The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: a randomised controlled trial

Howard, Robert, Gathercole, Rebecca, Bradley, Rosie, Harper, Emma, Davis, Lucy, Pank, Lynn, Lam, Natalie, Talbot, Emma, Hooper, Emma, Winson, Rachel, Scutt, Bethany, Ordonez Montano, Victoria, Nunn, Samantha, Lavelle, Grace, Bateman, Andrew, Bentham, Peter, Burns, Alistair, Dunk, Barbara, Forsyth, Kirsty, Fox, Chris, Poland, Fiona, Leroi, Iracema, Newman, Stanton, O’brien, John, Henderson, Catherine ORCID: 0000-0003-4340-4702, Knapp, Martin ORCID: 0000-0003-1427-0215, Woolham, John and Gray, Richard (2021) The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: a randomised controlled trial. Age and Ageing, 50 (3). 882 - 890. ISSN 0002-0729

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Abstract

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; R. Howard et al. 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. Key Points • There have been no large clinical trials of the clinical and cost-effectiveness and safety of assistive technology and telecare (ATT). • In this randomised clinical trial (RCT) of 495 people comparing those with ATT to the control, the adjusted hazard ratio was 0.84, which was not significant. • The study suggests that ATT does not enable people with dementia to maintain safe independent living for longer in their homes.

Item Type:	Article
Official URL:	https://academic.oup.com/ageing
Additional Information:	© 2021 The Authors
Divisions:	Care Policy and Evaluation Centre Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine H Social Sciences > HV Social pathology. Social and public welfare. Criminology T Technology > T Technology (General)
Date Deposited:	10 Feb 2021 11:06
Last Modified:	16 Nov 2024 02:48
URI:	http://eprints.lse.ac.uk/id/eprint/108628

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