Management of acute pain in dementia: a feasibility study of a robot-assisted intervention.

Background: The management of pain is particularly challenging in patients with moderate to severe dementia owing to the loss of communication ability or underlying causes such as behavioral symptoms. It is often associated with health care professionals' frustration and feeling of helplessness. The present study determined a framework and examined the feasibility of an innovative intervention using the PARO® robot for the management of acute pain in dementia. Method: A mixed-methods research design combining qualitative (five focus groups) and quantitative (questionnaire survey) approaches was used to define the intervention framework. We recruited 57 health care professionals from various medical and paramedical specialties (eg, nursing auxiliaries, nurses, physicians, psychologists) and with expertise in gerontology. The feasibility of the intervention was subsequently assessed with 12 patients suffering from dementia in painful situations to validate the procedure. Results: Four main issues have been addressed: 1) the identification of a core group of painful situations associated with care (washing, dressing/change, transfer/mobilization), currently considered as inefficiently managed; 2) the selection of an appropriate assessment methodology including criteria and tools for pain evaluation; 3) the definition of health professionals' training needs and organizational requirements for their implementation; and 4) the perceived usefulness of a robot-assisted intervention for the management of pain in dementia in daily practice. The feasibility study showed that the predefined intervention framework was applicable and acceptable for the majority of professionals and patients. Conclusion: A consistent and feasible intervention framework for the management of painful situations associated with care in dementia using the PARO robot was defined. Understanding of professionals' needs, opinions and perceived obstacles regarding the intervention was a useful step in the preparation of the forthcoming clinical trial.

[Exploring the impact of a group-based tablet-PC training program in older adults]. / Impact d'un programme de formation de groupe à l'utilisation de la tablette numérique chez des personnes âgées.

OBJECTIVES: There are several barriers to older adults using internet and information and communication technology (ICT). It has been suggested that appropriate training is necessary to support the learning process and is an important issue with regards to digital inclusivity for older adults. This study explored the impact of a tablet-PC training program for older adults, provided in a group setting. RESULTS: Thirteen community-dwelling older adults attended the program (ten one and half hour training sessions, taking place once every 2 weeks) and completed pre- and post- assessments. After the intervention, participants showed significantly higher levels of ICT acceptance (87.6 vs. 113.5, p=0.002) and proficiency (109.5 vs. 132.7, p=0.003) than before the intervention. However, they did not showed improvement in feelings of loneliness, symptoms of depression and global cognitive function. Qualitative analyses indicated that the intervention enabled older adults to become more up to date with the information society and promoted tablet-PC acceptance. Although it helped older adults to feel less isolated, it did not enable them to form genuine friendships. CONCLUSION: The intervention was effective in improving older adults' digital literacy and promoting ICT acceptance, allowing the digital divide to be narrowed.

Age-Related Evolution Patterns in Online Handwriting.

Characterizing age from handwriting (HW) has important applications, as it is key to distinguishing normal HW evolution with age from abnormal HW change, potentially triggered by neurodegenerative decline. We propose, in this work, an original approach for online HW style characterization based on a two-level clustering scheme. The first level generates writer-independent word clusters from raw spatial-dynamic HW information. At the second level, each writer's words are converted into a Bag of Prototype Words that is augmented by an interword stability measure. This two-level HW style representation is input to an unsupervised learning technique, aiming at uncovering HW style categories and their correlation with age. To assess the effectiveness of our approach, we propose information theoretic measures to quantify the gain on age information from each clustering layer. We have carried out extensive experiments on a large public online HW database, augmented by HW samples acquired at Broca Hospital in Paris from people mostly between 60 and 85 years old. Unlike previous works claiming that there is only one pattern of HW change with age, our study reveals three major aging HW styles, one specific to aged people and the two others shared by other age groups.

Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals.

BACKGROUND: People with dementia can benefit from a palliative care approach. Recommendations, such as those of the EAPC have been proposed to strengthen the provision of palliative care for this group of patients. Yet, it remains challenging for professionals to identify when a person with dementia is in need of palliative care. The objective of this study therefore was to explore when professionals in long-term care settings consider a person with dementia in need of palliative care. METHODS: Teams with in total 84 professionals working in 13 long-term care settings from 6 countries (France, Germany, Italy, Norway, Poland and the Netherlands) received a case-vignette concerning a person with dementia recently admitted to a nursing home. Teams were asked to discuss when they considered people with dementia eligible for palliative care. The constant comparative method was used to analyse their answers. RESULTS: Three different time points in the disease trajectory when people with dementia were considered to be eligible for palliative care were extracted: (1) early in the disease trajectory; (2) when signs and symptoms of advanced dementia are present; and (3) from the time point that curative treatment of co-morbidities is futile. Yet, none of these time points was uniformly considered by the professional teams across Europe. In some cases, professionals working in the same nursing home didn't even reach consensus when considering persons with dementia eligible for palliative care. CONCLUSION: The results of the study identified that professionals across Europe have different opinions regarding the time point when to consider a person with dementia in need of palliative care.

Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies.

