Dissertations / Theses on the topic 'Assistive technology aged care'

Thesis (Ph. D.)--University of Missouri-Columbia, 2006.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "May 2006" Includes bibliographical references.

Assistive technology is an important field that has gained a lot of attention and has developed rapidly in recent years. This thesis identified what kind of assistive technologies are currently used within elderly care and further examined the professionals’ attitude towards the assistive technology. A qualitative study with semi-structured interviews was conducted with a total of four professionals and the empirical findings were analyzed with the use of Technology Acceptance Model. The empirical findings showed that professionals have generally positive attitudes towards the assistive technology, however, the study showed that different types or versions of the same assistive technology affected the perception of using it. Additionally, the study examined the barriers and opportunities of using the technologies. There were concerns identified and potential improvements that could be made; however, the overall benefits outweigh the disadvantages.

Values associated with the care of the elderly have changed and developed during the last decades due to socio-political changes. Dignity is a basic concept for quality care regardless of how and where care is given. Assistive Technology Services (ATS) are used to promote quality care and support for care-dependent elderly living at home. Previous research has described quality care and the use of ATS in care; however, as values change over time it is necessary to illuminate values in care. The overall aim of this licentiate thesis was to describe elderly peoples' perceptions about care and the use of ATS if care is needed in the future. Qualitative research interviews were conducted with twelve healthy elderly couples living in their own homes. All participants were 70 years of age or older and received no professional care or social support. Open, individual, semi-structured interviews were conducted and analysis was supported by written vignettes describing three levels of care needs. A qualitative content analysis was used to analyze the interviews.This study shows that regardless of the health scenario presented ranging from required care while remaining in the home with a healthy partner to total dependence for care without a partner in the home; participants strived to maintain the self and desired dignified care at the end of life. As the health scenarios were changed they discussed new solutions to achieve the goals of individuality and dignity. The best care was related to their home and their relationship to the partner and later on the best care was perceived as being in a nursing home with well educated nursing staff. Participants hoped that nursing competence included a basic nursing competence as well as respect, compassion and ability to closeness. The risk of losing one's individuality and becoming anonymous without meaningful relationships was a pervading concern amongst participants. There were also a broad range of perceptions regarding the use of ATS in care. ATS was seen as either an asset or a threat depending on care needs and abilities. The use of ATS was viewed positively by participants of the study since it would enable them to continue a normal life even if they had some disabilities. The trust they experienced in their relationship with their partner was a firm foundation for learning and handling new technology. Hesitation in their abilities to use ATS increased if they lacked a partner and their cognitive impairment increased. Hesitation turned to fear and revulsion against the use of ATS if they were dependent for their care and they did not have a partner at home to assist them.These findings highlight elderly peoples' values about quality care and the use of ATS in care and should be taken into consideration when planning care of the elderly, and implementing new technology related to their care.
Det finns ett flertal uttryck som beskriver användandet av informations- och kommunikationsteknologiska hjälpmedel men det som genomgående använts i denna licentiatuppsats är ATS. Ett uttryck som vi anser väl beskriver olika teknologiska hjälpmedel. Därför kommer ATS även att användas i den svenska sammanfattningen. Värderingar inom god vård av äldre har förändrats och utvecklats under det senaste århundradet i takt med sociopolitiska förändringar. God vård handlar om värdig vård där grundläggande begrepp som värdighet utgör basen för hur vården skall utformas. Värdighet innebär att människan har en absolut värdighet och oberoende på vilket sätt eller var vården ges bör detta vara ett signum för vården. Vård av äldre på institution har