Embed Size (px)
Citation preview
Exploring opportunities for the personalization of assistive technologies in dementia care
Dr Grant GibsonLecturer in Dementia StudiesUniversity of Stirling
@DrGrantGibson@Dementiares
#DARG2018
Assistive technologies (AT) are increasingly becoming a part of care services for people with dementia.
AT currently being ‘mainstreamed’ within the UK – rolled out across health and social care at scale.
Growth of Mixed Economy of AT providers.
Little is known about how people with dementia and their carers use AT in everyday practice.
How to achieve effective ‘mainstreaming’.• how to ensure AT are implemented within health and social care.• Can its use be successful?
Background #DARG2018
Assistive technology/telecare currently provides a case study of non-adoption (Greenhalgh et al 2017).
Lack of evidence currently demonstrating efficacy and cost effectiveness of Assistive Technology at scale (Steventon et al 2013).
Lack of successful commercialisation of many assistive technology prototype technologies (Knapp et al 2015).
Neglect of questions of how do people with dementia and their carers actually use AT in their everyday lives. (Gibson et al 2015; 2016).
How do we achieve effective ‘mainstreaming’ of assistive technology in dementia care practice?
Assistive Technology and Dementia: gaps and challenges #DARG2018
Personalisation has been identified as a priority for assistive technologies in the future (Meiland et al 2017; Gibson et al in press).
Personalisation involves:• Identifying priorities for AT among people with dementia and their carers.• Helping people navigate the assistive technology landscape. (Burrow & Brooks
2011).• Understanding the ‘little arrangements’ supporting the use of technologies
(Lopez-Gomez 2015).• Integration of assistive technologies and everyday/mainstream technologies.• Adapting ad hoc arrangements according to individual need – Bricolage
(Greenhalgh et al 2013; Gibson et al in press).
Personalisation of Technologies in Dementia Care #DARG2018
Different stakeholders prioritise different aspects of AT based on their individual needs.
People with dementia – freedom, independence, unobtrusiveness, individualisation, flexibility, enjoyment, avoiding stigmaCarers – managing risk, safety, security, reducing carer burden.
Services – cost effectiveness savings, greater efficiencies, reduced formal care support, robustness and reliability.
Identifying Priorities for Technology Development #DARG2018
• AT forms fast paced and constantly shifting landscape.
• Greater Information provision about available technologies is a need recognised by people with dementia, carers, GPs and health/social care professionals (Gibson et al 2016; Newton et al 2016).
• ATDementia (www.ATdementia.org.uk) and Dementia Circle (www.dementiacircle.org) both provide information to stakeholder. But lack of long term funding for such projects.
Navigating the Assistive Technology Landscape #DARG2018
• Assistive technologies are placed in a range of social, technical and spatial arrangements which are required if a technology is to ‘work’ in practice.
• Such arrangements are often routine and habitual, but are essential to the use of technology.
• Technologies can help but must be designed with these arrangements in mind, rather than replacing and requiring wholly new arrangements.
Understanding ‘little arrangements’ (Lopez Gomez 2015)
As I say I couldn’t have continued working as long as I did, and I’m still, we’re still benefiting from it. I think it’s a wonderful device, wonderful. (Carer 109)
Example of a little arrangement - GPS.
#DARG2018
Integrating Assistiveand Mainstream Technologies #DARG2018
• Much of technology use characterised by ad hoc arrangements of technologies and practices.
• Bricolage - “The non conventional use of tools or methods designed and intended for a different use to address local and immediate needs” (Greenhalgh et al 2013).
• People frequently personalise technologies according to their own needs through ad hoc, bricolage based arrangements.
• Supporting people in such arrangements, rather than ‘dropping in’ equipment or services should be a key part of any personalisation of services.
Promoting Ad Hoc Arrangements and Bricolage #DARG2018
• There is a need for research exploring how technologies and services can be developed in ways which meet individual variations of need (Meiland et al 2017).
• One means through which personalisation of technologies in dementia care can be achieved is through co-design & co-production (Wherton et al 2015).• Co-design - getting people with dementia involved in identifying priorities for
technological innovation and technology design.• Co-production – co-producing technology enabled care services.
• We need to move away from exploratory studies to explore questions of mainstreaming and implementation of technologies within the everyday practice of care.
Personalisation of Technologies in Dementia Care: Next Steps #DARG2018
Burrow, S., Brooks, D. (2012) AT dementia: an information resource on assistive technologies that support the independence of people with dementia Dementia 11 (4) 553-557Gibson, G., Dickinson, G., Brittain, K., Robinson, L (2015) The everyday use of assistive technology by people with dementia and their family carers: a qualitative study BMC Geriatrics 15 (1) doi: 10.1186/s12877-015-0091-3Gibson, G., Newton, L., Pritchard, G., Finch, T., Brittain, K. Robinson, L. (2016) The provision of assistive technology products and services for people with dementia in the United Kingdom Dementia 15 (4) 681-701Gibson, G., Dickinson, C., Brittain, K. Robinson, L. (in press). Innovation, personalisation and bricolage: how people with dementia and their carers make assistive technology work for them Ageing & societyGreenhalgh, T., Wherton, J., Sugarhood, P., Hinder, S., Procter, R. (2013) What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare Social Science and Medicine. 93, 86-94Greenhalgh, T., Wherton, J., Papoutsi, C et al (2017) Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment and challenges to the scale-up spread and sustainability of health and care technologies Journal of Medical Internet Reseearch 19: (11) e367 doi: 10.2196/jmir.8775
References #DARG2018
Knapp, M.,Barlow, J., Comras-Herrera, A., Damant, J., Freddolino, P., Hamblin, K et al (2015) the case for investment in technology to arrange the global costs of dementia http://www.piru.ac.uk/assets/files/Dementia_IT_PIRU_publ_18.pdfMeiland, F., Innes, A., Robinson, L., et al (2017) Technologies to Support Community-Dwelling Persons with Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics. JIMR Rehabilitation and Assistive Technologies 1 (e1) doi: 10.2196/rehab.6376Lopez Gomez, D. (2015) Little arrangements that matter. Rethinking autonomy-enabling innovations for later life Technological forecasting and social change 93: 91-101Newton, L., Dickinson, C., Gibson, G., Brittain, K., Robinson, L (2016) Exploring the views of GPs, people with dementia and their carers on assistive technology: a qualitative study BMJ Opendoi:10.1136/bmjopen-2016-011132Steventon, A., Bardsley, M., Billings, J., Dixon, J., Doll, H., Beynon, M. (2013) Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator Cluster Randomised Trial. Age and Ageing 42: 4 501-508Wherton, J., Sugarhood, P., Procter, R., Hinder, S., Greenhalgh, T. (2015) Co-production in practice: how people with assisted living needs can help design and evolve technologies and services implementation Science 10: 75
References #DARG2018
