Rebecca Gathercole1, Rosie Bradley2, Emma Harper2, Lucy Davies2, Lynn Pank2, Natalie Lam2, Anna Davies3,4, Emma Talbot5, Emma Hooper6,7, Rachel Winson8, Bethany Scutt1, Victoria Ordonez Montano9, Samantha Nunn10, Grace Lavelle1, Matthew Lariviere11, Shashivadan Hirani3, Stefano Brini3, Andrew Bateman12, Peter Bentham13, Alistair Burns7, Barbara Dunk14, Kirsty Forsyth15, Chris Fox16, Catherine Henderson17, Martin Knapp17, Iracema Leroi18, Stanton Newman3, John O'Brien19, Fiona Poland20, John Woolham21, Richard Gray2, Robert Howard22. 1. Department of Old Age Psychiatry, King's College London, London, UK. 2. Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK. 3. School of Health Sciences, City, University of London, London, UK. 4. Population Health Sciences, University of Bristol, Bristol, UK. 5. Norfolk and Suffolk NHS Foundation Trust, Stowmarket, UK. 6. Lancashire Care NHS Foundation Trust, Preston, UK. 7. Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. 8. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. 9. Hertfordshire Community NHS Trust, Watford, UK. 10. Cambridgeshire Community Services NHS Trust, Cambridge, UK. 11. Centre for International Research on Care, Labour and Equalities, University of Sheffield, Sheffield, UK. 12. School of Health and Social Care, University of Essex, Colchester, UK. 13. Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK. 14. South London and Maudsley NHS Foundation Trust, London, UK. 15. School of Health Sciences, Queen Margaret University, Edinburgh, UK. 16. Norwich Medical School, University of East Anglia, Norwich, UK. 17. Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK. 18. Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland. 19. Department of Psychiatry, University of Cambridge, Cambridge, UK. 20. School of Health Sciences, University of East Anglia, Norwich, UK. 21. National Institute for Health Research (NIHR) Health & Social Care Workforce Research Unit, King's College London, London, UK. 22. Division of Psychiatry, University College London, London, UK.
Abstract
BACKGROUND: Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. OBJECTIVES: This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. DESIGN: This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. SETTING: This trial was set in 12 councils in England with adult social services responsibilities. PARTICIPANTS: Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. INTERVENTIONS: Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). MAIN OUTCOME MEASURES: The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. RESULTS: Of 495 participants, 248 were randomised to receivefull assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. LIMITATIONS: Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. CONCLUSIONS: A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. FUTURE WORK: Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN86537017. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.
RCT Entities:
BACKGROUND: Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. OBJECTIVES: This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. DESIGN: This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. SETTING: This trial was set in 12 councils in England with adult social services responsibilities. PARTICIPANTS: Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. INTERVENTIONS:Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). MAIN OUTCOME MEASURES: The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. RESULTS: Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. LIMITATIONS: Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. CONCLUSIONS: A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. FUTURE WORK: Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN86537017. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.
Entities:
Keywords:
ACTIVITIES OF DAILY LIVING; ANXIETY; CAREGIVERS; COST–BENEFIT ANALYSIS; DEMENTIA; INDEPENDENT LIVING; INSTITUTIONALISATION; QUALITY OF LIFE; QUALITY-ADJUSTED LIFE-YEARS; TECHNOLOGY ASSESSMENT
Authors: Henriëtte G Van der Roest; Jennifer Wenborn; Channah Pastink; Rose-Marie Dröes; Martin Orrell Journal: Cochrane Database Syst Rev Date: 2017-06-11
Authors: Milena von Kutzleben; Wolfgang Schmid; Margareta Halek; Bernhard Holle; Sabine Bartholomeyczik Journal: Aging Ment Health Date: 2012-01-18 Impact factor: 3.658
Authors: Kirsty Forsyth; Catherine Henderson; Lucy Davis; Anusua Singh Roy; Barbara Dunk; Eleanor Curnow; Rebecca Gathercole; Natalie Lam; Emma Harper; Iracema Leroi; John Woolham; Chris Fox; John O'Brien; Andrew Bateman; Fiona Poland; Peter Bentham; Alistair Burns; Anna Davies; Richard Gray; Rosie Bradley; Martin Knapp; Stanton Newman; Rupert McShane; Craig Ritchie; Emma Talbot; Emma Hooper; Rachel Winson; Bethany Scutt; Victoria Ordonez; Samantha Nunn; Grace Lavelle; Robert Howard Journal: Alzheimers Dement (N Y) Date: 2019-09-03
Authors: Robert J Lucero; Elizabeth A Fehlberg; Aditi G M Patel; Ragnhildur I Bjarnardottir; Renessa Williams; Karis Lee; Margaret Ansell; Suzanne Bakken; Jose A Luchsinger; Mary Mittelman Journal: Alzheimers Dement (N Y) Date: 2018-12-31
Authors: Joseph E Gaugler; Rachel Zmora; Lauren L Mitchell; Jessica Finlay; Christina E Rosebush; Manka Nkimbeng; Zachary G Baker; Elizabeth A Albers; Colleen M Peterson Journal: BMC Geriatr Date: 2021-12-18 Impact factor: 4.070