Factors associated with a history of critical wandering among Medic-Alert subscribers.

BACKGROUND: Critical wandering occurs when an individual living with dementia leaves a location and is unaware of place or time. Critical wandering incidents are expected to increase with the growing prevalence of persons living with dementia worldwide. We investigated the association between demographic, psychopathological, and environmental factors and a history of critical wandering among Medic-Alert subscribers, both with and without dementia. METHODS: Our retrospective study included data of 25,785 Canadian Medic-Alert subscribers who were aged 40 years or older. We used multivariable logistic regression analysis to examine the associations between a history of critical wandering and dementia status as psychopathological independent variable, controlled by demographic (age, ethnic background, sex at birth, Canadian languages spoken) and environmental (living arrangement, population density) factors. RESULTS: The overall study sample comprised of mainly older adults (77.4%). Medic-Alert subscribers who were older, male sex at birth, living with dementia, of a minority ethnic group and who did not have proficiency in an official Canadian language had a higher likelihood of a history of critical wandering. Residing in an urban environment, in an institution or with a family member, were environmental factors associated with a higher likelihood of a history of critical wandering. CONCLUSIONS: People living with dementia experience a higher likelihood of a history of critical wandering compared to those without dementia. Medic-Alert and similar organizations can develop algorithms based on the associated factors that can be used to flag risks of critical wandering. This can inform preventative strategies at the individual and community levels.

The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study.

BACKGROUND: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. OBJECTIVE: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. METHODS: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. RESULTS: The sample was overrepresented by White older adults (329/425, 77.4%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4%), living in urban areas with at least 1 family member (277/433, 63.8%). Most of the MedicAlert subscribers (345/434, 79.5%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1%), traveling on foot (248/270, 91.9%) and public transport (12/270, 4.4%), during the afternoon (262/560, 46.8%) and evening (174/560, 31.1%). Most were located by first responders (232/486, 47.7%) or Good Samaritans (224/486, 46.1%). Of the 560 missing incidents, 126 (22.5%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6%); and reports of harm, injuries (46/500, 9.2%), and death (1/500, 0.2%) were very low. CONCLUSIONS: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies.

Risk Factors Associated with Missing Incidents among Persons Living with Dementia: A Scoping Review.

Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.

Acceptance, adoption, and usability of information and communication technologies for people living with dementia and their care partners: a systematic review.

PURPOSE: This review aims to examine the instruments, approaches, scales, or assessment tools used to evaluate technology acceptance, technology adoption, and usability of information and communication technologies (ICTs) for people living with dementia and their care partners. METHODS: A systematic literature review was conducted. Studies that explored the use of instruments, approaches, scales, or assessment tools to evaluate the technology acceptance and usability of ICTs for people living with dementia and their care partners were identified through five databases: Medline, EMBASE, CINAHL, Web of Science, and Scopus. RESULTS: We included 74 out of 2182 papers. The most common scales used included the System Usability Scale (SUS) (11%), the ISONORM 9241/10 Questionnaire (4%), and the Post-Study System Usability Questionnaire (PSSUQ) (4%). Most (59%) of the included approaches, however, were bespoke (i.e., created by the authors for a particular study) and were not named. The approaches or tools used to assess technology acceptance, technology adoption, and usability of ICTs that applied to people living with dementia had an average of 15 items and used an average of 5.23 scale points. CONCLUSION: There is no clear, standardised approach for assessing the technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners. The findings of this review may be used by academics to design and implement improved and more consistent assessment tools to assess technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners.IMPLICATIONS FOR REHABILITATIONThe number of ICTs for people with dementia and their care partners that can be used for rehabilitation is increasingThe most commonly recognized assessment tools used in this study were the SUS, ISONORM 9241/10, and PSSUQ questionnaires.For the custom assessment tools, the average number of items included in this study was 15 with five-point bidirectional labelling.There is no clear, standardized approach for assessing the technology acceptance, technology adoption, or usability of ICTs for people with dementia and their care partners.

