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Study summaries and references

Study summaries

Study 1 published

EFORTT: Ethical frameworks FOR Telecare Technologies

Published, 2013, Mort

This qualitative study used observations of telecare-in-use and citizens’ panels to develop an ethical framework for telecare systems. It took place in England, Spain, the Netherlands and Norway between 2008 and 2011. Researchers observed practitioners’ and managers’ meetings; local telecare call / monitoring centres; installation visits in older peoples’ homes; needs assessments; training events and conferences. Researchers conducted interviews with older people and technology companies, and held 22 citizens’ panels across the four countries, comprising older people and carers. Respondents felt strongly that telecare is not a substitute for human carers, it has care limitations and creates additional work, involving new workers and relying on social networks of friends, family and neighbours. Telecare requires users and carers to weigh up potential reductions in privacy with gains in freedom. Some telecare systems promote independence; others increase dependency. Older people may not use the telecare as intended, for example not wearing falls sensors to avoid triggering them, or ‘over-using’ telecare to increase social contact with staff. Users, carers and staff sometimes worked together to make devices more practically useful. The authors concluded that telecare has limitations, users and carers should be engaged in decision-making throughout, and systems adapted to meet individual needs.

Mort M, Roberts C, Pols J, Domenech M, Moser I. Ethical implications of home telecare for older people: a framework derived from a multisited participative study. Health Expectations 2015 Jun; 18(3): 438-449. First published 06 August 2013.

https://doi.org/10.1111/hex.12109

Funder - European Union FP7 Science in Society Programme

Study 2 published

Exploring the views of GPs, people with dementia and their carers on assistive technology: a qualitative study

Published, 2016, Robinson

This qualitative study involved semi-structured interviews with GPs (n=17), people with dementia (n=13) and family carers (n=26), in the North East of England between 2013 and 2014. All participants had practical experience of assistive technology, including fall alarms, notice boards, pill dispensers and easy to use telephones. GPs, people living with dementia, and carers, were all uncertain about how to find information on assistive technology. They all saw voluntary sector organisations as important, trusted resources. People with dementia and their family carers, rather than health and social care services, appeared to be the main drivers of increasing awareness and use of assistive technology in dementia care. GPs felt that assistive technology was not a core part of their role in dementia care. Responsibility for dementia care spreads across different services and professionals, highlighting an urgent need for more integrated working. Participants suggested a single point of access for information and support, such as a dementia adviser or nurse specialist. Future research could usefully be carried out over a more varied geographical area, and involve perspectives of the wider dementia care team, and of people with dementia and their carers who are not already engaged in local support networks.

Newton L, Dickinson C, Gibson G, Brittain K, Robinson, L. Exploring the views of GPs, people with dementia and their carers on assistive technology: a qualitative study. BMJ Open 2016; 6:e011132. doi 10.1136/bmjopen-2016-011132

https://bmjopen.bmj.com/content/6/5/e011132

Funder - NIHR Professorship

Study 3 published

What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services

Published, 2015, Greenhalgh

This qualitative study in London and Manchester involved three stages: (i) interviews with seven technology suppliers and 14 service providers; (ii) ethnographic case studies of 40 people aged between 60 and 98 with multi-morbidity and assisted living needs; (iii) 10 co-design workshops with users, carers, suppliers and providers of assistive technology. The researchers identified six themes of “quality” telehealth or telecare: Anchored in a shared understanding of what matters to users; Realistic about illness and progression; Co-creative; Human, supported through personal relationships and social networks; Integrated, with effective information sharing; and Evaluated (the ‘ARCHIE’ principles). They concluded that although technological advances are important, they should be based on a user-centred approach to design and delivery. Telehealth relies on the ability of the person to use the equipment and / or help from family and friends. The focus should move from assistive technology products in general, to how products perform practically to meet individual needs over time, and how different components can combine for flexible use across devices and platforms. The authors also recommend a shift away from standardised care packages towards a more personalised commissioning model.

Greenhalgh T, Procter R, Wherton J, Sugarhood P, Hinder S, Rouncefield M. What is quality in assisted living technology? The ARCHIE framework for effective telehealth and telecare services. BMC Medicine 2015;13(91). https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0279-6

Funder – TSB Assisted Living Platform and NIHR Senior Investigator Award

Study 4 published

Barriers to Telecare Adoption

Published, 2016, Mountain

This small qualitative study comprised semi-structured interviews with 22 people who did not currently use telecare, but for whom it could be relevant. Fourteen participants were aged 65 or over. The researchers noted a weakness in that participants were self-selected, and only one had previously refused telecare. They defined telecare as technology that remotely monitors changes in an individual, and is distinct from telehealth, which involves a health-care professional providing remote care using a digital network. This study focused mainly on alarms triggered by the user (e.g. pendants), and sensors (e.g. temperature sensors) which detect conditions and trigger alerts automatically, rather than on recently emerging technology which can monitor lifestyle, such as Global Positioning System tracking. Barriers to telecare use included financial cost to the individual, stigma, and perceived reduction in independence. Decision-making was also affected by the design and suitability of telecare, the impact of changing health, opinions within an individual’s support network including ‘peace of mind’, and information about available telecare. Individuals often perceived telecare as a last resort. The researchers recommended raising awareness of telecare, and suggested that adapting technology that is already widely accepted, such as mobile phones, might be more popular than carrying separate devices.

Bentley CL, Powell LA, Orrell A, Mountain GA. Making Telecare desirable rather than a last resort. Ageing & Society 2018; 38(5)926-953. Cambridge: Cambridge University Press. Published online December 21, 2016. https://doi.org/10.1017/S0144686X16001355

Funder - NIHR CLAHRC Yorkshire and Humber

Study 5 published

Advancing Knowledge of Telecare for Independence and Vitality in later life project (AKTIVE)

Published, 2014, Yeandle

This mixed methods study looked at the everyday experiences of 60 frail older people using telecare in Leeds and Oxfordshire, and prone to falls or living with memory loss or dementia. It comprised repeat visits over six to nine months, interviews with relatives, care workers and neighbours, and workshops with response centre staff and manufacturers. Telecare in participants’ homes included pendant alarms, door sensors, gas leak detectors, medication reminders and tracker devices. Results indicated that design, comfort, ease of use and understanding how the technology worked were important. Various practical issues caused concern, such as setting off false alarms, lack of direct communication between the monitoring centre and the user, and lack of routine maintenance. Frailty had a serious impact on the 60 participants’ daily lives, and many felt lonely. When the right equipment was provided, telecare was successful not only in providing safeguards, but in helping people get out and about, increasing their vitality and reducing family tensions. If telecare was not appropriate to their needs, people rejected it. The researchers concluded that telecare is not an intervention but a ‘tool for living’. It is best to introduce technology early, before a crisis. Individual circumstances, which can change rapidly, should determine the timing of upgrades. At its best, telecare can enhance networks of support.

http://www.aktive.org.uk/conference2014-presentations.html

Funder – TSB

Study 6 published

Delivering Digital Health and Well-Being at Scale: Lessons Learned during the Implementation of the dallas Program in the United Kingdom

Published, 2016, Mair

The Delivering Assisted Living Lifestyles at Scale (dallas) programme is a large-scale, UK-wide technology programme that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Four multi-agency partnerships, involving public, voluntary and private organisations, aim to deliver services to 169,000 individuals across remote, rural and urban areas. Technologies include interactive, person-centred websites, telecare, electronic personal health records and mobile applications. This implementation study used qualitative methods, over time, to identify challenges. Data collected included interviews with stakeholders involved in service design and delivery at the start (n=17) and midway through implementation (twelve to fourteen months later, n = 21), barrier and solutions reports, observational logs, and evaluation interviews with project leads (n=5). The study identified five key implementation challenges: establishing large, multi-agency partnerships; needing resilience to cope with set-backs and external changes; a tension between involving users in design, and also delivering quickly and widely across the UK; branding and selling digital health services to the public; sharing data between organisations and ensuring different technologies can work together, which may seem threatening to commercial partners. The authors concluded that the dallas programme is building up an extensive network of expertise.

