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

被引：41

作者：

Howard, Robert ^{[1
]}

Gathercole, Rebecca ^{[2
]}

Bradley, Rosie ^{[3
]}

Harper, Emma ^{[3
]}

Davis, Lucy ^{[3
]}

Pank, Lynn ^{[3
]}

Lam, Natalie ^{[3
]}

Talbot, Emma ^{[4
]}

Hooper, Emma ^{[5
,6
]}

Winson, Rachel ^{[7
]}

Scutt, Bethany ^{[2
]}

Montano, Victoria Ordonez ^{[8
]}

Nunn, Samantha ^{[9
]}

Lavelle, Grace ^{[2
]}

Bateman, Andrew ^{[10
]}

Bentham, Peter ^{[11
]}

Burns, Alistair ^{[6
]}

Dunk, Barbara ^{[12
]}

Forsyth, Kirsty ^{[13
]}

Fox, Chris ^{[14
]}

Poland, Fiona ^{[14
]}

Leroi, Iracema ^{[15
]}

Newman, Stanton ^{[16
]}

O'Brien, John ^{[17
]}

Henderson, Catherine ^{[18
]}

Knapp, Martin ^{[18
]}

Woolham, John ^{[2
]}

Gray, Richard ^{[3
]}

机构：

[1] UCL, London, England

[2] Kings Coll London, London, England

[3] MRC, Populat Hlth Res Unit, London, England

[4] Norfolk & Suffolk NHS Fdn Trust, Norwich, Norfolk, England

[5] Lancashire Care NHS Fdn Trust, Preston, Lancs, England

[6] Univ Manchester, Manchester, Lancs, England

[7] Cambridgeshire & Peterborough NHS Fdn Trust, Cambridge, England

[8] Hertfordshire Community Serv NHS Trust, Welwyn Garden City, Herts, England

[9] Cambridgeshire Community Serv NHS Trust, Cambridge, England

[10] Univ Essex, Colchester, Essex, England

[11] Birmingham & Solihull Mental Hlth NHS Fdn Trust, Birmingham, W Midlands, England

[12] South London & Maudsley NHS Fdn Trust, London, England

[13] Queen Margaret Univ, Musselburgh, Scotland

[14] Univ East Anglia, Norwich, Norfolk, England

[15] Trinity Coll Dublin, Dublin, Ireland

[16] City Univ London, London, England

[17] Univ Cambridge, Cambridge, England

[18] London Sch Econ & Polit Sci, London, England

来源：

AGE AND AGEING | 2021年 / 50卷 / 03期

关键词：

assistive technology; telecare; dementia; social care; independent living; older people; SHORT-FORM; HEALTH; HOME; INSTITUTIONALIZATION; SERVICES; EUROQOL; PEOPLE;

D O I：

10.1093/ageing/afaa284

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

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; 95% CI, 0.63 to 1.12; P = 0.20. There were no significant differences between arms in health and social care (mean -909; pound 95% CI, -5,336 pound to 3,345 pound, P = 0.678) and societal costs (mean -3,545; pound 95% CI, -13,914 pound to 6,581 pound, 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.

引用

页码：882 / 890

页数：9

共 42 条

[11] Assessment of activities of daily living in dementia: Development of the Bristol activities of daily living scale [J].