Feasibility of a user and caregiver centered telehealth technology to support community-dwelling older adults with dementia: TV-AssistDem (Preprint)

Abstract

BACKGROUND Considering the changing demographic trends in Europe, the rising prevalence of dementia, and the increasing demand, limited accessibility and finite resources for long-term healthcare and support services, developing active and assisted living technological solutions becomes necessary for the independent living of community-dwelling adults. The TV-AssistDem project aims to develop a TV-based assistive integrated service for people with mild cognitive impairment by conducting a feasibility study for prototype development and refinement. OBJECTIVE To identify (1) usability barriers and facilitators to implementation, (2) usage and clinical change from baseline and (3) user and caregiver satisfaction. METHODS A two-phased study was carried out between August 2018 and April 2019. PHASE I consisted of a one-time introduction to the TV-AssistDem functionalities at the users´ home environment for usability testing and clinical evaluation at baseline. PHASE II analyzed the usage of the service during a one-month intervention period. Completion of the System Usability Scale, clinical evaluation and assessment of satisfaction was carried out to conclude PHASE II. Participants: Two European countries: Biomedical Research Institute of Malaga (IBIMA) and the Romanian NGO Home Care Association (Îngrijiri La Domiciliu). Twelve dyads (N=24) formed by people with mild cognitive impairment and mild dementia and their informal caregivers, healthcare professionals (nurse and social worker) and technological developers. RESULTS Usability testing reported 72 issues, identifying implementation barriers and corresponding solutions, categorized into human (7) and technological axis (7); and implementation facilitators (4). The likelihood to recommend TV-AssistDem is “passive” and the prototype may be considered as “marginally acceptable”. For almost all services the usage analysis identified 3 very intensive users (more than twice the expected average), 5 normal users and 4 with almost no use of the system. The limited sample size did not provide statistically significant clinical data but the overall increase in clinical average values and delta values is a promising finding that will be validated during the randomized clinical trial which will cover a larger population (N=240) over a longer period of time (12 months). Dyads satisfaction reported TV-AssistDem to be user-friendly, innovative and interactive overall. CONCLUSIONS This user and caregiver centered study with healthcare professional participation tested the TV-AssistDem prototype as an important starting point in prototype refinement, intervention planning, adaptation and successful implementation demonstrating the technological viability for full trial commitment. CLINICALTRIAL NCT03653234 May 13, 2020 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12877-019-1267-z