Devlin AM, McGee-Lennon M, O’Donnell CA, Bouamrane M, Agbakoba R, O’Connor S et al. Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom. Journal of the American Medical Informatics Association 2016 Jan; 23(1): 48–59.

https://doi.org/10.1093/jamia/ocv097

Funder - NIHR, Innovate UK, the Scottish Government, Scottish Enterprise, Highlands and Islands Enterprise

Study 7 published

Ready, Steady, Go: A telehealth implementation toolkit

Published, 2012, Brownsell and Ellis

This toolkit provides a detailed framework for the implementation of telehealth at local level. It is based on a systematic review of studies evaluating telehealth implementation, and the authors’ own experience of telehealth implementation and change management. Many projects worked well at a small scale, but struggled when deployed more widely. Local context made a significant difference. The toolkit has five phases: understanding the vision, preparation and securing support, testing and training, focus, and endurance. After implementation, review and reflection is required to decide whether to close down the service, keep it as it is, or expand it. A later qualitative study considered the key qualities of a successful telehealth implementation toolkit, and assessed the usability of the ‘Ready, Steady, Go’ toolkit. The study experienced recruitment challenges. It comprised interviews (n=13) and a focus group (n=10) with telehealth experts from academia, the NHS, industry and a UK and European local authority. The results highlighted the importance of considering staff workload and time needed to use the toolkit, layout, inclusion of case studies, having a practical focus and services being fully ready before implementation. These results will inform the development of a web-based version of the Ready, Steady, Go toolkit.

Brownsell S, and Ellis T. Ready, Steady, Go: A telehealth implementation toolkit. Sheffield Teaching Hospital NHS Foundation Trust and the University of Sheffield, members of National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY); 2012.

https://drive.google.com/file/d/0B3-SF4FxenwJdmhGNnBHV1ZZNGc/view

Powell LA, Ellis T and Mawson S. What makes a successful telehealth implementation toolkit: A qualitative study exploring the usability and perceived value of the “Ready, Steady Go” Telehealth Toolkit. Academic Report 2015. NHS Sheffield Clinical Commissioning Group, the University of Sheffield and NIHR CLAHRC Yorkshire and Humber; 2015.

https://drive.google.com/file/d/0B3-SF4FxenwJaWxjR0R4Z2tGX1E/view

Funder - NIHR CLAHRC South Yorkshire and EC

Study 8 published

Is there a clearer role for telecare in adult social care that will deliver better outcomes for older people?

Published, 2018, Woolham

This study aimed to understand how and why local authority Adult Social Care departments in England are using telecare to support older people. It comprised semi-structured interviews with telecare managers and stakeholders (still to be published), and an online survey of telecare managers in all local authorities in England (n=152) between November 2016 and January 2017. The survey achieved an overall response rate of 75% (n=114). It found that only 24% of respondents had developed their telecare strategy in collaboration with local NHS and other partners. Many adult social care departments said telecare saved money but found it difficult to evidence this claim. Assessments for telecare were not always done, and not always done in people’s homes. Most training was brief and provided by manufacturers or suppliers. Small numbers of telecare suppliers were used. The most commonly provided telecare items were wearable pendant alarms and fall detectors. A 24/7 response service was not always used and sometimes, if unpaid carers were not available around-the-clock, telecare was not provided. The researchers called for better matching of need to telecare through greater investment in training, deploying a wider range of devices, and widening strategic focus beyond risk management, for example using telecare to improve social contact.

Woolham JG, Steils N, Fisk, M, Porteus J, Forsyth K. The UTOPIA project. Using Telecare for Older People In Adult social care: The findings of a 2016-17 national survey of local authority telecare provision for older people in England. London: Social Care Workforce Research Unit, King's College London; 2018.

https://kclpure.kcl.ac.uk/portal/files/87498580/Utopia_project_report.pdf

https://www.sscr.nihr.ac.uk/projects/P89.php

Funder – NIHR SSCR

Study 9 published

Overcoming the Barriers to Mainstreaming Assistive Living Technologies (MALT)

Published, 2015, Taylor

These qualitative studies explored why the UK has not embraced telehealth as quickly as anticipated. Previous studies suggested acceptance by frontline staff was a key barrier. The researchers conducted case studies of four community health services in England that use telehealth to monitor patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. They interviewed nursing and other frontline staff (n=84), and managers and key stakeholders (n=21) between May 2012 and June 2013. Attitudes towards telehealth ranged from resistance to enthusiasm. Early negative experiences had a long-lasting impact. Early successes helped overcome barriers, as did reliable and flexible technology; dedicated resources; ongoing training with time to experiment; ‘local champions’; targeting the right patients; and a partnership approach. The authors concluded that telehealth will not become embedded within mainstream health services until clinicians see demonstrable patient and clinical benefits. They also conducted ‘action research’ with 57 staff and one patient, in which they supported each service to increase telehealth adoption, from July 2013 to April 2014. Services were able to make planned changes to telehealth, and to share learning across stakeholders. However, continual changes to service provision hampered adoption, implementation and staff motivation, as did technological barriers and uncertainties about goals.

Taylor J, Coates E, Brewster L, Mountain G, Wessels B & Hawley MS. Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption. Journal of Advanced Nursing 2015 Feb; 71(2): 326-337.

https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12480

Taylor J, Coates E, Wessels B, Mountain G & Hawley MS. Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings. BMC Health Services Research 2015; 15(1): 529.

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-1195-3

Funder - Assisted Living Innovation Platform, with support from the TSB and the ESRC

Study 10 waiting to publish

Innovation to enhance health in care homes: Rapid evidence synthesis

First Look Summary published, 2018, Hanratty

This study reviewed published research about enhancing health in care homes. It focused on four key areas: use of technology, workforce, community and engagement, and evaluation. 65 studies from high-income countries, published between 2000 and 2016, were included across the four categories. The authors concluded that there is a lack of large, high quality research studies, particularly from the UK. Digital technology has many potential uses in care homes, and experimental studies have investigated a range of technological interventions. However, a majority of studies are pilot or feasibility trials, and not large enough to detect clinically significant outcomes. Studies frequently identify cost, ease of use and staff demands as both barriers and facilitators in the use of technology. The evidence base about impact on residents’ well-being does not allow firm conclusions to be drawn. Resident and family participation is essential in future research.

https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/157705#/

Funder – NIHR HS&DR 15/77/05

Study 11 published

Consumer Models for Assisted Living (COMODAL)

Published, 2016, Ward

This mixed methods project aimed to understand the barriers to market development of electronic living technologies. People aged 50-70, approaching retirement and older age, helped to create business models led by consumers, rather than based solely on needs, to reduce potential stigma. Consumers, industry and non-governmental organisations and charities worked together. There were five work programmes: understanding consumer needs; developing solutions and consumer led business models; developing an industry support system for practical implementation; developing a guide for industry based on consumer insights; spreading the messages. The research included focus groups and street surveys with people aged 50-70, joint work with consumers and industry, and interviews, workshops and a telephone survey with industry representatives. The top three barriers for consumers were cost, knowing how to choose a product, and lack of awareness of helpful products. The top three enablers were believing a product would make a difference, be affordable and make life safer at home. Consumers would like to test products out in practice, and would like products and services to link together to meet their independent living needs as a whole. The project developed four business models – ‘complementor’, ‘diversifier’, ‘independent advisor/broker’, and ‘insurance’ – which it has presented to industry.

