Abstract
Fall prevention and management of behavioural and psychological symptoms of dementia (BPSD) in long-term care (LTC) facility is a major challenge. The objective of this systematic review is to assess the evidence of digital technology in their management. All studies of English-language excluding case-reports were eligible for review. Databases chosen were MEDLINE, EMBASE, Scopus, Web of Science and PSYCINFO from January 2000 to June 2020. Downs and Black checklist was used to check for risk of bias. Papers with a focus in LTC setting, using digital technology as intervention for older adults with dementia, and with measurable outcomes (outcomes that are quantified, not descriptive) were included in the final review. Seventeen original papers (8 RCTs, 8 quasi-experimental and 1 mixed method) were included. Three articles examining position-sensor technology for fall prevention showed mixed results. Two showed no difference and 1 showed small reduction in fall after alarm removal but the positive effect might be due to bias. Overall, the sample sizes were too small to draw meaningful conclusion. Fourteen studies (9 pet robots of which 8 were robotic seal/PARO) were identified for BPSD and results were mixed. Overall, PARO might have modest benefit in BPSD compared to usual care but might be no better than plush toy with more hallucinations or delusions seen in advanced dementia. However, the significant heterogeneity in methodology (intervention intensity, lack of record in psychoactive drug use), clinical tools used (different BPSD scales, different digital technologies) and variability in outcomes made it difficult to draw clear-cut conclusion. Studies involving other digital technologies are scarce and in pilot phases; hence, conclusion is premature. One limitation of the review was that only 9 out of 17 studies were of good quality. The limited research work in position-sensors meant insufficient evidence to prove efficacy for their use in LTC setting. The possible modest benefit of PARO in BPSD (e.g. in agitation, apathy or reduction in psychoactive drugs) was off-set by possible adverse events such as delusions or hallucinations in advanced dementia.
Similar content being viewed by others
References
Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, Stein K, Thompson-Coon J (2019) How do “robopets” impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence. Int J Older People Nurs 14(3):e12239. https://doi.org/10.1111/opn.12239
Barrett E, Burke M, Whelan S et al (2019) Evaluation of a companion robot for individuals with dementia, quantitative findings of the MARIO project in an irish residential care setting. J of Gerontological Nursing 45(7):36–45
Bemelmans R, Gelderblom G, Jonker P et al (2012) Socially assistive robots in elderly care: a systematic review into effects and effectiveness. J Am Med Dir Assoc 13:114–120
Bemelmans R, Gelderblom GJ, Jonker P, de Witte L (2015) Effectiveness of robot paro in intramural psychogeriatric care: a multicenter quasi-experimental study. J Am Med Dir Assoc 16(11):946–950
Bergen G, Stevens MR, Burns ER (2016) Falls and fall injuries among adults aged ≥65 Years—United States, 2014. Morb Mortal Wkly Rep 65:993–998. https://doi.org/10.15585/mmwr.mm6537a2
Berry SD, Miller RR (2008) Falls: epidemiology, pathophysiology, and relationship to fracture. Curr Osteoporos Rep 6(4):149–154
Borda A, Gilbert C, Said C, Smolenaers F et al (2018) Non-contact sensor-based falls detection in long term care facilities: developing a real-life picture. Stud Health Technol Inform 252:33–38
Bressler K, Redfern RE, Brown M. (2011) Elimination of position-change alarms in an Alzheimer’s and dementia long-term care facility. Am J Alzheimer’s Dis Other Demen [Internet]. 26(8):599–605. Available from: http://aja.sagepub.com/archive/
Broekens J, Heerink M, Rosendal H (2009) Assistive social robots in elderly care: a review. Gerontechnology 8:94–103
Burns E, Stevens J, Lee R (2016) The direct costs of fatal and non-fatal falls among older adults—United States. J Safety Res 58:99–103
Burstein A, DaDalt O, Kramer B et al (2014) Technology and the caregiving dilemma: a comparative look at awareness, attitudes, and the role of technology. Alzheimer’s Dement 10(suppl):571
