1. The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: a randomised controlled trial
- Author
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Peter Bentham, Natalie Lam, Alistair Burns, Catherine Henderson, Iracema Leroi, Lucy Davis, Martin Knapp, John Woolham, Stanton Newman, Emma Talbot, Bethany Scutt, Rebecca Gathercole, Emma Hooper, Barbara Dunk, Kirsty Forsyth, Rosie Bradley, Victoria Ordonez Montano, Grace Lavelle, Andrew Bateman, Fiona Poland, John T. O'Brien, Rachel Winson, Chris Fox, Lynn Pank, Richard Gray, Robert Howard, Samantha Nunn, and Emma Harper
- Subjects
Aging ,medicine.medical_specialty ,endocrine system ,Activities of daily living ,Cost effectiveness ,Cost-Benefit Analysis ,BF ,RT ,HV Social pathology. Social and public welfare. Criminology ,law.invention ,older people ,T Technology (General) ,03 medical and health sciences ,AcademicSubjects/MED00280 ,Z726 ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,telecare ,law ,RA0421 ,RA0421 Public health. Hygiene. Preventive Medicine ,Activities of Daily Living ,assistive technology ,medicine ,Humans ,030212 general & internal medicine ,independent living ,Family caregivers ,business.industry ,030503 health policy & services ,Telecare ,Z72 ,General Medicine ,Self-Help Devices ,social care ,Quality-adjusted life year ,England ,Physical therapy ,Quality of Life ,Dementia ,Quality-Adjusted Life Years ,Geriatrics and Gerontology ,0305 other medical science ,business ,Independent living ,Research Paper - Abstract
Objectives The use of assistive technology and telecare (ATT) has been promoted to manage risks associated with independent living in people with dementia but with little evidence for effectiveness. Methods Participants were randomly assigned to receive an ATT assessment followed by installation of all appropriate ATT devices or limited control of appropriate ATT. The primary outcomes were time to institutionalisation and cost-effectiveness. Key secondary outcomes were number of incidents involving risks to safety, burden and stress in family caregivers and quality of life. Results Participants were assigned to receive full ATT (248 participants) or the limited control (247 participants). After adjusting for baseline imbalance of activities of daily living score, HR for median pre-institutionalisation survival was 0.84; 95% CI, 0.63 to 1.12; P = 0.20. There were no significant differences between arms in health and social care (mean -£909; 95% CI, -£5,336 to £3,345, P = 0.678) and societal costs (mean -£3,545; 95% CI, -£13,914 to £6,581, P = 0.499). ATT group members had reduced participant-rated quality-adjusted life years (QALYs) at 104 weeks (mean − 0.105; 95% CI, −0.204 to −0.007, P = 0.037) but did not differ in QALYs derived from proxy-reported EQ-5D. Discussion Fidelity of the intervention was low in terms of matching ATT assessment, recommendations and installation. This, however, reflects current practice within adult social care in England. Conclusions Time living independently outside a care home was not significantly longer in participants who received full ATT and ATT was not cost-effective. Participants with full ATT attained fewer QALYs based on participant-reported EQ-5D than controls at 104 weeks.
- Published
- 2021