COMODAL COnsumer MODels for Assisted Living: Project Summary and Findings http://www.comodal.co.uk/

Ward G, Fielden S, Muir H, Holliday N, Urwin G. Developing the assistive technology consumer market for people aged 50-70. Ageing and Society 2017 May; 37(5):1050-1067. Published online February 22, 2016.

https://doi.org/10.1017/S0144686X16000106

Funder - Innovate UK

Study 12 published

Structured telephone support or non-invasive telemonitoring for patients with heart failure

Published, 2015, Inglis

This Cochrane review examined evidence from 41 randomised controlled trials that compared heart failure management delivered through structured telephone support and non‐invasive telemonitoring with usual post-discharge care, to people living in the community. Participants were aged 18 years and over. Two of the studies involved the UK, and over half were conducted in the USA. 25 of the studies evaluated structured telephone support (total of 9332 participants), and 18 evaluated telemonitoring (total of 3860 participants). Two studies evaluated both interventions. The authors concluded that, compared to usual care, implementation of structured telephone support and non‐invasive home telemonitoring can reduce mortality and heart failure‐related hospitalisations, and improve quality of life, heart failure knowledge and self‐care behaviours. For the eighteen studies focused just on telemonitoring, there was a 20% reduction in mortality and a 29% reduction in heart-failure related hospitalisation. There was not an important effect on all-cause hospitalisations. The quality of evidence ranged from very low (all-cause hospitalisation) to moderate (all-cause mortality and heart failure-related hospitalisation). Most participants, including the elderly, learned to use the technology easily and were satisfied with the interventions. The authors noted that, in most cases, the equipment was provided as part of the study, and therefore there may be implications for purchase, installation and maintenance of equipment during everyday practice.

Inglis SC, Clark RA, Dierckx R, Prieto‐Merino D, Cleland JGF. Structured telephone support or non‐invasive telemonitoring for patients with heart failure. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD007228. DOI: 10.1002/14651858.CD007228.pub3.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007228.pub3/full

Funder - Cochrane: Cochrane Heart Group

Study 13 ongoing

Assistive Technology and Telecare to maintain Independent Living At home for people with dementia: The ATTILA Trial

Protocol published, 2013, Howard

ATTILA is a pragmatic, randomised controlled trial involving 500 participants. It compares outcomes amongst people with dementia who receive assistive technology and telecare, and those who receive equivalent community services without technology. The trial will test whether fewer people in the technology group enter institutional care over a five-year period. It will consider care costs for participants, quality of life, and caregivers’ levels of stress. All participants will receive a needs assessment from their local authority. The technology group will then receive an individually tailored, dementia-specific, technology package, decided on by the local authority. This technology may include monitored sensors (e.g. property exit sensors, bed exit sensors) and stand-alone systems (e.g. automatic lights, carer alerting devices). The control group will receive equivalent community services without technology, apart from non-electronic items such as walking frames, smoke and carbon monoxide detectors, and simple pendant alarms and key safes, if required. The trial plans to report results in Spring 2019.

https://www.journalslibrary.nihr.ac.uk/programmes/hta/105002/#/

Funder – NIHR HTA - 10/50/02

Study 14 published

Seamless User-centred Proactive Provision Of Risk-stratified Treatment for Heart Failure (SUPPORT-HF)

Published, 2015, Rahimi

This study developed a home tele-monitoring system for patients with heart failure. Fifteen patients took part in an initial co-design workshop, and 52 participants with heart failure (average age 77 years) then tested the system over six months. The researchers used patient observations, interviews and analysis of the remote data, to improve the system’s ease of use. The system operated via a tablet PC application that wirelessly collected information on weight, blood pressure and heart rate. It enabled participants and the study team to exchange messages, and had built-in alerts. Almost half of the participants had very little or no previous experience with digital technologies. It took participants 1.5 minutes to complete the daily monitoring tasks. 46 participants completed the final survey, of which 93% said they found the system easy to use, and 38% asked to keep the system after the study ended. The system did not involve active intervention by clinicians, but patients felt connected and reassured. A follow-up randomised trial (SUPPORT-HF2), explored whether integrating the home monitoring system with electronic health records and personalised feedback improved its effectiveness. It recruited 202 patients with heart failure from seven UK hospitals. The primary outcome was the use of recommended medical therapy. The trial has completed and data analysis is underway.

Rahimi K, Velardo C, Triantafyllidis A, Conrad N, Shah SA, Chantler T, et al. A user-centred home monitoring and self-management system for patients with heart failure: a multicentre cohort study. European Heart Journal - Quality of Care and Clinical Outcomes 2015 November; 1(2):66–71. https://doi.org/10.1093/ehjqcco/qcv013

https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/13114102/#/

Rahimi K. Home monitoring with IT-supported specialist management versus home monitoring alone in patients with heart failure: Design and baseline results of the SUPPORT-HF 2 randomized trial. American Heart Journal. Available online 25 September 2018. https://doi.org/10.1016/j.ahj.2018.09.007

Funder – NIHR HS&DR - 13/114/102, NIHR Oxford BRC Programme and NIHR Career Development Fellowship

Study 15 published

NANA - Novel Assessment of Nutrition and Ageing

Published, 2018, Astell

The Novel Assessment of Nutrition and Ageing toolkit collects information over time about older people’s health and behaviour via a touchscreen computer, on which people enter information about themselves. Two studies explored six items for measuring self-reported mood and appetite as part of this toolkit. One was conducted in a supervised laboratory setting with community-living older adults (n=48), and compared the computerised items with established paper measures, in three individual testing sessions over a week-long period. The researchers concluded that the computerised items were a valid and reliable way of measuring participants’ mood and appetite, and there was significant correlation between the computerised items and established methods. The second study was conducted in people’s own homes (n=40), unsupervised, over three periods of seven days each. Participants were also assessed at home and in clinic before and after the measurement periods. The computerised methods worked well at home. Limitations included most participants being relatively high-functioning, with previous experience of using computers. Adaptations would be needed for people with visual impairment. The researchers concluded the toolkit can be effective in identifying people who are experiencing changes in mood or appetite, and in understanding more about the links between mood, appetite and health.

Brown LJE, Adlam T, Hwang F, Khadra H, Maclean LM, Rudd B et al. Computerized self-administered measures of mood and appetite for older adults: the Novel Assessment of Nutrition and Ageing toolkit. Journal of Applied Gerontology 2018 Feb 1; 37(2): 157-176. First published online February 10, 2016. DOI: 10.1177/0733464816630636.

http://journals.sagepub.com/doi/abs/10.1177/0733464816630636#

Timon CM, Astell AJ, Hwang F, Adlam TD, Smith T, Maclean L et al. The validation of a computer-based food record for older adults: the Novel Assessment of Nutrition and Ageing (NANA) method. British Journal of Nutrition 2015 Feb 28; 113(4):654-64. doi: 10.1017/S0007114514003808

https://www.cambridge.org/core/product/identifier/S0007114514003808/type/journal_article

Funder – NDAP

Study 16 published

USEFIL: Unobtrusive Smart Environments For Independent Living

Published, 2015, Clarkson

This project aimed to develop low-cost applications to monitor activity, physical health and emotion, for older people living at home. It added software to off-the-shelf devices such as smart watches, tablets and smart TVs. A ‘smart mirror’ monitored users’ emotions and health indicators, such as pupil size. Users, family and friends, carers and health professionals logged in to an online project portal to see monitoring data and communicate with each other. A ‘decision support system’ analysed users’ data and flagged up problem trends in health. The system was tested at three sites in the UK, Greece and Israel, in the laboratory, and in the homes of thirteen older people aged over 65 who had had a stroke, were living with mild cognitive impairment or had chronic conditions (without dementia). Users completed questionnaires and took part in interviews, but full results are not available. Challenges included maintaining the system in users’ own homes. Early findings suggested differences in perception between the laboratory and the home. Overall, users found monitoring much more invasive at home, and harder to use without a facilitator there. Although smart watches felt less like monitoring devices at home, their use declined since they required daily charging.