Digital Storytelling with Persons Living with Dementia: Elements of Facilitation, Communication, Building Relationships, and Using Technology.

Digital storytelling is a process that can be used to co-create multimedia stories with persons living with dementia to affirm identity, support person-centered care, and leave a legacy. Although digital storytelling typically involves a facilitator, little is known about the co-creation process between a facilitator and persons living with dementia. This study explored and described elements of digital storytelling facilitation with persons living with dementia using a secondary analysis of qualitative data from a primary study that took place across three Canadian cities. Three elements were identified during digital storytelling facilitation with persons living with dementia: communicating, building collaborative relationships, and using technology. Digital storytelling facilitators employ the three elements to weave together a person's narrative with meaning. The communication, relational, and technological elements of digital storytelling may be employed by facilitators from varying professional backgrounds and lived experiences to create meaningful digital stories for persons living with dementia.

Technology Acceptance of a Mobile Application to Support Family Caregivers in a Long-Term Care Facility.

BACKGROUND: Family caregivers are unpaid individuals who provide care to people with chronic conditions or disabilities. Family caregivers generally do not have formal care-related training. However, they are an essential source of care. Mobile technologies can benefit family caregivers by strengthening communication with care staff and supporting the monitoring of care recipients. OBJECTIVE: We conducted a mixed-method study to evaluate the acceptance and usability of a mobile technology called the Smart Care System. METHODS: Using convenience sampling, we recruited 27 family caregivers to evaluate the mobile Smart Care System (mSCS). In the quantitative phase, we administered initial and exit questionnaires based on the Unified Theory of Acceptance and Use of Technology. In the qualitative phase, we conducted focus groups to explore family caregivers' perspectives and opinions on the usability of the mSCS. With the quantitative data, we employed univariate, bivariate, and partial least squares analyses, and we used content analysis with the qualitative data. RESULTS: We observed a high level of comfort using digital technologies among participants. On average, participants were caregivers for an average of 6.08 years (standard deviation [SD] = 6.63), and their mean age was 56.65 years (SD = 11.62). We observed a high level of technology acceptance among family caregivers (7.69, SD = 2.11). Behavioral intention (ß = 0.509, p-value = 0.004) and facilitating conditions (ß = 0.310, p-value = 0.049) were statistically significant and related to usage behavior. In terms of qualitative results, participants reported that the mobile application supported care coordination and communication with staff and provided peace of mind to family caregivers. CONCLUSION: The technology showed high technology acceptance and intention to use among family caregivers in a long-term care setting. Facilitating conditions influenced acceptance. Therefore, it would be important to identify and optimize these conditions to ensure technology uptake.

Ageing, technology, and health: Advancing the concepts of autonomy and independence.

The global pandemic expedited the adoption of AgeTech solutions that aim to help older adults maintain their autonomy and independence. This article examines the negative impact of the Western worldview of autonomy and independence on older adults. Negative impact can manifest as ageism and may be compounded by intersections of identities with race, gender, and culture. We propose an inclusive framework for health leaders, one that is not binary or categorical, but instead, on a continuum: (1) relational autonomy which assumes that relationships form one's identity; therefore, no one is autonomous to the exclusion of others, and (2) interdependence which proposes that one's lifestyle choice is supported by interreliance with aspects of one's environment. We examine two examples of AgeTech from the perspective of relational autonomy and interdependence and discuss how health leaders can use this inclusive framework to ensure that their services do not discriminate against older adults.

Data silos undermine efforts to characterize, predict, and mitigate dementia-related missing person incidents.

It is estimated that up to 60% of people living with dementia go missing at least once during the course of their disease. Databases on missing incidents involving people living with dementia are managed in silos with minimal or incomplete data. A national strategy for the collection of data on missing incidents of people living with dementia would optimize time and resources spent on police and search and rescue and enhance chances of saving lives of those who go missing. Such a strategy would be a first step toward developing strategies to prevent future missing person incidents among this population. The objectives of this manuscript are to: (1) describe the issues and challenges related to the lack of integrated data on people living with dementia at risk of going missing, and (2) propose directions to create a national database.

Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study.

BACKGROUND: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. OBJECTIVE: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. METHODS: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre- and post-paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs' summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The α level of significance for all tests was set at P≤.05 (2-tailed). RESULTS: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides' strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. CONCLUSIONS: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues.

Digital Storytelling in Older Adults With Typical Aging, and With Mild Cognitive Impairment or Dementia: A Systematic Literature Review.

The rates of dementia are on the rise as populations age. Storytelling is commonly used in therapies for persons living with dementia and can be in the form of life review, and reminiscence therapy. A systematic literature review was conducted to examine the range and extent of the use of digital technologies for facilitating storytelling in older adults and their care partners, and to identify the processes and methods, the technologies used and their readiness levels, the evidence, and the associated outcomes. Eight electronic databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Abstracts in Social Gerontology, ERIC, Web of Science, and Scopus. We included 34 studies. Mild cognitive impairment or dementia represented over half of medical conditions reported in the studies. Overall, our findings indicate that the most common use of digital storytelling was to support older adults' memory, reminiscence, identity, and self-confidence; however, the level of evidence of its effectiveness was low.

Identifying adoption and usability factors of locator devices for persons living with dementia.

A growing number of Canadians live with dementia. Strategies to reduce the risks of getting lost include physical barriers, restraints and medications. However, these strategies can restrict one's participation in meaningful activities and reduce quality of life. Locator devices can be used to manage safety risks while also supporting engagement and independence among persons living with dementia. As more locator devices become available on the market, adoption rates would be affected by certain factors. There is no clear, standardized approach to identify the factors that have an influence on the acceptance and usability of locator devices for persons with dementia and their care partners. This project aimed to identify factors related to acceptance and usability of locator devices that are important to individuals with dementia, their care partners, service providers and technology developers. Qualitative description and conventional content analysis guided our approach. We conducted 5 focus groups with 21 participants. Trustworthiness strategies included multiple data sources, data verification for accuracy and peer debrief. Five overarching factors emerged as critical aspects in the acceptance and usability of locator devices. These factors were inclusivity, simplicity, features, physical properties and ethics. Participants thought that locator devices do not adequately consider privacy and stigma. Therefore, the acceptance and usability of locator devices could be enhanced if privacy and stigma are addressed. The factors identified will inform the creation of an acceptance and usability scale for locator devices used by persons living with dementia, their care partners and service providers.

Mobile alert app to engage community volunteers to help locate missing persons with dementia.

The prevalence of persons living with dementia and at risk of going missing is rising. In this study, we engaged persons living with dementia, care partners, police services, search and rescue organizations, and health and social service providers to develop Community ASAP, a mobile alert system that engages community citizens, as volunteers, to look out for persons with dementia reported missing. We completed three phases of development and evaluation of the usability and functionality of the alert system with stakeholders in three Canadian provinces. In this paper we describe features of the Community ASAP and the findings of these evaluation phases.

Worth the Risk? Muddled Relationships in Community-Based Participatory Research.

Community-based participatory research (CBPR) is a collaborative research approach that has two purposes: (a) to generate knowledge about and (b) to take action to improve the lives of people facing health, social, economic, political, and environmental inequities. The foundation of all CBPR projects is its partnership--its cooperative relationship between community members, service providers, program planners, policy makers, and academics. It is with people--and through relationships--that partnerships are built and sustained. Although relationships between academics and community members are critical to creating knowledge and change, they are overlooked in the literature. We often hear about CBPR "gone wrong," when tensions and conflicts arise because relationship boundaries become blurred. Our purpose is to expose the muddled relationships that can be created between academics and community members in CBPR projects. Drawing upon our experiences presented in a series of vignettes, we consider the nature of these relationships. We explore whether we conduct, in CBPR, good research at the expense of muddling relationships. Despite the potential for muddled relationships, we believe that CBPR is the best approach for research aimed at achieving a more equitable and just society.