alltmer ersatts av vård i hemmet. Detta underlättas till stor del av att ATS alltmer används för att stödja och underlätta boende i hemmet. Forskning som beskriver värderingar om god vård finns men eftersom värderingarna förändras över tid är det av stort värde att kontinuerligt kartlägga dessa värderingar. Det övergripande syftet med denna licentiatuppsats var att beskriva äldre personers föreställningar om god vård och användande av ATS i händelse av vård. Licentiatuppsatsen består av två delstudier, delstudie I vars syfte var att beskriva äldre personers förställning av god vård och delstudie II, vars syfte var att beskriva äldre personers föreställning om användande av ATS i vård. I studierna ingår tolv par. Kriterier för att kunna delta i studierna var att alla deltagarna var > 70 år, etablerad pensionär, sammanboende i minst 5 år och inte någon form av teknisk support som exempelvis alarm eller annat beviljat bistånd. Den yngsta var 70 år och den äldste deltagaren var 83 år. Kvalitativa individuella forskningsintervjuer har använts som datainsamlingsmetod. För att få fram deltagarnas föreställningar om god vård och användande av ATS användes en vinjett med olika scenarier som alltmer komplicerades. Frågorna ställdes utifrån två olika perspektiv, eget perspektiv och partnerns perspektiv. Deltagarna ombads reflektera över dessa scenarier och besvara de frågor som följde. Intervjuerna spelades in på band och skrevs därefter ut ordagrant. Utifrån syftet användes en kvalitativ tematisk innehållsanalys för att analysera intervjuerna. Resultatet visar att värderingarna förändras beroende vilken livssituation man befinner sig i. Så länge som informanterna själv kunde bestämma över sitt liv, hade kontroll över tillvaron beskrevs hemmet som en självklarhet att bo kvar i även om man var i behov av viss assistans för att klara den personliga hygienen. En mycket viktig förutsättning var också att det fanns en frisk partner i hemmet. Tillsammans med partner uttryckte informanterna att det fanns möjlighet att klara av oväntade, nya situationer. Tilliten till den långvariga relationen utgjorde den självklara bas där yttre omständigheter som sjukdomar och åldrande kunde hanteras och uthärdas. När deltagarna reflekterade över att vara totalt beroende av vård ändrades deras föreställning om att få vård i hemmet. Av hänsyn till partners hälsa och rätt till ett eget liv menade de allra flesta att det var fel att belasta partnern. Partnern skall inte vårda den som är sjuk, det poängterades att det var viktigt att bibehålla den äktenskapliga relationen. I dessa scenarier valde deltagarna att få vård på institution där det fanns välutbildad personal. Föreställningar om användande av ATS visade på stor variation beroende på egen förmåga och behovet av vård. Vid ett ringa behov av vård värderades användande av ATS som en tillgång. Samtliga deltagare beskrev många positiva effekter med den nya teknologin, exempelvis kunde det innebära att man kunde bo kvar hemma betydligt längre och även känna trygghet eftersom användande av ATS innebär att man kände sig trygg. Med ett alltmer ökat beroende av vård uttrycktes osäkerhet om vilka konsekvenser användande av ATS kunde medföra. Även här nämndes partners närvaro som en viktig förutsättning för att man skulle kunna båda lära sig men även kunna känna tillit till ATS. Totalt beroende av vård och ingen partner i hemmet uppfattades användande av ATS som ett hot. Att i en sådan situation använda ATS för vård i hemmet väckte både rädsla och förtvivlan. Det fanns en genomgående överensstämmelse om att användande av ATS aldrig kan ersätta det mänskliga mötet. Ensamhet, isolering and osäkerhet var uttryck som ofta återkom när föreställningarna om god vård och ATS diskuterades. Speciellt när behovet av vård var totalt och ingen partner längre fanns i hemmet. I de situationerna var deltagarnas behov av att bli sedd och berörd det som var det allra viktigaste. Att bli behandlad med värdighet poängterades ofta, en önskan om att vårdpersonalen förutom tekniskt kunnande även har kunskap som medkänsla och respekt.
Godkänd; 2009; 20090420 (chrhar)
Friska äldre personers resonemang om användning av Informations- och Kommunikations Teknologi, IKT, vid vård och omsorg i hemmet, Forskning - Omvårdnad – Äldre

This research identifies the affordances of technology in aged care from the perspectives of senior managers. Interviews with Executives and Directors in a large aged care provider, an aged care industry body, and an aged care technology developer revealed the numerous ways in which technology shapes the aged care work environment. The findings suggest that government, aged care organisations, and technology providers need to balance the efficiencies of technology adoption with the humanistic nature of aged care work.

