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.

(Contact the author)
Official URL:


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.

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.

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.

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.

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.
01 23 2021 afaa284 10.1093/ageing/afaa284 The Lancet Neurology Collaborators 18 88 2019 10.1016/S1474-4422(18)30403-4 Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the global burden of disease study 2016 Alzheimers Dement Wimo 13 1 2017 10.1016/j.jalz.2016.07.150 The worldwide costs of dementia 2015 and comparisons with 2010 Age Ageing Luppa 39 31 2010 10.1093/ageing/afp202 Prediction of institutionalization in the elderly. A systematic review BMC Geriatr Olsen 16 137 2016 10.1186/s12877-016-0312-4 Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study Alzheimers Dement Samus 14 104 2018 10.1016/j.jalz.2017.10.006 Home is where the future is: the BrightFocus Foundation consensus panel on dementia care Prime Minister's challenge on dementia 2020: Implementation plan Health, D.o 2016 Journal of Assistive Technologies Fleming 8 14 2014 10.1108/JAT-09-2012-0021 Empirical studies on the effectiveness of assistive technology in the care of people with dementia: a systematic review Safe at home: the effectiveness of assistive technology in supporting the independence of people with dementia: the safe at home project Woolham 2006 Building Telecare in England Health, D.o 2005 Age Ageing Steventon 42 501 2013 10.1093/ageing/aft008 Effect of telecare on use of health and social care services: findings from the whole systems demonstrator cluster randomised trial Aging Ment Health Brims 23 942 2019 10.1080/13607863.2018.1455805 Effectiveness of assistive technology in improving the safety of people with dementia: a systematic review and meta-analysis Fair access to care services: Guidance on eligibility criteria for adult social care Health, D.o 2002 Trials Leroi 14 349 2013 10.1186/1745-6215-14-349 Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial Health Policy Group 16 199 1990 10.1016/0168-8510(90)90421-9 EuroQol-a new facility for the measurement of health-related quality of life Age Ageing Bucks 25 113 1996 10.1093/ageing/25.2.113 Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale Am J Psychiatry Molloy 148 102 1991 10.1176/ajp.148.1.102 Reliability of a standardized mini-mental state examination compared with the traditional mini-mental state examination User's manual for the Model of Human Occupation Screening Tool (MOHOST) Parkinson 2002 Gerontologist Leggett 51 76 2010 10.1093/geront/gnq055 Stress and burden among caregivers of patients with Lewy body dementia Am J Prev Med Andresen 10 77 1994 10.1016/S0749-3797(18)30622-6 Screening for depression in well older adults: evaluation of a short form of the CES-D Marteau 301 1992 The development of a six-item short-form of the state scale of the Spielberger state—trait anxiety inventory (STAI) J Epidemiol Community Health Jenkinson 53 46 1999 10.1136/jech.53.1.46 Assessment of the SF-36 version 2 in the United Kingdom J Telemed Telecare Hirani 23 460 2017 10.1177/1357633X16649531 Quantifying beliefs regarding telehealth: development of the whole systems demonstrator service user technology acceptability questionnaire Measuring Mental Health Needs Beecham 2 200 2001 Costing psychiatric interventions Consortium procurement web page Consortium, N.H The Green Book: Appraisal and Evaluation in Central Government, London, UK, 2011 Treasury 2015 Med Care Dolan 1095 1997 10.1097/00005650-199711000-00002 Modeling valuations for EuroQol health states Value Health van Hout 15 708 2012 10.1016/j.jval.2012.02.008 Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets Health Economics Basu 19 1010 2010 10.1002/hec.1640 Estimating Lifetime or Episode-of-Illness Costs under Censoring Biometrika Bang 87 329 2000 10.1093/biomet/87.2.329 Estimating medical costs with censored data Handbooks in health economic evaluation series Gray 2011 Applied methods of cost-effectiveness analysis in health care Stat Methods Med Res Billingham 11 25 2002 10.1191/0962280202sm269ra Simultaneous analysis of quality of life and survival data Lancet Courtney 363 2105 2004 10.1016/S0140-6736(04)16499-4 Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial Alzheimer's and Dementia: Translational Research and Clinical Interventions in Aging Forsyth 5 420 2019 10.1016/j.trci.2019.07.010 Assessment of need and practice for assistive technology and telecare for people with dementia—the ATTILA (assistive technology and telecare to maintain independent living at home for people with dementia) trial Health Qual Life Outcomes Fang 14 105 2016 10.1186/s12955-016-0510-y A comparison of health utility scores calculated using United Kingdom and Canadian preference weights in persons with Alzheimer’s disease and their caregivers Qual Life Res Walters 14 1523 2005 10.1007/s11136-004-7713-0 Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D Int J Geriatr Psychiatry Scocco 21 281 2006 10.1002/gps.1453 Nursing home institutionalization: a source of eustress or distress for the elderly? N Engl J Med Hurd 368 1326 2013 10.1056/NEJMsa1204629 Monetary costs of dementia in the United States Nat Rev Neurol Moyle 1 2019 The promise of technology in the future of dementia care BMC Geriatr Dawson 15 59 2015 10.1186/s12877-015-0053-9 Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach BMJ Open Greenhalgh 6 e010208 2016 10.1136/bmjopen-2015-010208 SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context Dementia (London) Gibson 15 681 2016 10.1177/1471301214532643 The provision of assistive technology products and services for people with dementia in the United Kingdom

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

Actions (repository staff only)

Edit Item Edit Item