Psychosocial applications of technology for health and wellness coaching of older adults with dementia and mild cognitive impairment and their carers in rural areas

Abstract

Introduction: The transition to an ageing population has brought several challenges to societies and healthcare systems around the world. The need for new healthcare approaches and interventions to adjust to the new situation is one of the most relevant issues worldwide. This project particularly targets three of these challenges: the complexity of older adult care, the increase of people living with dementia and their caregivers, and the poor accessibility of rural populations to access healthcare services to face these challenges. Aims: To develop a proof of concept of a technological platform integrating several innovative digital tools for health and wellness coaching of older adults with dementia and cognitive impairment and their carers, and to study the effects of utilisation of the platform on physical health, mental and emotional wellbeing, activities of daily living, social and cognitive functioning and professional care use. To involve older adults with dementia and their carers in the design and development of the platform, assessing their satisfaction, the impact of the system in realistic settings, acceptability and usability, to enable them to manage the system autonomously in daily life. Methodologies: Two systematic reviews were conducted in July 2021 and April 2023 in PubMed, CINAHL, and Web of Science. A qualitative appraisal/risk of bias was performed for the studies included. Three qualitative studies were conducted, implementing online and face-to-face workshops, semi-structured interviews, focus groups, and co-design and co-production processes with Patient and Public Involvement (PPI). Thematic analysis was the chosen approach for the analysis of the results. A mixed-methods usability and user experience study and a pilot study of an online training and support programme for caregivers of people living with dementia are being carried out, implementing semi-structured interviews and questionnaires targeting usability, dementia knowledge and caregiver burden. Results: A series of steps necessary to create the foundations of a technological platform were identified: a) the interRAI LTFC and the interRAI HC were recommended as the CGAs to be used for the assessment and monitoring of potential users in long-term care facilities and home care, respectively; b) the barriers for the usability and implementation of DHTs to assist and to help to reach the full potential of CGAs are described, as well as a series of recommendations to improve its usability and implementation by healthcare professionals and clinical settings; c) a framework to study the pros and cons of developing digital patient and public involvement and suggestions to improve the implementation of e-PPI were developed and identified; d) the facilitators and barriers to implementing the socio-community intervention of the Meeting Centre Support Programme were identified and several recommendations were described to overcome the limitations for a successful implementation; and e) as an attempt to offer a support service alternative for caregivers of PLwD in remote rural areas, the cultural adaptation of the iSupport training and support programme for carers of PLwD was developed, and its usability and user-experience, and impact on dementia knowledge and caregiver burden are under study. Conclusions: This project described a series of steps necessary to create the foundations of a technological platform for health and wellness coaching of older adults with dementia and cognitive impairment and their carers. By embedding the findings in this project and including novel technologies such as AI, robotics, wearable technologies, and monitoring devices, the idea of the technological platform could be feasible. Further projects could implement these initiatives to generate an impact on facing the current challenges of the ageing population.