Burton A (2013) Dolphins, dogs, and robot seals for the treatment of neurological disease. The Lancet Neurology 12(9):851–852
Calo CJ, Hunt-Bull N, Lewis L, Metzler T. (2011) Ethical Implications of Using the Paro Robot with a Focus in Dementia Patient Care. Human-Robot Interaction in Elder Care: Papers from the AAAI Workshop
Cerejeira J, Lagarto L, Mukaetova-Ladinska EB (2012) Behavioural and psychological symptoms of dementia. Front Neurol 3:73
Chan DKY, Chan LKM (2019) Falls in nursing homes: challenges from a nursing perspective. Br J Community Nurs 24:6–9
Chan DKY, Sherrington C, Naganathan V et al (2018) Key issues to consider and innovative ideas on fall prevention in the Geriatric Department of a teaching hospital. Austral J Age 37(2):140–143
Chan DKY, Diu E, Loh F et al (2013) Pilot study into impaired judgement self-toileting behaviour in fallers and non-fallers. Eur J Age 10(3):257–260
Christie H, Martin J, Connor J et al (2019) eHealth interventions to support caregivers of people with dementia may be proven effective, but are they implementation-ready? Internet Interv 18:100260. https://doi.org/10.1016/j.invent.2019.100260
Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health 52:377–384
Gattinger H, Hantikainen V, Ott S, Stark M (2017) Effectiveness of a mobility monitoring system included in the nursing care process in order to enhance the sleep quality of nursing home residents with cognitive impairment. Health Technol (Berl) 7(2–3):161–171
Geraedts H, Zijlstra W, Zhang W et al (2014) Adherence to and effectiveness of an individually tailored home-based exercise program for frail older adults, driven by mobility monitoring: design of a prospective cohort study. BMC Public Health 14:570
Hawley-Hague H, Boulton E, Hall A et al (2014) Older adults’ perceptions of technologies aimed at falls prevention, detection or monitoring: a systematic review. Int J Med Inf 83:416–426
Holmes D, Teresi JA, Ramirez M, Ellis J et al (2007) An evaluation of a monitoring system intervention: falls, injuries, and affect in nursing homes. Clin Nurs Res 16(4):317–335
Ienca M, Jotterand F, Elger B et al (2017) Intelligent assistive technology for Alzheimer’s disease and other dementias: a systematic review. J Alzheimer’s Dis 56(4):1301–1340. https://doi.org/10.3233/JAD-161037
Inel Manav A, Simsek N (2019) The effect of reminiscence therapy with internet-based videos on cognitive status and apathy of older people with mild dementia. J Geriatr Psychiat Neurol 32(2):104–113
Jones C, Moyle W (2020) A feasibility study of DreampadTM on sleep, wandering and agitated behaviours in people living with dementia. Geriatr Nurs. https://doi.org/10.1016/j.gerinurse.2020.04.014
Jones C et al (2018) Does cognitive impairment and agitation in dementia influence interventional effectiveness? findings from a cluster-randomized-controlled trial with the therapeutic Robot PARO. JAMDA 19:623e626
Joranson N, Pedersen I, Rokstad AMM, Ihleaek C (2016) Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomised controlled trial. J Adv Nurs 72(12):3020–3033
Jøranson N, Pedersen I, Rokstad AMM, Ihlebæk C (2015) Effects on symptoms of agitation and depression in persons with dementia participating in robot-assisted activity: a cluster-randomised controlled trial. J Am Med Dir Assoc 16(10):867–873
Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OBF et al (2013) Efficacy of nintendo wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomised controlled trial. J Gerontol Ser A Biol Sci Med Sci 68(7):845–852
Kennelly J (2011) Methodological approach to assessing the evidence. In: Kennelly J (ed) Reducing racial/ethnic disparities in reproductive and perinatal outcomes. Springer, pp 7–19
Kim S, Toloui O, Jain S. Enhancing Dementia Care Through Digital Health [Internet] (2017). The American Journal of Accountable Care. [cited 26 September 2019]. Available from: https://www.ajmc.com/journals/ajac/2017/2017-vol5-n4/enhancing-dementia-care-through-digital-health
Kormelinck C, Teunenbroek C, Kollen B et al (2019) Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomised trial. BMC Psychiat 19:298
Kosse NM, Brands K, Bauer JM et al (2013) Sensor technologies aiming at fall prevention in institutionalized old adults: a synthesis of current knowledge. Int J Med Inf 82:743–752