Background: Persons with developmental disabilities (DDs) represent about 1-3% of the total population in Canada; however, very little statistical data exists regarding this population in the context of long-term care (LTC). As the life expectation of these individuals increases, the distinct needs they have that are associated with aging should be addressed in LTC to help improve the quality and relevancy of the care they receive. Methods: An exploratory qualitative study. Semi-structured interviews were conducted. Open coding of interview transcripts, and content analysis was completed. Descriptive statistics of the sample were calculated using Excel. Results: All participants had experienced earlier functional decline which resulted in changes in their care needs. Often this meant needing to change their assistive devices. Many participants feared losing their independence as they aged. Conclusion: There is insufficient understanding of the unique needs that face people aging with DDs or how they access LTC. The preference for these individuals is to age in place, their independence must be maintained in order for this to be successful. Three factors help to facilitate this: assistive devices, attendant care and accessibility of health care services. Contexte: Les personnes ayant un handicaps developmental représentent environ 1-3% de la population totale au Canada. Cependant, très peu de données statistiques concernant cette population existent dans le contexte de soins de longue durée. L’espérance de vie de ces personnes augmente, les besoins distincts associés au vieillissement devraient être examinés pour aider à améliorer la qualité et la pertinence des soins qu'ils reçoivent dans les soins de longue durée. Méthodes: Une étude qualitative exploratoire. Des entrevues semi-structurées ont été menées. Les transcriptions d'entrevues ont été codées en utilisant un style de codage ouvert et l'analyse de contenu a été accomplie. Les statistiques descriptives des participants ont été calculées. Résultats: Plusieurs thèmes sont devenus apparents. Tous les participants avaient connu un déclin fonctionnel à un jeune âge qui a entraîné des changements dans leurs besoins de soins. Souvent, cela signifit avoir à changer leurs appareils et accessoires fonctionnels. De nombreux participants craignaient de perdre leur indépendance en vieillissant. Conclusion: Il y a une méconnaissance des besoins uniques auxquels font face les personnes vieillissant avec un handicap developmental et la façon dont ils accident aux soins de longue durée. La préférence pour ces personnes est de viellir en place, leur indépendance devant être maintenue pour que ce soit un succès. Trois facteurs contribuent à faciliter ceci: les appareils et accessoires fonctionnels, les soins auxiliaires et l'accessibilité aux services santé.

Assistive technology may delay cognitively impaired elders’ need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah’s 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer’s or other dementia by 2037. Data were collected from a focus group of 10 seniors at a senior center in a large mid-Atlantic city, as well as survey data from with 5 family members of the cognitively impaired elderly and 16 technology developers from an engineering society. These data were coded according to the thematic content analysis and causal layered analysis. The future triangle analysis served as a second layer of analysis. Findings indicated that the most desirable outcome for 2037 is that of the “happy retiree,” characterized by flourishing cultural and financial opportunities, and the least desirable is that of the “struggling pensioner” characterized by monetary gains of the social elite at the expense of the poor and working class. The most expected outcome, though, is the “caring robot” that is characterized by the use of technology and artificial intelligence to promote equitable social and health care benefits to aging citizens. Positive social change may be achieved through recommendations to state, local, and national policy makers that support the improvement in the elders' well-being, the delay of hospitalization, and greater support for the duties of family members, and greater caretaker independence.