https://usefil.eu/pudeliverables/USEFIL_WP8_D8%204_End_of_Project_Volume_v3.0.pdf

Funder - EC

Study 17 published

The Mainstreaming on Ambient Intelligence (MonAMI) project

Published, 2012, Damant

This project aimed to develop computer technology to deliver care services for older and disabled people using mainstream devices, such as mobile phones and personal computers. Services included local and remote home monitoring and appliance control, safety and security alarms (such as visitor validation), and planning and reminder applications. Users first tested the technology in laboratories in six European countries: the UK, France, Germany, Slovakia, Spain and Sweden. A trial then took place in three communities in Slovakia, Sweden and Spain. 62 users (average age 79 years, 73% women, 90% living alone) tested the services in their own homes over a three-month period. Researchers conducted semi-structured interviews at the start and end of the trial-period. Results demonstrated that users with more disabilities, compared to those with fewer disabilities, found the services had a positive effect on their perceptions of security, and ability to manage pain. Overall, more than half of users rated the acceptability and usefulness of the services highly. However, users who were more independent and had better self-rated health benefited from the services more than users who were less independent and were in poorer health. The researchers concluded that this developmental model showed potential to improve the quality of life of older people with care needs.

Damant J, Knapp M, Watters S, Freddolino P, Ellis M, King D. The impact of ICT services on perceptions of the quality of life of older people. Journal of Assistive Technologies 2013; 7(1): 5-21. https://doi.org/10.1108/17549451311313183

Funder – EC

Study 18 published

TOTALCARE: a digital health-care framework integrating secure personal monitoring with P2P (peer to peer) medical condition community support focused on ageing & obese

Published, 2011, Darlington

This project developed and tested a system for monitoring the elderly living at home, informed by an earlier study. It used motion sensors, and shared data between all those involved in the elderly person’s care, such as carers, the health professionals, social workers and friends. Researchers tested it in practice with 16 residents and their carers, as well as four medical professionals, in a sheltered housing complex in London. Five sensors were installed in each dwelling, in the kitchen, bathroom, living area, hall and bedroom. Carers could monitor over the web when, and how often, residents moved between different rooms. The researchers reported that all those involved, including residents, found the system easy to use and supportive. On several occasions during the trial, monitoring data revealed a problem, such as spending an unusually long time in the bathroom, which led to helpful intervention. Six participants chose to continue using the system after the trial ended.

https://gtr.ukri.org/projects?ref=TS%2FH000135%2F1

Funder - EPSRC

Study 19 published

SOPRANO: Service Oriented Programmable Smart Environments for Older Europeans

Published, 2010

This project involved 25 academic, industrial and telecare service organisations across seven countries, and aimed to develop smart assisted living technology to promote older people’s independence and quality of life. It aimed to combat older people’s worries about technology being intrusive, or difficult to use, by involving them in regular focus group meetings to develop the design. Laboratory and in-home trials involved more than 300 participants in the UK, Spain and the Netherlands. The system enabled different applications to be installed and adapted to individuals’ needs, including those that monitor a user’s home, notify them of someone at the front door, give reminders about medication, monitor health, and alert carers. Researchers found that minor alterations to design and function made a large difference to acceptance and ease of use. These included replacing icons with numbers on a touch screen to resemble a TV remote control. A priority was helping the user feel in control; alerts were issued first to the user and only to the carer if reminders were continually ignored, or sensors indicated a more serious problem. This early design has been made available to other researchers.

https://cordis.europa.eu/project/rcn/80527_en.html

Funder – EC

Study 20 published

Ecaalyx - Enhanced Complete Ambient Assisted Living Experiment

Published, 2011, Kamel Boulos

This study developed a smartphone application for older people with multiple, ongoing health conditions. The application receives input from wireless sensors worn by the older person (measuring heart rate and temperature for example), and from a Global Positioning System location sensor in the smartphone. The application communicates over the internet with a remote server, accessed by health professionals overseeing the remote monitoring and management of the patient. It analyses the raw data, and issues alerts to the patient. Patients, carers and clinicians helped to design and test this experimental application. The project came up with practical solutions to increase ease of use, including: dock-stations for charging; mobile phones with large touch screens which enabled large virtual buttons to be built in; maintenance carried out remotely but visibly to the user, or by technicians on site. Clinical trials have not been conducted yet.

Kamel Boulos MN, Wheeler S, Tavares C and Jones R. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from Ecaalyx. Biomed Engineering Online 2011 Apr; 10: 24.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080339/

Funder – AAL Joint Programme – National Funding Agencies and EC

Study 21 published

CompanionAble: Integrated Cognitive Assistive and Domotic Companion Robotic Systems for Ability and Security

Multiple publications, 2010-2012, Badii

This project developed a robotic companion, ‘Hector’, to support older people with early stage dementia to live independently. The robot system linked with smart home systems, enabling it to close windows or regulate temperature, and responded to voice commands and large touchscreens. The robot issued medicine and other reminders, and connected the older person to friends and family via a video-telephone. The robot could monitor the user, registering heart rate and falls for example, and dial up a response centre in emergencies. The centre could remotely control the robot. Interaction between the robot and the user aimed to be mentally stimulating and to reduce feelings of loneliness, but emotion recognition by the robot was limited. The researchers noted that, due to budget and time constraints, a wider evaluation with more participants did not proceed. Safety and other practical considerations meant that users had to test the system in demonstration homes, rather than in their own homes. The project demonstrated that this design is feasible. Limitations to address before developing a product for wider use include: enabling the robot to differentiate between different people, enhancing the robot’s microphones, and enabling ‘re-mapping’ to cope with furniture being moved.

https://cordis.europa.eu/project/rcn/85553_en.html

Funder – EC

Study 22 published

Care at Home using Intelligent Robotic Omni-functional Nodes (CHIRON)

Published, 2018, Harris

Building on earlier Innovate UK projects, this project aimed to develop a robot that users would choose to introduce into their homes before care needs arose, and which could learn and adapt as users’ needs changed. Engineers worked together with care providers and older adults to design different components to add in, as required, to meet people’s varying needs. The intention is for the robot to work alone, or complement support from care workers. The robot is being designed to help older people to stand up from a chair or bed, move around and carry objects. It responds to voice, gestures or touch screen commands. The aim is for compatibility and interactivity with other smart devices and sensors in the house, enabling it to inform friends and family of individuals’ health status and wellbeing. Older adults provided feedback over 24 months in a laboratory set-up of a studio with kitchenette. The protoype is at an early stage; exploration of engineering, safety and ethical issues, and significant further testing, is required to gain regulatory approval and bring the product to market. The team has prepared a business case, and noted the robot’s potential to provide a cost-effective alternative to residential care.

