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, Knapp, Martin, 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 . Full text not available from this repository.

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Official URL: https://doi.org/10.1093/ageing%2Fafaa284

Abstract

The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: a randomised controlled trial Robert Howard University College London, UK Rebecca Gathercole King’s College London, UK Rosie Bradley Medical Research Council Population Health Research Unit, UK Emma Harper Medical Research Council Population Health Research Unit, UK Lucy Davis Medical Research Council Population Health Research Unit, UK Lynn Pank Medical Research Council Population Health Research Unit, UK Natalie Lam Medical Research Council Population Health Research Unit, UK Emma Talbot Norfolk and Suffolk NHS Foundation Trust, UK Emma Hooper Lancashire Care NHS Foundation Trust and University of Manchester, UK Rachel Winson Cambridgeshire and Peterborough NHS Foundation Trust, UK Bethany Scutt King’s College London, UK Victoria Ordonez Montano Hertfordshire Community Services NHS Trust, UK Samantha Nunn Cambridgeshire Community Services NHS Trust, UK Grace Lavelle King’s College London, UK Andrew Bateman University of Essex, UK Peter Bentham Birmingham and Solihull Mental Health NHS Foundation Trust, UK Alistair Burns University of Manchester, UK Barbara Dunk South London and Maudsley NHS Foundation Trust, UK Kirsty Forsyth Queen Margaret University, UK Chris Fox University of East Anglia, UK Fiona Poland University of East Anglia, UK Iracema Leroi Trinity College Dublin, Ireland Stanton Newman City, University of London, UK John O’Brien University of Cambridge, UK Catherine Henderson London School of Economics and Political Science, UK Martin Knapp London School of Economics and Political Science, UK John Woolham King’s College London, UK Richard Gray Medical Research Council Population Health Research Unit, UK 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; 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.
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Item Type: Article
Journal / Publication Title: Age and Ageing
Publisher: Oxford Academic
ISSN: 0002-0729
Departments: Departments > Institute of Health > Urgent and Primary Care
Depositing User: Christian Stretton
Date Deposited: 01 Feb 2021 09:45
Last Modified: 01 Feb 2021 09:45
URI: https://insight.cumbria.ac.uk/id/eprint/5912

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