Background: An ageing society and rising prevalence in dementia are associated with rising demand for care home places. Monitoring technologies (e.g. bed-exit alarms; wearable location-tracking devices) are appealing because of their potential to enhance safety, increase resident freedom, and reduce staff burden. However, it is unclear how far use of such technologies can deliver potential benefits, and there are ethical challenges from their use. This study explored the implementation of monitoring technologies in care homes for people with dementia, to identify facilitators and barriers to the implementation of these technologies in practice. Methods: An embedded multiple-case study design was employed with 3 dementia-specialist care homes in North-West England. Data collection included 36 semi-structured interviews with staff, relatives and residents, informed by Normalization Process Theory to focus on individual and organisational factors within implementation; 175 hours’ non-participant observation; investigation of care records and technology manufacturer literature; and questionnaires to establish participant attitudes towards technologies. Qualitative data were analysed using Framework Analysis. Findings: 5 overarching themes emerged: (1) Reasons for using technologies; (2) How technologies were implemented; (3) What happened when using technologies; (4) Understanding of technologies; (5) Business and environmental influences. Mitigation of risk seemed to override other potential benefits (e.g. resident freedom) or ethical concerns (e.g. the remote monitoring of residents with impaired cognition), as a reason for use. This emphasis seemed to position monitoring technologies as being understood as fundamentally different to other interventions, and challenged adherence to philosophies of care emphasising resident choice. Some staff, relatives and residents did not seem to be involved in discussion and decision-making regarding technologies, and seemed to lack knowledge about technologies within the homes. Staff training appeared mainly informal, based upon assumptions of simplicity of use, which might not have been sufficient to ensure that staff fully understood the technologies. Staff understanding and awareness of the technologies appeared to be influenced in part by location, both organisationally (i.e. their role) and physically (i.e. within the building). Technical and physical properties of the technologies appeared to work in relation with the physical environments of the homes, which suggested that there may not be an ideal set of physical properties for any particular technology. Some technologies offered a range of functional and information-gathering capabilities, which at times were perceived to be useful complements to practice, but at other times less useful, particularly if they were imbued with a financial cost that was not justifiable from a business perspective. Conclusions: Care homes may need to consider greater involvement of all stakeholders in discussions and decisions regarding the use of monitoring technologies, in order to deepen understandings about the potential benefits and challenges from their use. There is also a need to consider the technical compatibility of technologies with the care home premises, and the financial implications from investing in technologies.

Thesis (Ph. D.)--Ohio State University, 2003.
Title from first page of PDF file. Document formatted into pages; contains xv, 204 p.; also includes graphics Includes vita. Includes bibliographical references (p. 197-204). Available online via OhioLINK's ETD Center

Bakgrund: Diagnosen demens förekommer världen över och i framtiden förutses antalet drabbade stiga i takt med att livslängden ökar. Demens är en diagnos som innefattar olika symptom. Symptom uppkommer i samband med sjukdomar eller skador i olika delar av hjärnan och den drabbade kan uppleva problem med att hantera sin tillvaro. Några av symptomen vid demenssjukdom kan vara glömska, svårigheter med fysiken och motoriken, svårigheter att orientera sig samt rastlöshet och irritabilitet. Sjuksköterskan skall kunna arbeta ensam eller tillsammans med andra för att bedöma, diagnostisera, planera, genomföra, och utvärdera omvårdnadsarbetet. Utvecklingen av teknik inom vården ställer sjuksköterskor inför nya krav och uppgifter. Syfte: Litteraturstudiens syfte var att beskriva sjuksköterskors erfarenheter av tekniska hjälpmedel inom demenssjukvården. Metod: Beskrivande litteraturstudie där kvalitativa artiklar användes. Totalt inkluderades 11 artiklar. Databasen MEDLINE via PubMed användes för att söka upp samtliga artiklar. Resultat: Sjuksköterskor hade både positiva och negativa erfarenheter. Det ansågs vara viktigt med ett gott samarbete tillsammans med rutiner för implementering och användning av tekniska hjälpmedel. Kunskap om teknologin och ett personcentrerat förhållningssätt var en grundläggande del av omvårdnaden med tekniska hjälpmedel. Sjuksköterskornas erfarenheter visade även att etiken var ett viktigt område att ha i åtanke vid arbetet med tekniska hjälpmedel. Slutsats: Rutiner, teamarbete, kunskap och utbildning är grunden för att arbeta kvalitetssäkert med tekniska hjälpmedel. Den tekniska utvecklingen går hela tiden framåt och teknik i vården är något alla sjuksköterskor någon gång kommer att möta. Det är viktigt att vi tar vara på de erfarenheter som redan finns för att sjuksköterskeyrket och omvårdnadsarbetet skall kunna växa i takt med tekniken.
Background: The diagnosis dementia exists all over the world and the occurrence is expected to rise in the future, as the life span increases. Dementia is a diagnosis that includes different symptoms. Symptoms occurrences is associated with diseases or damages in different parts of the brain and the affected can experience difficulties with handling their existence. Some of the symptoms of dementia can be forgetfulness, difficulties with physics and motor skills, difficulties in finding their way, restlessness and irritability. Nurses shall be able to work alone or with others to assess, diagnose, plan, implement and evaluate the nursing work. The development of technology in health care settings introduces nurses to new demands and tasks. Aim: The aim of the literature study was to describe nurses’ experiences with assistive technology when caring for people with dementia. Method: Descriptive literature study using qualitative articles. A total of 11 articles was included. The database MEDLINE through PubMed was used when searching for articles. Main results: Nurses experiences with assistive technology was both positive and negative. It was crucial that all the professions were working together with routines for the implementation and application of assistive technology. Knowledge of the technology and a person-centered approach was a key-point in the work with assistive technology. The nurses experiences showed that the ethics was an important subject to consider when talking about and using the technology. Conclusion: Routines, teamwork, knowledge and education is the foundation of quality assured care with assistive technology. The technical development is constantly moving forward and technology in health care is something every nurse is eventually going to face. That is why it is important to take care of the existing experiences so that the nursing profession and work can grow alongside the technology.

Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context. Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology. The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions. The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment. The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system. In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.

Through a case study about the impact of IT adoption in a residential aged care organisation, this thesis examines the increasing pressure for service integration as mainstreamed through reform policies. Specifically, the research investigates the role of IT in facilitating the 1997 aged care reform agenda of 'ageing in place' focusing on the levels of transformation from the policy context to the organisational/management context, and to the context of service provision by care staff. A single embedded case study (Yin, 1993) is used in order to meet the general objective to capture the dynamics of the impact of ageing in place in the three social contexts. The research is informed by social constructionism, a theoretical framework that emphasises the significance and effects of language in shaping social realities (Ainsworth, 2001; Hosking, 1999). The framework, therefore, justifies the qualitative analysis of both written (i.e., policy documents) and spoken (i.e., interviews with staff) texts to address meaning in relation to context. Changing technologies can result in altered societal structures (Betz, 2003) at all levels, from the very complex to the very basic. As such, it is important to understand a few basic premises of technology. First, technology is a human invention to improve the well-being of society (Ayres, 1996). Consequently, technological inventions that improve the quality of life are seen by people as a necessity for modern living. In the case of ageing, modernisation and technological advances effectively resulted in people becoming healthier and living longer (Department of Health and Aged Care [DHAC], 2000). Second, technology is a human means to control nature (Betz, 2003). As such, technological advances can be seen as a modernising process of predicting and regulating the effects of the trends existing in the environment, such as ageing. Ageing in the twenty first century presents a challenge to government's development policies because ageing is depicted as a steady force with a long-term economic impact (Johnson, 1999). Third, a technology becomes powerful when it is sponsored by the market (Betz, 2003; Hughes, 1983). Unless a technology is backed by business, it lacks the influence on a large scale. Fourth, technology is used to enable change. By using IT, governments, business and the community are co-operating through a paradigm similar to the business sector. As a result, the service environment is shifting towards more business-like approaches. To sustain the changes brought by a different paradigm and modes of operation, the rhetoric of technology is employed. Therefore, the purpose of the study is to investigate the use of IT in processes of organisational adaptations to reform, which requires the examination of: a) specific meaning of IT as used in long-term care policies for older people since the last structural reform, b) the rationale behind the introduction of a new IT system into a residential care organisation, and c) the meaning of IT as articulated by care staff who have experienced a change in technology. The first paper represents a rhetorical analysis at the macro or policy level. There is a significant influence of a global political actor in developing proactive strategies on ageing, which results in a new, multi-organisational approach in delivering government-subsidised services, such as residential care. Three key institutional texts were selected to represent international to local policy development since the time ageing became a global concern. Since then, ageing is also viewed as a human rights issue. Using Burke's pentad, an analytic framework to analyse rhetoric in texts (Stillar, 1998), these institutional texts are seen to employ the rhetoric of 'technology for sustainability' to justify changes to policy approaches that seek long-term viability. Technology, in the name of sustainable development ensures support for economic growth, which balances the long-term effects of population ageing. The existence of a global force, such as population ageing, allows the intervening powers of the UN in mainstreaming ageing into development policies. Accordingly, it initiates corresponding actions at national (Australian Commonwealth Government) and state (Queensland Government) levels. IT is a medium of communication, knowledge transfer, and standard practice at these levels of actions. The second paper represents a qualitative analysis at the meso or organisational level. This paper explores the cogent rationale in the introduction of a computer-based, care documentation system in a large residential aged care organisation. Twenty two staff, from every level of the organisation, were interviewed to get an insight into the role of IT in substantive changes to organisational structure and modes of service provision. Responses from staff indicate external and internal influence that pressured the organisation to change. In the bid to sustain the future of aged care, the industry is changing through the introduction of new structure of service delivery. The Aged Care Structural Reform instigated a shift towards sustainable service provision that is consumer-driven, with a fixed cost compliance mechanism and performance criteria that are tied to funding. Facing the requirement for evidence to corroborate funding, a residential care organisation changed its structure of service delivery by introducing a new strategic direction. IT is part of this new strategic direction, planning, and operations of a changed service environment. The third paper represents a qualitative analysis at the micro or individual level to examine the impact of IT at frontline service delivery. This study is also based on interviews with twenty-two staff, across the organisational structure; however, this time the focus is more on staff who are involved in providing direct care to older residents at the organisation. The reason behind this is that IT has always been a management tool which handles management priorities such as financial planning and performance monitoring. The themes arising from the interviews indicate discord at the level of service delivery from the introduction of a new technical system. It also points to the idea that staff generally refer to ethical ideas and future promise of the new system. In summary, these three papers attached to this thesis support the notion that the meaning of technology is socially constructed. First, technology in the aged care sector has particular reference to improving or enhancing the well-being of older people, and in this case, the provision of high quality services that fulfil the needs of older people. Second, IT has an important role in meeting the evidence-based requirement, such as in the use of information in manipulating the use of resources required for the ageing population. Third, the meaning of IT is conceived from the context requiring its use such as the need to use resource efficiently to ensure long-term sustainability, which were emphasised in the last reform. Fourth, IT is used to enable structural changes in organisations to implement generic practices originated from the business sector, requiring the use of strong rhetoric such as balance and future. The limit of this case study is that these dimensions of technology can only be applied to the specific context of aged care and is not generalisable to other political contexts. However, the strength of the study rests on the macro-, meso- and micro-analysis of the meaning of technology. Therefore, future studies should investigate and compare the dimensions of technology in other contexts.

Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing. In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses. Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.

The aim of this study was to analyze how high-tech assistive technology in the elderly care are represented in selected Swedish newspapers during the time between August 2018 and March 2020. The initial perspective of this study was to conduct a discourse analysis based on social constructivism. I have investigated what daily newspapers describe to be central needs for the elderly care and for elderly people. I have also looked at what the daily newspapers describe to be important for elderly people during implementation of high-tech assistive technology in the Swedish elderly care. In the study’s result, I concluded the need for autonomy was central for what the daily newspapers described as important for elderly people. The result also showed that the daily newspapers described high-tech assistive technology to be important for the organization, due to shortage of staff and demographic challenges.

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Mestrado Acadêmico em Ciências do Cuidado em Saúde
Trata-se de um estudo sobre a abordagem da terapia ocupacional em nível de reabilitação em saúde, cujo foco é a autonomia de pacientes com sequelas da hanseníase. Constituem temas desta pesquisa: a adoção da tecnologia assistiva no processo de cuidado, a subjetividade, a autonomia do cliente. Os objetivos: descrever a repercussão da tecnologia assistiva na autonomia do sujeito; analisar a relação entre sujeito e tecnologias no processo de cuidado. Quanto ao método, o estudo qualitativo, cujas técnicas foram entrevista semiestruturada e observação participante. O cenário do estudo foi o Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. A pesquisa foi realizada no período de novembro/2014 a fevereiro/2015. Foram entrevistados oito clientes que se tratam no serviço de Terapia Ocupacional. O tipo de análise escolhido foi hermenêutica do sujeito. Quanto aos resultados, três categorias foram descritas e discutidas sendo elas: a contribuição dos dispositivos nas suas rotinas e no cuidado de si; os sentimentos e sensações gerados pelo uso dos instrumentos adaptados e por fim, a percepção do cuidado recebido pelos profissionais de saúde. Conclui-se que tecnologia assistiva representa uma ferramenta com potencial transformador no resgate de possibilidades, através desta, é possível instrumentalizar o sujeito para o exercício do cuidado de si e promover inclusão social. Constatamos ainda, que os participantes deste estudo, percebem o cuidado recebido em nosso serviço como acolhedor, sensível e competente.
This is a study on the approach of occupational therapy at the level of health rehabilitation, which focuses on the autonomy of patients with leprosy sequelae. Are themes of this research: the adoption of assistive technology in the care process, subjectivity, customer autonomy. The goals: to describe the impact of assistive technology in the autonomy of the subject; analyze the relationship between subject and technologies in the care process. A far as a qualitative study was preferred, the techniques used were semi-structured interview and participative observation. Having been made in the University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, the research was performed between November/2014 and February/2015. Eight patients under treatment in the Occupational Therapy Service were interviewed. The kind of analysis chosen was the hermeneutics of the subject. As for the results, three categories were described and discussed. They are: the contribution of the devices in the patients´ routine and in self-care; the feelings and sensations arosen by the use of adapted instruments; and, finally, the patient’s perception about the health professional’s care. It is concluded that assistive technology is a potential tool with transformer in the rescue possibilities, through this; you can equip subject to the exercise of self-care and promote social inclusion. We note also that the study participants perceive the care received in our service as warm, sensitive and competent.