Harris N, Dogramadzi S, Caleb-Solly P. Final Report – executive summary: CHIRON. Innovate UK; 2018. https://chironrobotics.files.wordpress.com/2018/10/971441_chiron-final-report-executive-summary-public-no-appendix.pdf

Funder - Innovate UK

Study 23 published

RoboSafe: Trustworthy Robotic Assistants

Multiple publications, 2013-2016

This is a joint project between academic and industrial organisations in the UK, which aims to improve robots so that they can interact with humans in a safe and trustworthy way within the home environment. It focuses on whether robots ever deliberately make unsafe moves. Researchers are combining three approaches; standard analysis of all a robot’s possible choices; simulations in a laboratory setting; and work with human participants to assess robot and human interaction in the real world. This includes the robots providing human volunteers with physical help and / or help with thinking, perception and memory, such as prompts to take medicine. They are exploring how robots can make their own decisions, based on their analysis of monitoring data from sensors, about when to raise an alarm for example. Researchers are exploring designs that make robots more expressive and human-like. They are looking at how elderly people, or their carers or relatives, can make robots learn and respond to activities in a ‘robot house’ (an ordinary home that has been fitted with sensors). The project website gives access to the full range of publications since the project’s start in 2013 (21 publications to date).

www.robosafe.org

Funder – EPSRC

Study 24 published

NOCTURNAL - Night Optimised Care Technology for UserRs Needing Assisted Lifestyles

Published, 2013, Martin

This project developed a technology-based system, NOCTURNAL, to address the nighttime needs of people with dementia. It aimed to move beyond risk management to improving well-being. Disturbed sleep patterns and nighttime wandering often result in admission to institutional care. The researchers worked directly with people with dementia, and their carers. Participants lived in their own homes in Northern Ireland, including in supported housing. The project combined qualitative observations and interviews with technical analysis of system usage, and the academic team worked with a commercial provider. A focus group with healthy older people (n=12) added insights. The project comprised three phases of three months each: (i) moving the initial prototype from the lab into the home (ii) evaluation of a second prototype, with personalised soothing music, photographs and guiding lights triggered by sensor data if the participant awoke (iii) evaluation of the final prototype with full integration into the existing telecare system. Recruiting and retaining participants was challenging; eight people with dementia had the final prototype installed for a three-month evaluation at home. The authors concluded that the system is feasible, with positive user feedback; larger-scale research needs to explore the potential of this system as a healthcare intervention.

Martin S, Augusto JC, Mc Cullagh P, Carswell W, Zheng H, Wang H et al. Participatory Research to Design a Novel Telehealth System to Support the Night-Time Needs of People with Dementia: NOCTURNAL. International Journal of Environmental Research and Public Health 2013 Dec; 10(12): 6764–6782.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881140/

Funder – TSB and EPSRC

Study 25 published

Supporting safe walking for people with dementia: User participation in the development of new technology

Published, 2013, McCabe and Innes

This study explored the views of 12 people with dementia, three carers and five older people about using Global Positioning System (GPS) devices to support safe walking. It formed part of a larger project involving health and social care professionals, people with dementia, family carers, designers, and technology companies, to develop a new safe walking device. GPS devices can be an alternative to restraints, such as locked doors, enabling people with dementia to keep active without getting lost. Researchers conducted two focus groups, one in Scotland (n=11, all white, rural-dwelling) and one in England (n=9, all African-Caribbean, city-dwelling). Walking and ‘getting out and about’ were common and valued activities. Potential users felt that GPS devices would increase their independence and confidence, and help as their dementia progressed. Carers saw the benefits of reducing risk and addressing safety concerns. Devices needed to be discreet, so they did not increase stigma or vulnerability, and light, easy to wear, to operate and to charge, possibly with a ‘panic button’. Potential users were less concerned with the ethical issues of ‘tagging’ and surveillance. Effective practical use will require good quality assessment processes, and support from carers. Further research should demonstrate actual devices, and involve more user groups.

McCabe L and Innes A. Supporting safe walking for people with dementia: User participation in the development of new technology. Gerontechnology 2013; 12(1): 4-15.

https://doi.org/10.4017/gt.2013.12.1.006.00

Funder - NIHR i4i

Study 26 published

Design for Ageing Well: Improving the quality of life for the ageing population using a technology enabled garment system

Published, 2013, McCann

This project developed a design for layered ‘Smart’ clothing to wear whilst walking, in order to improve comfort, independence and enjoyment. This was a proof of concept study, for early development and testing. It focused on the ‘Active Ageing’ population, aged 60-75 years. In a co-design process, academics, designers, clothing producers, materials and electronics suppliers, experts in the care of older people, and older participants, worked together. Older participants were selected to represent the UK figure, based on height and Body Mass Index. They underwent body scanning, which informed the designs. The clothing comprised base-layers that could monitor heart rate and activity, mid-layer insulating garments with warming devices, and protective outer layers with a Smart phone. The authors concluded that the co-design process succeeded in developing useful Smart clothing, attractive to older people, with appropriate colours, shape, fit and positioning of electronic devices. These early designs could be used more widely in the future, for example for activity monitoring. However, the authors note that wearable electronics currently lack robustness and reliability, which reduces the confidence of older users. They can also be bulky, and do not necessarily integrate with other devices. Developing new technology components is expensive. Training in design for smart clothing and wearable electronics is limited.

McCann, J et al. Design for Ageing Well: Improving The Quality of Life For The Ageing Population Using A Technology Enabled Garment System: ESRC Impact Report, RES-353-25-0004. Swindon: ESRC; 2013.

https://www.researchcatalogue.esrc.ac.uk/grants/RES-353-25-0004/outputs/read/96a69b3b-ebe6-4827-b4d5-290d1a6dc6a2

Funder – NDAP

Study 27 published

A Randomized Controlled Pilot Study to Evaluate a Technology Platform for the Assisted Living of People with Dementia and their Carers

Published, 2014, Torkamani

This pilot study comprised a randomised controlled evaluation of ‘A technology pLatform for the Assisted living of Dementia elDerly INdividuals and their carers’ (ALADDIN). Carers are at risk of depression, early mortality, social isolation, and reduced quality of life and employment. This technology aims to help via four main features: a smart television with information, music, relaxation and exercise techniques; a social networking forum for carers; remote monitoring of information uploaded by carers that can trigger rapid intervention; and a feature to enable carers to contact clinicians easily. The study compared the platform with no intervention at three sites in the UK, Spain and Greece, over six months. All participants and carers, in both the platform intervention group (n=30), and the control group (n=30), were assessed in their homes at baseline, three months and six months. Those in the control group received no further contact or intervention. The results suggested some improvement in quality of life for carers in the platform group. Carers’ overall response to using the platform was positive. However, there was no significant reduction in carer burden. As this was a pilot study, these results are not definitive. Further research and a larger trial is needed to demonstrate effectiveness.

Torkamani M, McDonald L, Saez Aguayo I, Kanios C, Katsanou M, Madeley L et al. A Randomized Controlled Pilot Study to Evaluate a Technology Platform for the Assisted Living of People with Dementia and their Carers. Journal of Alzheimer’s Disease 2014 41:515–523. doi: 10.3233/JAD-132156

https://content.iospress.com/articles/journal-of-alzheimers-disease/jad132156

Funder – AAL Programme and EC

Study 28 ongoing

The Project About Loneliness and Social networks (PALS) study

Protocol published, 2018, Rogers

This randomised controlled trial will test whether an online tool that maps people’s social networks (GENIE) can reduce the negative impacts of loneliness and social isolation. The intervention delivered by trained facilitators helps participants to create visual maps of current networks and use technology to identify local activities and resources suiting their preferences. Participants will be aged 18 or over, socially isolated, and living within the community in Southampton or Liverpool. Participants will be randomly allocated to use the online tool (n=197) or to usual care (n=197). Facilitators will help participants use the online tool to map existing social networks, consider how to widen them, and link to new community activities. Participants’ mental health will be assessed at three and six months. Researchers will interview some participants.

https://www.journalslibrary.nihr.ac.uk/programmes/phr/160841#/

Funder – NIHR PHR - 16/08/41

Study 29 published

Putting Life in Years (PLINY): Telephone friendship groups research study. Evaluation of the effectiveness and cost effectiveness of an intervention to promote mental wellbeing in community living older people

Published, 2014, Mountain

This randomised controlled trial aimed to find out whether telephone friendship can improve the well-being of older people living in their own homes. An initial pilot phase planned to recruit at least 68 participants aged over 74, and 20 volunteers from a voluntary sector organisation to deliver a telephone friendship service. If successful, a larger study would go ahead. Participants were randomly allocated to the telephone friendship group (n=78) or a control group receiving usual health and social care provision (n=79). The telephone friendship participants would receive short, weekly one-to-one telephone calls for 6 weeks, followed by 12 weeks of one-hour calls in groups of up to six people, facilitated by trained volunteers. Participants’ quality of life was assessed at the start, and six months later. Researchers also interviewed participants and volunteers about their experiences. Although the pilot met and exceeded its participant recruitment target, it retained only three volunteers to deliver the group intervention. This resulted in only 28 participants receiving the intervention, and the trial closed early. The authors concluded that small voluntary sector organisations may be unable to recruit, train and retain sufficient volunteers. Future research could benefit from using multiple providers.

