The number of people living with dementia will continue to grow over the coming decades and is already putting pressure on health and care systems and on costs. By making greater use of technology it may be possible to contain costs and improve outcomes for people with dementia. PIRU was asked to examine the economic case for investing in technology that could lead to savings on the overall cost of care for people with dementia.
Our study had the following aims:
- To conduct a rapid review of the effectiveness and cost-effectiveness of technology in the care and support of people with dementia and/or their unpaid family and other carers.
- To review the necessary conditions for the adoption of available technology, including the quality of the assessment that enables proper matching of technology-based services with needs and preferences.
- To liaise with experts to understand the state of development of new technology for care and support in dementia.
- To engage with people with dementia, carers and their representatives, in order to understand their views on the use of technology in dementia care and support.
- To examine the economic case in the UK for the use of technology in the care and support of people with dementia and/or their carers.
- To examine barriers to the wider use of technology.
The review covered digital, robotic and other technologies.
Our methods included: literature reviews; interviews with experts in academia, government, industry and the third sector; interviews with carers; a review of publicly available material on the use of technology by people with dementia (e.g. blogs); and economic modelling.
Key findings from the different elements of the study are briefly summarised below.
There was some evidence of increased independence for people with dementia, and reduced carer distress, burden or mental health morbidity, or better quality of life. But effectiveness evaluations are complicated by the speed of technological development and by the difficulties of separating out effects for technologies which are used alongside other services.
Matching technology to needs and preferences
Some of the conditions that are necessary for the successful adoption of technology include:
- match technology to need through careful and ongoing assessment
- conduct user-focused assessments, and include carers
- provide up to date information about products and services
- be aware of ethical issues when using technology with people with limited capacity to consent
- introduce people to technologies before they reach local authority thresholds for support
- provide guidance to help relatives choose technologies they are purchasing independently.
Current state of development of technologies
Different technologies suit different levels of dementia and different settings. For people with mild dementia living at home, technologies often help with memory problems, keeping them safe, self-managing their health and reducing worry for relatives. For people with moderate/severe dementia living at home, assistive and safety technology can support independence and help maintain skills. Technology can also support carers by providing ‘respite’ and reassurance, coordinating care between different unpaid carers, and facilitating social interaction and networking.
For people with moderate/severe dementia in a care home, technology may help them retain some independence, provide therapeutic effects (e.g. through pet robotics) or therapeutic ‘entertainment and reminiscence’, and maintain links with their family.
New areas of R&D include: analytics technologies, including ‘stratified medicine’; integration of ‘digitalised care pathways’; gaming technologies to support management of long-term needs; and memory and augmented reality technologies.
Views of people with dementia and carers
Both people with dementia and their carers mostly used technologies not specific to dementia (e.g. smartphones, tablets, light sensors), generally with positive experiences. Difficulties included, for people with dementia, remembering passwords and, for carers, obtaining advice and support.
There is very little evidence on the economic case for adopting technologies. The report includes three scenarios that were modelled to look at the impact of technologies on lifetime costs, which average £200,000 per person over the (average) 4.5 years from diagnosis to end of life.
Barriers to wider use of technology
Technologies are not currently widely used in dementia care and support. A number of barriers were identified including: under-developed technologies; a weak evidence base; cost; design; trust and preferences; limited awareness; the need for individualisation; commissioning; social attitudes; staff skills, awareness and attitudes.
The blog "Council information brokers could help technology to play a vital role in dementia care" can be accessed here>>
The report “The case for investment in technology to manage the global costs of dementia” was provided to the Department of Health in November 2015 and was released for publication in April 2016. The report can be accessed here >>
A number of journal articles are in preparation.