Due to the rise in the elderly population and the prevalence of chronic diseases, healthcare organizations around the world are faced with an economic burden which will continue to grow. For this reason there is an urgent demand to reduce the intake of elders in hospitals and nursing homes by allowing them to live independently for greater lengths of time. In response to this demand, researchers are strongly focusing on 'telemonitoring', which is the use of information technology (IT) to monitor the health status of an individual from a remote location (e.g. their home). The first aim of this thesis was to investigate how telemonitoring technologies can detect elderly activities for health assessment purposes. To assess a patient's health status holistically, a wide variety of factors needed be considered by practitioners. Currently many telemonitoring technologies in research have addressed these factors/assessments by monitoring elderly activities. However based on the literature reviews, researchers have not been able to develop a comprehensive understanding of how these technologies support each assessment. Therefore the first contribution in chapter 3 of this thesis addresses this gap. A literature review was conducted where 215 telemonitoring technologies were identified from 82 papers, published between 2000 and 2016. Six assessments which involve monitoring of activities were identified as (1) mobility, (2) nutrition, (3) safety, (4) cognitive, (5) social, and (6) routine. All included technologies were categorized into six tables according to the assessment that they supported. From assessing the contents of these tables, it was found that a significant portion of ITs relate to mobility, nutritional, safety and routine assessments. Many of the studies were found to assess technologies inside of laboratory setting and still require improvement before they are suited for real world application. It also found that many of the technologies were not equipped with wireless communication. In recent years recently have been focusing been integrating wireless sensing technology into telemonitoring applications. Many of these wireless technologies are small, unobtrusive, and usually need to be powered by small batteries (e.g. coin cell) which have limited capacity. For this reason, researchers have had difficulties prolonging battery life to a duration that is practical. However the recent release of Bluetooth Low Energy (BLE) has the potential of resolving this issue due to its power saving qualities. The 2nd aim of this thesis is to assess the performance of Bluetooth Low Energy (BLE) in telemonitoring frameworks using advertising mode. Advertising mode is often used for device discovery purposes, however it can also be used to send context data without the need for device connection establishment. This method has received little investigation from researchers and yet it has the potential of offering advantages such as reduction in power consumption and manufacturing costs. Therefore in this thesis, the performance of BLE advertising mode was used within two telemonitoring applications. Firstly, a new device called 'BLUESOUND' is proposed. The device uses ultrasound sensing technology which can efficiently differentiate multiple residents in a home environment based on their height. The device consists of three sensing/communication modules: A Passive Infrared (PIR) occupancy module, an ultrasound array module and a BLE communication module. The PIR occupancy module is used to detect walking direction, while the ultrasound array measures the resident's height. The combination of these two technologies can also be used to detect a resident's velocity. BLE advertising mode is used to communicate acquired data to a smart phone gateway/database. A new embedded algorithm was able to increase the energy efficiency of the identification technology. Comprehensive modelling and experimentation was undertaken to assess the performance the BLUESOUND device. The BLUESOUND device was able to distinguish between multiple resident identities by measuring height accurately. Currently researchers have developed various wearable ECG monitors as there is a demand to detect the onset of cardiac disease earlier in the elderly population. However most of these devices have only lasted a couple of days on a coin cell battery which is not practical. Therefore the performance of BLE advertising mode was explored using a virtual BLE based ECG model in MATLAB. To further minimize power consumption, an ECG extraction technique (based on the 'So and Chan' algorithm [1]) was used in the model to extract some of the most significant points on the signal. Based on three simulation trails, ECG data was transferred to a scanning device with high accuracy (average of 99.62%). It was estimated that the virtual system is approximately 13 times more energy efficient compared to sending ECG stream data continuously when a connection is established.

