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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.

BackgroundAssistive 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.ObjectivesThis 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.DesignThis 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.SettingThis trial was set in 12 councils in England with adult social services responsibilities.ParticipantsParticipants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare.InterventionsParticipants 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 measuresThe 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.ResultsOf 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.LimitationsCompliance 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.ConclusionsA 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 workFuture work could examine whether or not improved assessment that is more personalised to an individual is beneficial.Trial registrationCurrent Controlled Trials ISRCTN86537017.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.

INTRODUCTION, Assistive Technology and Telecare (ATT) may alleviate psychological burden in informal caregivers of people with dementia. This study assessed the impact of ATT on informal caregivers’ burden and psychological wellbeing.METHODS, Individuals with dementia and their informal caregivers were recruited to a randomized controlled trial assessing effectiveness of ATT. Caregivers were allocated to two groups according to their cared-for person’s randomization to a full or basic package of ATT and were assessed on caregiver burden, state anxiety, and depression. Caregivers’ data from three assessments over six months of the trial were analysed. RESULTS, No significant between- or within-group differences at any time point on caregivers’ burden, anxiety, and depression levels were found.DISCUSSION, Full ATT for people with dementia did not impact caregivers’ psychological outcomes compared to basic ATT. The length of follow up was restricted to six months.

Introduction: The objective of this study was to define current assistive technology and telecare (ATT) practice for people with dementia living at home.Methods: This is a randomized controlled trial (N = 495) of ATT assessment and ATT installation intervention, compared with control (restricted ATT package). ATT assessment and installation data were collected. Qualitative work identified value networks delivering ATT, established an ATT assessment standard.Results: ATT was delivered by public and not-for-profit telecare networks. ATT assessments showed 52% fidelity to the ATT assessment standard. Areas of assessment most frequently leading to identifying ATT need were daily activities (93%), memory (89%), and problem-solving (83%). ATT needs and recommendations were weakly correlated (τ = 0.242; P < .000), with ATT recommendations and installations moderately correlated (τ = -0.470; P < .000). Half (53%) of recommended technology was not installed. Safety concerns motivated 38% of installations.Discussion: Assessment recommendations were routinely disregarded at the point of installation. ATT was commonly recommended for safety and seldom for supporting leisure.

Many people with a cognitive impairment are likely to become lost at some stage of their illness; this can cause great distress to individuals and to their relatives. GPS location equipment has become available recently and has been trialled with a number of families. Although the technology itself is not complicated, it introduces a number of problems including battery management, device selection and returning the individual when they have become lost. A process has been developed to simplify these problems. When it is followed, the outcomes have been positive for all stakeholders.

This paper is based on the joint experiences of assistive technology (AT) clinical leads in two London boroughs. The paper explores some of the practical aspects of the use of AT to support people with dementia. Its aim is to share the practical experiences gained by the authors in conjunction with health, social services, primary care trust and voluntary sector colleagues.

There are many new devices and systems now available to help manage the risk of an individual becoming lost or disoriented when out walking, especially at night. Many use radio devices carried by, or worn by, users that communicate with receivers carried by carers. They generate alerts when the user goes out of range. Other intelligent devices are based on virtual sensors that monitor exits and generate alarms through a telecare system if the person leaves the property at an unsafe time and fail to return within a reasonable period. This approach is particularly useful when used in conjunction with a GPS location device carried by the individual. The latest technologies, which can be integrated into mobile phones, PDAs, wrist watches or key fobs, include a geofencing option that raises an alarm if the individual moves outside a defined zone of safety. The success of these technologies depends on a full assessment of the individual and their support mechanisms in order to determine the management of the devices and their batteries.

The development of telecare services in the UK has been supported by grants from the respective governments of Scotland and Wales, and by the Department of Health in England. New services are being established, sometimes to operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed if service users are to be able to choose appropriately if offered direct payments. Two service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e‐care and m‐care, and telemedicine, where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three technology groups designed to make people more independent, or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term ‐ ARTS (assistive and remote technology services) ‐ to describe this area of support.

Background: Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers.Method/design: ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial.Discussion: In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use.Trial registration: Current Controlled Trials ISRCTN86537017