Hind D, Mountain G, Gossage-Worrall R, Walters S, Duncan R, Newbould L, et al. Putting Life in Years (PLINY): a pilot randomised controlled trial and mixed-methods process evaluation of telephone friendship groups for community living older adults. Public Health Res 2014; 2(7).

https://www.journalslibrary.nihr.ac.uk/programmes/phr/09300401#/

Funder – NIHR - PHR 09/3004/01

Study 30 published

Computer Interactive Reminiscence and Conversation Aid groups—Delivering cognitive stimulation with technology

Published, 2018, Astell

This study aimed to compare a technology-based group activity known as ‘Computer Interactive Reminiscence and Conversation Aid’ with cognitive stimulation therapy, which has been shown to be as effective as dementia drugs in improving cognitive function and quality of life. The technology comprises an interactive application, with photographs, video and music, delivered on a touch screen. Its goal is to enhance speech production and recall from long-term memory. In this study, people with dementia in Sheffield participated in eight hour-long technology-based group sessions. Groups comprised three to six participants with a facilitator. Cognition, quality of life and general health were assessed before intervention (n=151), one week later (n=143), and three months later (n=42). The study found a significant improvement in cognition and quality of life after the intervention, similar to that previously found with 14 x 45 minute sessions of cognitive stimulation therapy. Further improvement was found at three-month follow-up. The low number at follow-up is a limitation of this study, and most participants lived in long-term care so the findings may not apply to other settings. A web-based version of the technology can be adapted to different cultures and languages; further testing in different contexts could be useful. This was an uncontrolled before-after study and experimental designs, such as randomised trials, may be needed to demonstrate effectiveness at scale.

Astell AJ, Smith SK, Potter S, Preston-Jones E. Computer Interactive Reminiscence and Conversation Aid groups—Delivering cognitive stimulation with technology. Alzheimer’s & Dementia: Translational Research & Clinical Interventions 2018; 4: 481-487.

https://doi.org/10.1016/j.trci.2018.08.003

Funder – EC, supported by the Ontario Shores Foundation

Study 31 published

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Published, 2011, Chamberlain

This project aimed to improve the quality and design of bathroom furniture, producing products acceptable to all bathroom users, while meeting the needs of older and disabled people. It used a co-design approach, involving older users and carers, together with design researchers, health experts and a commercial bathroom supplier. Participants included people with arthritis, sight and hearing loss and disability after stroke, living in Sheffield. Older Sheffield residents were recruited and trained as lay researchers (n=11). They conducted 23 home visits and gained greater insights from interviewees, in this very personal aspect of life, than younger researchers had done. Paper surveys, online blogs and design workshops with students also contributed insights. A prototype mock up bathroom was installed in a ‘user lab’, enabling detailed observations and testing, such as getting in and out of a bath. The project emphasised the importance of product flexibility, to support unknown future and changing needs, especially given that people may replace their bathroom suite just once or twice in a lifetime. Products should not carry the stigma of ‘special equipment’. The project proposed a range of designs for consideration by the commercial partner to feed into the design of mainstream products.

Chamberlain P, Reed H, Burton M and Mountain, G. Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities. In Research and development work relating to assistive technology 2010-11. Department of Health 2011; pp. 28-29.

http://shura.shu.ac.uk/4659/

Funder – EPSRC

Study 32 ongoing

Bathing Adaptations in the Homes of Older Adults – The BATH-OUT Trial

Ongoing, Whitehead

This study will test the feasibility of conducting a randomised controlled trial of bathing adaptions for older adults and their carers, and will inform its design. It will examine the effect of adaptations, and explore whether waiting times lead to worse outcomes. Participants will be randomised to receive immediate adaptations or routine waiting list. Outcomes will be assessed at three and six months: health and social care related quality of life, ability to perform activities and tasks, and use of services. Researchers will also interview users and carers.

https://www.sscr.nihr.ac.uk/P90

Funder – NIHR SSCR

Study 33 published

TiKL - Transitions in Kitchen Living

Published, 2014, Maguire

This qualitative study recorded 48 older people’s memories of kitchen use throughout their lives, and investigated their current kitchen experience. Experts in equipment design, and in the social aspects of growing old, worked together. Participants were aged 60 to 80+, lived in Bristol or Loughborough, and reflected a range of backgrounds. Some lived in supported housing and all had their own kitchen. Researchers conducted interviews and collected measurements of participants’ kitchen spaces. People had developed solutions to their kitchen problems, such as amplifying light with mirrors, using a perching stool, a grabber and a board to stand on. Researchers compiled all these ideas and distributed them to consumers, kitchen designers and installers. They developed the traditional kitchen ‘work triangle’ of refrigerator, sink/dishwasher and cooker, into a ‘kitchen star’ to include cooking, laundry and eating/clearing up triangles. Recommendations for future kitchen design included: ensuring enough light; providing easier access and more storage; addressing problems of strength and dexterity including with lighter utensils, lever taps, sensor-operated bins; more flexible kitchens that adapt over time; bespoke kitchens to match individual needs, such as worktop height. The authors emphasised the importance of the kitchen in enabling older people to live independently.

Maguire M, Peace S, Nicolle C, Marshall R, Sims R, Percival J, Lawton C. Kitchen living in later life: Exploring ergonomic problems, coping strategies and design solutions. International Journal of Design 2014; 8(1): 73-91.

http://www.ijdesign.org/index.php/IJDesign/article/view/1216/615#15

Funder – NDAP

Study 34 published

Co-Motion: Mobility and wellbeing in later life

Published, 2017, Bevan

This three-year mixed methods project explored practical ways of supporting mobility instead of, or complementary to, re-design of the built environment. It focused on key transitions commonly experienced by older people, such as stopping driving or losing sight or hearing. The study took place in Hexham, Leeds and York. Participants (n=99) were older people aged 55 or over, who had experienced a key transition in the previous 12 months. Participants completed wellbeing questionnaires at study start (2014) and finish (2016, n=66), and had two face-to-face and four telephone interviews. Limitations included difficulties engaging with people on very low incomes or from minority ethnic communities. The journeys of 39 participants were mapped using low cost portable computers, and combined with photo diaries and online surveys to identify barriers and potential solutions for older people’s journeys. Researchers also fixed sensors onto mobility scooters to record experiences, and made recommendations for improving scooter technology and safety, and increasing accessibility. A co-design process in a series of workshops (n=33 participants aged 55-85), resulted in a prototype ‘Walking for Wellbeing’ smartphone application, which enables people to plan walking routes locally, avoiding barriers such as steep stairs, and including rest stops.

Bevan M, Andrews E, Attuyer K, Cambridge H, Cinderby S, Croucher K et al. Co-Motion: Mobility and wellbeing in later life. Summary of key findings and recommendations. York: University of York; 2017.

http://eprints.whiterose.ac.uk/121607/1/CoMotion_key_findings_summary_2017.pdf

Funder – LHWCP

Study 35 ongoing, published (interim)

AAL-WELL: Ambient Assistive Living Technologies for Wellness, Engagement, and Long Life

Interim publication, 2016, Astell

This project aims to combine technology with the social environment to promote active and healthy ageing. It focuses on older adults with mild cognitive impairment, such as memory loss and confusion, which are not severe enough to be diagnosed as dementia. One aspect of the project involved a scoping study, to identify activities that mattered to people with mild cognitive impairment, early-stage dementia, or minor stroke. The researchers selected the 16 most relevant qualitative studies for analysis, conducted in the UK, Sweden, Belgium and Canada/USA. The number of participants in each study ranged from one to 66. Important activities included engaging in social activities, performing significant roles such as handling finances, being independent, reducing the worries of others, and being safe and secure. Many involved being outdoors, and were more challenging. Previously enjoyable activities could become too demanding and lead to anxiety or stress. Different people valued different activities. Some activities (such as driving) were the key that unlocked many others. The researchers concluded that identifying such key activities is important in deciding on interventions, and that support should be planned to enable activities outside the home, in nature and public space.