Leng M, Liu P, Zhang P, Hu M, Zhou H, Li G, Yin H, Chen L (2018) Pet robot intervention for people with dementia: a systematic review and meta-analysis of randomized controlled trials. Psychiat Res 271:516–525. https://doi.org/10.1016/j.psychres.2018.12.032
Levine DM, Lipsitz SR, Linder JA (2018) Changes in everyday and digital health technology use among seniors in declining health. J Gerontol A Biol Sci Med Sci. https://doi.org/10.1093/gerona/glx116
Liang A, Piroth I, Robinson H et al (2017) A pilot randomised trial of a companion robot for people with dementia living in the community. J Am Med Dir Assoc 18(10):871–878
Libin A, Cohen-Mansfield J (2004) Therapeutic robocat for nursing home residents with dementia: preliminary inquiry. Am J Alzheimer’s Dis Other Demen 19(2):111–116
Livingston G, Sommerlad A, Orgeta V et al (2017) Dementia prevention, intervention, and care. Lancet 390(10113):2673–2734
Miller S, Vermeersch PEH, Bohan K, Renbarger K et al (2001) Audio presence interventions for decreasing agitation in people with dementia. Geriatr Nurs (Minneap) 22(2):66–70
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097
Moyle W, Jones C, Dwan T, Petrovich T (2018) Effectiveness of a virtual reality forest on people with dementia: a mixed methods pilot study. Gerontologist 58(3):478–487
Moyle W, Jones CJ, Murfield JE et al (2017) Use of a robotic seal as a therapeutic tool to improve dementia symptoms: a cluster-randomised controlled trial. JAMDA 18:766–773
Moyle W. (2013) Robots in Dementia Care—Australian Journal of Dementia Care [Internet]. Australian Journal of Dementia Care. [cited 26 September 2019]. Available from: https://journalofdementiacare.com/robots-in-dementia-care/
Moyle W, Cooke M, Beattie E et al (2013) Exploring the effect of companion robots on emotional expression in older adults with dementia: a pilot randomised controlled trial. J Gerontol Nurs 39(5):46. https://doi.org/10.3928/00989134-20130313-03
Oliver D (2018) Do bed and chair sensors really stop falls in hospital? BMJ 360:k433. https://doi.org/10.1136/bmj.k433
Orenstein D. (2017) National report notes barriers to better adoption of assistive devices for disabled [Internet]. Brown University. [cited 26 September 2019]. Available from: https://www.brown.edu/news/2017-05-12/assistive
Parsons C (2017) Polypharmacy and inappropriate medication use in patients with dementia: an under researched problem. Ther Adv Drug Saf 8(1):31–46
Petersen S, Houston S, Qin H et al (2017) The utilization of robotic pets in dementia care. J Alzheimer’s Dis 55(2):569–574
Pu L, Moyle W, Jones C et al (2019) The Effectiveness of social robots for older adults: a systematic review and meta-analysis of randomised controlled studies. Gerontologist 59(1):e37–e51
Schoene D, Valenzuela T, Lord SR, de Bruin ED (2014) The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review. BMC Geriatr 14:107
Selbæk G, Engedal K, Bergh S (2013) The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc 14:161–169
Shubert TE (2011) Evidence-based exercise prescription for balance and falls prevention: a current review of the literature. J Geriatr Phys Ther 34(3):100–108
Soler M, Agüera-Ortiz L, Rodríguez J et al (2015) Social robots in advanced dementia. Front Aging Neurosci 7:133–144
Thodberg K, Sørensen LU, Christensen JW, Poulsen PH et al (2016) Therapeutic effects of dog visits in nursing homes for the elderly. Psychogeriatrics 16(5):289–297
Waldron N (2012) Falls prevention in older adults: assessment and management. Aust Fam Phys 41(12):930–935
Wimo A, Prince M. World Alzheimer Report 2010 [Internet]. Alzheimer's Disease International. [cited 26 September 2019]. Available from: https://www.alz.co.uk/research/files/WorldAlzheimerReport2010.pdf
Acknowledgement
We acknowledge we were not aware of registering of the manuscript before commencement of systematic review as a preferred approach.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Responsible Editor: Matthias Kliegel.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Chan, D.K.Y., Chan, L.K.M., Kuang, Y.M. et al. Digital care technologies in people with dementia living in long-term care facilities to prevent falls and manage behavioural and psychological symptoms of dementia: a systematic review. Eur J Ageing 19, 309–323 (2022). https://doi.org/10.1007/s10433-021-00627-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-021-00627-5