PURPOSE: In a society where technology progresses at an exponential rate, older adults are often unaware of the existence of different kinds of information and communication technologies (ICTs). To bridge the gap, we launched a 2-year project, during which we conducted focus groups (FGs) with demonstrations of ICTs, allowing older adults to try them out and to share their opinions. This study aimed at investigating how participants perceived this kind of initiative and how they reacted to different kinds of ICTs. PATIENTS AND METHODS: In total, 14 FGs were conducted with community-dwelling older adults, with a frequency of two FGs on the same topic once per trimester. Twenty-three older adults (four men and 19 women) attended at least one FG but only nearly half of them were regular attendants (ten participating in at least five sessions). Age of participants ranged from 63 years to 88 years, with a mean of 77.1 years. All of them had completed secondary education. The analyses of the data were performed according to inductive thematic analysis. RESULTS: Four overarching themes emerged from the analysis. The first concerned participants' motivation for and assessment of the project. The second theme identified the underlying factors of the "digital divide" between the younger and the older generations. The third theme concerned the factors of technology adoption among older adults. The fourth one identified participants' attitudes toward assistive ICTs, designed specifically for older adults ("gerontechnologies"). DISCUSSIONS AND CONCLUSION: This project encouraging older adults to be informed about different kinds of ICTs was positively rated. With regard to ICTs, participants perceived a digital divide. The underlying factors are generation/cohort effects, cognitive and physical decline related to aging, and negative attitudes toward technologies. However, more and more older adults adopt different kinds of ICTs in order to fit in with the society. Concerning assistive ICTs, they manifested a lack of perceived need and usefulness. Also, there was a negative image of end users of this kind of technologies. The so-called gerontechnologies specifically targeting older adults contain stigmatizing symbolism that might prevent them from adopting them.

Acceptance of an assistive robot in older adults: a mixed-method study of human-robot interaction over a 1-month period in the Living Lab setting.

BACKGROUND: There is growing interest in investigating acceptance of robots, which are increasingly being proposed as one form of assistive technology to support older adults, maintain their independence, and enhance their well-being. In the present study, we aimed to observe robot-acceptance in older adults, particularly subsequent to a 1-month direct experience with a robot. SUBJECTS AND METHODS: Six older adults with mild cognitive impairment (MCI) and five cognitively intact healthy (CIH) older adults were recruited. Participants interacted with an assistive robot in the Living Lab once a week for 4 weeks. After being shown how to use the robot, participants performed tasks to simulate robot use in everyday life. Mixed methods, comprising a robot-acceptance questionnaire, semistructured interviews, usability-performance measures, and a focus group, were used. RESULTS: Both CIH and MCI subjects were able to learn how to use the robot. However, MCI subjects needed more time to perform tasks after a 1-week period of not using the robot. Both groups rated similarly on the robot-acceptance questionnaire. They showed low intention to use the robot, as well as negative attitudes toward and negative images of this device. They did not perceive it as useful in their daily life. However, they found it easy to use, amusing, and not threatening. In addition, social influence was perceived as powerful on robot adoption. Direct experience with the robot did not change the way the participants rated robots in their acceptance questionnaire. We identified several barriers to robot-acceptance, including older adults' uneasiness with technology, feeling of stigmatization, and ethical/societal issues associated with robot use. CONCLUSION: It is important to destigmatize images of assistive robots to facilitate their acceptance. Universal design aiming to increase the market for and production of products that are usable by everyone (to the greatest extent possible) might help to destigmatize assistive devices.

Evaluating the efficacy of a web-based program (diapason) for informal caregivers of patients with Alzheimer's disease: protocol for a randomized clinical trial.

BACKGROUND: Informal caregivers (CGs) of patients with Alzheimer's disease are at risk of suffering from psychological and physical weakening. Several psychoeducational interventions have been designed to prevent stress and burden of caregivers. In France, despite health authorities' recommendations, to our knowledge there is no rigorously assessed Web-based psychoeducational program to date. OBJECTIVE: The objective of our study was to assess the efficacy of a French Web-based psychoeducational program (called Diapason) with an unblinded randomized clinical trial. METHODS: In this protocol, 80 informal caregivers of patients followed at Broca Hospital are recruited offline and randomized in the experimental condition (EC) or the control condition (CC). The volunteers in EC have to visit a closed online user group at least once a week and validate one new session of this fully automated Web program, during 12 weeks. Each week a new thematic is added to the website. The participants in the CC receive usual care, and have access to the Diapason program after their participation (6 months). Face-to-face evaluations for both groups are planned every 3 months (M0-M3 and M6). The main objective of this program is to provide CGs with information on the disease process, how to prevent psychological strain (using anticipation and relaxation techniques), and offering a virtual space (forum) to discuss with other caregivers. The primary outcome of this study is the self-perceived stress, while self-efficacy, burden, depression, and self-perceived health status are defined as secondary outcomes. Other variables that might have an impact on the program efficacy are collected. RESULTS: This protocol was accepted for funding. The enrollment began in October 2011, and participants currently recruited will finish their evaluations in January 2014. The results are expected for June 2014. CONCLUSIONS: Findings might provide empirical evidence on: (1) the feasibility of an Internet-based program in the French context, (2) the effectiveness of a Web-based program for informal caregivers, and (3) the identification of caregivers who will benefit from this type of intervention. TRIAL REGISTRATION: Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286 (Archived by WebCite at http://www.webcitation/6KxHaRspL).