Lindqvist E, Persson Vasiliou A, Gomersall T, Astell A, Mihailidis A, Sixsmith A, et al. Activities people with cognitive deficits want to continue mastering – A scoping study. British Journal of Occupational Therapy 2016 April; 79(7): 399-408. https://doi.org/10.1177/0308022616636895

http://www.aal-well.org/index.html

Funder – ESRC, Canadian Institutes of Health Research and Swedish Council for Working Life and Social Research

Study 36 published

Seeing what they see: compensating for cortical visual dysfunction in Alzheimer’s Disease

Published, 2018, Yong

People with dementia can have trouble finding their way around. This study evaluated whether visual cues support navigation within a movement laboratory in individuals with typical Alzheimer's disease (n=10, average age 66), posterior cortical atrophy (a rare form of dementia that predominantly affects visual function, n=8, average age 64), and healthy controls (n=12, average age 64). Participants repeatedly walked to visible target destinations (an open door) positioned in three locations, with or without an obstacle present. Overall, patients took two to three times longer than controls to reach the open door, and took indirect walking routes to get there. Researchers compared walking time when there was no visual cue, a contrast cue (black box above the door handle), or a motion cue (a rotating light pattern displayed on the black box). When cues were present, patients overall took almost 12% less time than without a cue, and were more likely to direct their gaze towards the target door to begin with. The motion cue did not significantly improve the result obtained with the contrast cue alone. Further research with a greater number and more diverse group of patients is needed.

Yong KX, McCarthy ID, Poole T, Suzuki T, Yang B, Carton AM et al. Navigational cue effects in Alzheimer's disease and posterior cortical atrophy. Annals of clinical and translational neurology 2018 June; 5(6): 697-709. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989777/

Funder – ESRC, NIHR, EPSRC, Alzheimer’s Research UK, Brain Research Trust, Wolfson Foundation, Avid Radiopharmaceuticals, The National Brain Appeal – Frontotemporal Dementia Research Fund

Study 37 published (interim)

Dementia Friendly Architecture: Reducing Spatial Disorientation in Dementia Care Homes

Interim publications, Wiener

This project aimed to develop design guidelines for dementia-friendly architecture to minimise spatial disorientation and help people with dementia find their way. Researchers used virtual reality technology in a laboratory to simulate unfamiliar care home environments, to change features of these environments one by one, and to monitor the impact of these changes on learning to way-find over several weeks. They used eye-tracking technology to record gaze direction and identify the cues people use to find their way. They compared people with early signs of cognitive impairments with healthy adults of a similar age, and young adults. This enabled them to study the effects of typical and atypical ageing on navigation abilities, and the underlying cognitive processes. Early findings point to the importance of landmark objects for learning routes, if they are carefully placed, and meaningful to the individual. A first draft of design guidelines is available at: https://microsites.bournemouth.ac.uk/wayfinding/consultancy/

https://gtr.ukri.org/projects?ref=ES%2FM009254%2F1

Funder – ESRC

Study 38 published

BESiDE - The Built Environment for Social Inclusion in the Digital Economy

Multiple publications, 2015-2017, Hanson

This study explored how the building and technology design of care homes can maximise independence, physical activity and social interaction for residents, across ten care homes in Scotland and England. The research involved architects, experts in design, ageing, healthcare and engineering, and care home residents. It included long-term case studies with care home managers, nurses, and care staff. Outputs included software to help architects involve residents in designing and planning homes, monitoring technologies and location sensors, a baseline of physical activity levels amongst this population, and reflections on conducting research in care homes. Observations in five urban care homes provided evidence about the effect of design on everyday activities. Spatial cues, such as internal windows, helped people find their way. Sometimes the built environment was misleading and caused frustration, for example when a locked door appeared usable. Connections between spaces could increase social interaction. Easy movement through the care home, signals about time of day, a choice of rooms, points of interest and a connection to the outside, were important. One aspect of the study involved care home residents (n=14) helping to design personalised, wearable activity-monitoring devices, using a craft approach with textiles. The project website lists related publications.

https://gtr.ukri.org/projects?ref=EP%2FK037293%2F1

Funder - EPSRC

Study 39 published

DWELL (Designing for Wellbeing in Environments for Later Life)

Completed, 2016, Wigglesworth

This three-year research project involved three neighbourhoods in Sheffield. It aimed to find out how the design and management of housing and neighbourhoods could be improved to support older people’s mobility in the home, street and neighbourhood, and their participation in community life. Older people, carers, designers, managers and service providers worked together to develop designs for housing and neighbourhoods. The research team formed a partnership with Sheffield City Council, enabling data sharing and ongoing input from council officers. The team considered designs both for newly built housing and neighbourhoods, including for ‘downsizers’, and for refitting existing ones. All the neighbourhoods had some land allocated for new-build housing, enabling emerging designs to be tested. Engagement with older people and professionals occurred through an advisory group, online survey, focus groups, project meetings, regional workshops, conference presentations, a project website and social media. The project website includes links to the specific design outcomes. The authors’ recommendations included not leaving older people’s housing needs to the market alone, and developing homes that enable people to enjoy their current life while feeling secure that their home will adapt to future needs.

http://dwell.group.shef.ac.uk/

Park A and Ziegler F. A Home for Life? A Critical Perspective on Housing Choice for “Downsizers” in the UK. Architecture MPS, UCL Press 2016 April; 9(1).

https://www.scienceopen.com/document/read?vid=4d58e812-61cd-4512-9380-adf7c6a324fe

Funder – LHWCP

Study 40 published

Design evaluation of older people's extra care housing: development and testing of an assessment tool (EVOLVE)

Published, 2010, Lewis

‘Evaluation of Older People’s Living Environments’ (EVOLVE) is a tool for assessing how housing design contributes to the physical support and wellbeing of older people. It is based on research into extra care housing, which included focus groups with residents and relatives, and interviews with architects, commissioners and housing providers. Researchers piloted draft versions of the tool in five extra care schemes, surveyed 23 extra care schemes in England, and then commissioned independent researchers to use the tool to evaluate a further 12 extra care schemes, making revisions at each stage. It uses a set of checklists, on paper or electronically, scoring 487 items for a single dwelling, and 2020 items for a housing scheme, grouped into 13 broad ‘domains’. The domains include universal needs, such as choice, privacy and social contact, as well as specific support for older age, such as physical support and dementia support. The tool is suitable for various housing types, including sheltered housing and private homes, but not for residential care or nursing homes (a separate tool is available). It can be used at any time from initial design to after the building is occupied, alongside existing guidance and standards.

