everyday Cognition in MCI and Unimpaired Older Adults]. Neuropsychology. 2014; 28(1):123-34.	United States.	EG= 909 elderly. CG= 1890 elderly.	Patients with MMSE score ≥ 23; No prior diagnosis of dementia or ADL limitations.	Stimuli through verbal prompts.	Medication administration; finance control.	10 years.
A3. ⁽¹⁶16. Hattink BJ , Meiland FJ , Overmars-Marx T , Boer M , Ebben PW , Blanken M , et al . The electronic, personalizable Rosetta system for dementia care: exploring the user-friendliness, usefulness and impact . Disabil Rehabil Assist Technol . 2016 ; 11 ( 1 ): 61 – 71 .⁾	Hattink BJ, Meiland FJ, Overmars-Marx T, Boer M, Ebben PW, Blanken M, et al. [The electronic, personalizable Rosetta system for dementia care: exploring the user-friendliness, usefulness and impact.]. Disabil Rehabil Assist Technol. 2016;11(1):61-71.	Holland, Belgium and Germany.	EG= 20 elderly and caregivers. CG= 22 elderly and caregivers.	Present mild cognitive impairment or moderate dementia, have at least one caregiver, live at home.	Activity and location monitoring system.	Mobilization; meal preparation and grooming.	1 to 8 months (average ≅4 months).
A4. ⁽¹⁷17. Werner C , Moustris GP , Tzafestas CS , Hauer K . User-oriented evaluation of a robotic rollator that provides navigation assistance in frail older adults with and without cognitive impairment . Gerontology . 2018 ; 64 ( 3 ): 278 – 90 .⁾	Werner C, Moustris GP, Tzafestas CS, Hauer K. [User-Oriented Evaluation of a Robotic Rollator That Provides Navigation Assistance in Frail Older Adults with and without Cognitive Impairment]. Gerontology. 2018; 64:278–90.	Germany.	EG= 22 elderly. CG= 20 elderly.	Institutionalized elderly people using a rollator, with motor impairments, with and without cognitive impairments. Age ≥ 65 years, capable of performing the activity and understanding the instructions, without severe health problems.	Robotic navigation assistance for elderly people.	Mobilization.	Route 1 ≅ 84.1 seconds. Route 2 ≅ 104.9 seconds.

Articles	Assistive technologies	Variables measured	Outcomes
A1. ⁽¹⁴14. Rowe MA , Kelly A , Horne C , Lane S , Campbell J , Lehman B , et al . Reducing dangerous nighttime events in persons with dementia by using a nighttime monitoring system . Alzheimers Dement . 2009 ; 5 ( 5 ): 419 – 26 .⁾	Home monitoring system with domestic safety system platform, bed occupation sensors and alerts.	Caregiver satisfaction; Reliability.	System assessed as extremely reliable. No errors or false alarms. No adverse events caused by system failures. Subjects were classified as “highly satisfied” with the use of the technology. Nine nighttime events took place, three of which in EG, two falls and one nighttime leave. The nighttime events happened due to improper handling and the caregiver who did not awake when the alarms went off.
A2. ⁽¹⁵15. Thomas KR , Marsiske M . Verbal prompting to improve everyday cognition in MCI and unimpaired older adults . Neuropsychology . 2014 Jan ; 28 ( 1 ): 123 – 34 .⁾	Verbal prompts in the form of reminders or motivation to help in the performance of financial control and medication management activities, activated when the elderly behaves unable to proceed with the activity.	Usage efficacy.	The group with cognitive impairment achieve improvements in the performance of medication management and financial control activities. The performances of the subjects who used the technologies were superior to the subjects in the control group. The technology demonstrated improvements and maintenance in the performance of daily tasks.
A3. ⁽¹⁶16. Hattink BJ , Meiland FJ , Overmars-Marx T , Boer M , Ebben PW , Blanken M , et al . The electronic, personalizable Rosetta system for dementia care: exploring the user-friendliness, usefulness and impact . Disabil Rehabil Assist Technol . 2016 ; 11 ( 1 ): 61 – 71 .⁾	Multifunctional system Rosetta, resulting from the integration of three systems: “Elderly Day Navigator (EDN)”, including a daily organizer, telephone agenda with pictures, simplified telephone call system and Global Positioning System (GPS); “Early Detection System (EDS)”, registering the elderly’s behavioral pattern through the analysis of sensor signals, such as sleep-wake rhythm, mobility and meal preparation; “Unattended Autonomous Surveillance – Advanced Awareness and Prevention System (UAS-AAPS)”, detecting situations through cameras and triggering alarms in case of a period of inactivity, such as a fall.	System utility; Easy use.	Rosetta assessed as “highly useful” and potentially resulting in feeling of greater safety in care provision. Informal caregivers indicated signs of decreased work burden. Three informal caregivers described feelings of trust and safety. Formal caregivers considered the system complex and hard to work with. EDN: considered useful by the caregivers and demented subjects. Classified as hard to manage. Different technical problems of the system were reported and informal caregivers mentioned dissatisfaction with the layout of the access portal. Caregivers were unable to use the GPS function due to technical errors. EDS: caregivers considered it useful to monitor the demented subjects’ ADLs. The technology was considered hostile and hard to manage. Different errors occurred when accessing the portal. UAS-AAPS: participants indicated that the system was very useful and granted a feeling of safety. Presented false alarms that were considered bothersome and three fall events when the system failed and the alarm did not go off.
A4. ⁽¹⁷17. Werner C , Moustris GP , Tzafestas CS , Hauer K . User-oriented evaluation of a robotic rollator that provides navigation assistance in frail older adults with and without cognitive impairment . Gerontology . 2018 ; 64 ( 3 ): 278 – 90 .⁾	Robotic navigation assistance innovation called MOBOT, offering integrated navigation system with audio-guided suggestions.	Performance on two routes; Success rate; Conclusion time; Number of stops; Gait speed; Distance walked.	Route 1: no significant associations were found between success rate and use of the device. For the conclusion and stop times, significant interaction was found between navigation assistance and cognitive condition. The participants using the device presented shorter conclusion and stop times. No significant effect was found on the number of stops, gait speed and distance walked. Route 2: no significant associations were found between success rate and use of the device. For the conclusion time and the number of stops, significant interaction effects were observed. The participants using the technology presented shorter conclusion time, fewer stops and shorter distance walked. No significant effect was found on the gait speed and stop time.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
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[1] Corresponding author. Juliana Cunha Maia http://orcid.org/0000-0002-1982-0186 Email: julianacmaia.cunha@gmail.com