Lewis A, Torrington J, Barnes S, Darton R, Holder J, McKee K et al. EVOLVE: a tool for evaluating the design of older people’s housing. Housing, Care and Support 2010 Oct; 13(3):36-41. DOI: 10.5042/hcs.2010.0709.

https://www.researchgate.net/publication/48546431_EVOLVE_A_tool_for_evaluating_the_design_of_older_people's_housing

Funder - EPSRC

Funder Organisations

  • Ambient Assisted Living AAL
  • European Commission EC
  • Economic and Social Research Council ESRC
  • Engineering and Physical Sciences Research Council EPSRC
  • Lifelong Health and Wellbeing Cross-Council Programme LHWCP
  • New Dynamics of Ageing Programme NDAP
  • NIHR Biomedical Research Centre BRC
  • NIHR Collaboration for Leadership in Applied Health Research and Care NIHR CLAHRC
  • NIHR Health Services and Delivery Research NIHR HS&DR
  • NIHR Health Technology Assessment NIHR HTA
  • NIHR Invention for Innovation NIHR i4i
  • Nihr Public Health Research NIHR PHR
  • NIHR School for Social Care Research NIHR SSCR
  • Technology Strategy Board TSB

References (apart from featured research studies)

Age UK (2016). Malnutrition Task Force State of the Nation: Older people and malnutrition in the UK today. http://www.malnutritiontaskforce.org.uk/wp-content/uploads/2017/10/AW-5625-Age-UK-MTF_Report.pdf

Barnett K et al (2012). Epidemiology of multimorbidity and implications for health care, research and medical education: a cross-sectional study. Lancet Lancet 2012;380:37–43 https://www.ncbi.nlm.nih.gov/pubmed/22579043

Care Quality Commission (CQC) 2018. The state of adult social care services 2014-2017 https://www.cqc.org.uk/sites/default/files/20170703_ASC_end_of_programme_FINAL2.pdf

Federici, S., Meloni, F. and Borsci, S. (2016), ‘The abandonment of assistive technology in Italy: a survey of National Health Service users’, European Journal of Physical and Rehabilitation Medicine, 52, 4, 516–26. https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2016N04A0516

Henderson C, Knapp M, Fernandez J-L, Beecham J, Hirani S, Beynon M, et al (2014) Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial. Catherine Henderson

Age and Ageing 2014: 43(6): 794–800 https://doi.org/10.1093/ageing/afu067

Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, Romeo R, et al. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technol Assess. 2014;18(61). https://www.journalslibrary.nihr.ac.uk/hta/hta18610/#/abstract

Marmot M et al (2016). English Longitudinal Study of Ageing: Waves 0-7, 1998-2015, 25th edition. UK Data Service. SN: 5050

Ofcom (2018). Adults Media Use and Attitudes Report (2018) https://www.ofcom.org.uk/research-and-data/internet-and-on-demand-research/internet-use-and-attitudes

Office of National Statistics (2017). National population projections 2016-based statistical bulletin https://www.ons.gov.uk/businessindustryandtrade/itandinternetindustry/bulletins/internetusers/2018

Office of National Statistics (ONS) (2018). Statistical Bulletin: Internet Users. UK: 2018 https://www.ons.gov.uk/businessindustryandtrade/itandinternetindustry/bulletins/internetusers/2018

Skills for Health (2014) Technology to Care: A Workforce Learning Strategy to Embed Electronic Assistive Technology (eAT) in Social Care’. https://www.skillsforcare.org.uk/Topics/Assistive-living-technology/Assistive-living-technology.aspx

Social Care Institute for Excellence (SCIE) (2008). SCIE Research Briefing 28: Assistive Technology for Older People. https://www.scie.org.uk/publications/briefings/files/briefing28.pdf

Social Care Institute for Excellence (SCIE). 2014. Electronic surveillance in health and social care settings: a brief review, Review of literature on the use of video and associated technology. https://www.cqc.org.uk/sites/default/files/CM111408_Item_8_Surveillance_literature_review

Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, et al (2012). Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ. 2012;344:e3874. https://www.bmj.com/content/344/bmj.e3874

Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Beynon M, et al (2013). Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial, Age Ageing , 2013, vol. 42. https://academic.oup.com/ageing/article/42/4/501/9333

World Health Organisation (WHO) (2017) Global priority research agenda for improving access to high-quality affordable assistive technology World Health Organization. http://www.who.int/iris/handle/10665/254660

Search strategies and selecting studies 

This review focuses on NIHR and other publicly funded research on assistive technology to support older people’s independent living. This is not a systematic review of all available research. We have taken a pragmatic approach and highlighted studies of interest that have added to our knowledge.

We explored eight consecutive years of government funding of Assistive Technology, from 2009-2010 through to 2016-2017. These are summarised in statutory reports on assistive technology that have been laid before Parliament annually since 2009. We picked out the studies we felt were relevant to categories (i) and (ii) below, and which had clear, publicly accessible outputs.

We then searched the NIHR database using keywords relating to technology, disability and older people, and added in further relevant studies. The Steering Group provided guidance for final selection of studies featured in the report.

We grouped the studies into three themes:

  • Remote monitoring at home for older people, including fall sensors and social support
  • Environmental adaptations to support independent living for older people
  • Contextual studies, which help understand the issues that assistive technology can tackle, potential barriers to its uptake, and implications for service delivery

We excluded studies if they:

  • Did not relate specifically to older people
  • Related to medical devices over which the user has no control, such as pacemakers
  • Related to care after hip fracture, stroke rehabilitation and other specialist rehabilitation, general falls prevention, chronic obstructive pulmonary disease or palliative care
  • Related to physical activity and exercise programmes for older people
  • Related more to funding collaboration and networks than research
  • Were in hospital settings. (We included studies based in people’s homes and care homes, and in a laboratory setting)
  • Published earlier than 2010
  • Lacked publicly available, preferably peer-reviewed publication

Acknowledgements

This report was written by Tara Lamont with Tansy Evans, Alison Ford and Katharine Hanss of the NIHR Dissemination Centre.

Expert input was provided by a steering group consisting of:

  • Manik Arora - GP Lead for Long-Term Conditions - Nottingham City CCG
  • Rachel Atiyah – Occupational Therapist - Oxfordshire County Council
  • Clare Barber - Training Services Development Manager - Disabled Living Foundation, Shaw Trust
  • Kate Brown – Public Contributor
  • Helen Chapman - Head of Integrated Community Care - Sheffield Teaching Hospitals NHS Trust
  • John Clarkson - Group Leader & Principal Investigator, Inclusive Design Group (Healthcare design) - University of Cambridge
  • Laura Cook – Policy & Evidence Officer – Healthwatch Sheffield
  • Paul Cooper - Practice Advisor - Royal College of Occupational Therapists
  • Peter Cudd - Senior Research Associate - University of Sheffield Centre for Assistive Technology and Connected Healthcare
  • Luc de Witte – University of Sheffield Centre for Assistive Technology and Connected Healthcare, President – Association for the Advancement of Assistive Technology in Europe
  • Bridget Harper – Public Contributor
  • Anne Lakin – Public Contributor
  • Adi Latif - Accessibility and Usability Consultant – AbilityNet
  • Carole Lee – Lead Occupational Therapist - Reading Borough Council
  • Maria Martin-Saez - Occupational Therapist, Cambridge University Hospitals NHS Trust – CAHPR
  • Sue Mawson - Director - NIHR CLAHRC Yorkshire and Humber
  • Andrew Needham - Assistant Director of Community Services - Somerset Care
  • Mark Nicholas - Chief Social Worker and Strategic Account Manager, Social Care - NHS Digital
  • Gill Owen-John - Specialist, Section Housing - Royal College of Occupational Therapists
  • Adrian Quinn - Assistant Business Manager - Innovation Agency (North West Coast AHSN)
  • Brenda Riley – Public Contributor
  • Helen Roberts – Professor of Medicine for Older People, University of Southampton and National Specialty Lead, Ageing - NIHR CRN
  • Alice Roe - Professionals & Practice Programme Officer - Age UK
  • Martin Vernon - National Clinical Director for Older People and Integrated Person-Centred Care - NHS England
  • Gill Ward - Research and Development Manager - Royal College of Occupational Therapists
  • Adam Wells - Commissioner, Market Development Lead - Southampton City Council/Southampton City CCG
  • John Woolham - Senior Research Fellow & Fellow of the School for Social Care Research Social Care Workforce Research Unit - King’s College London

 

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