This thesis follows the everyday movements of a group of elderly Australians, to critically examine how they came to experience a sense of home while living with bodily and cognitive impairments in a nursing home. In tracing their steps and the minutiae of their day-to-day activities, this research illustrates how nursing home residents experience ‘home’ as a sense of ‘rightness’ of being through doing the most mundane activities of walking, transferring position and eating. Examining care through the lens of home, I analyse how home, bodies and movement are reconfigured through multiple contexts of care. I argue that it is only in constellations of care that produce movements that residents attempt to make, but are unable to make on their own, that the potential to become at home is made possible. Based on 12 months of fieldwork in two nursing homes in metropolitan Adelaide, South Australia, this research attends closely to the sensory extensions (Dennis 2007) and restrictions of residents’ bodies vis-à-vis their engagements with other people and things. From the taste of a home cooked meal, to the touch of staff and family members, medications, handrails, carpeted floors and walking aids, residents’ ageing and declining bodies respond to, and may resist, assistance to walk, stand or eat. Care plans, staff and equipment, as this thesis will show, can also restrain residents’ bodies, inhibiting their movements and their becoming at home. This thesis draws on Deleuze and Guattari’s (1977, 1988) theories of becoming and desiring production to expand Jackson’s notion of home (1995, 2002) and ‘existential imperative’ (2002, p. 14) to propose that home is a matter of becoming-at-home-in-the-world. Key to my argument is how residents experience an innermost drive to move, and in examining how their urge to move is responded to, I demonstrate the multiple and at times contested forces that can propel residents to sit, to stand, or to put one foot ahead of the other. It is through this Deleuzian approach that I detail the multiple persons and things that enact and produce assemblages (Deleuze & Guattari 1988) of care. In so doing, I demonstrate that an ethically responsive care, or the care that was communicated and experienced as ‘right’ by residents, requires tinkering (Mol, Moser & Pols 2010) to achieve a balance between inclusion and autonomy (Rapport 2018). From moment to moment, and day-to-day, as bodies age, decline and eventually die, each resident requires different assemblages of care to move and to become at home. Examining the varieties of experience for nursing home residents through the theoretical lens of becoming at-home-in-the-world, this thesis provides new knowledge about the interrelations between movement and care, and the generative and productive affects of walking, standing and eating in residents’ lives. I argue that this ethnographically informed understanding of the sensibilities and potentialities of movement presents a challenge to clinical constructions of bodily and cognitive impairment and is at odds with aged care discourses and practices that may render the lives of nursing home residents inactive or meaningless and thus further constrain their existential and bodily potentials.
Thesis (Ph.D.) -- University of Adelaide, School of Social Sciences, 2020

Health, housing and much more recently, assistive technology, are key determinants of elderly independence in British Columbia. This thesis discusses these three determinants in some detail, and also stresses their interrelationship with each other. Throughout the entire thesis, the elderly's preference to age-in-place (Blackie, 1986; Wheeler, 1982) is stressed. In the issue of health, the current community-based health care delivery system of the British Columbia Ministry of Health's Continuing Care Division is compared and contrasted with a "counterpart" in the United States: the On Lok Health Services System in San Francisco, California. On Lok is discussed to highlight its effectiveness in delivering a community-based holistic health care system for a group of aging-in-place elderly in need of long term care with relatively low cost. In the issue of housing, the thesis investigates three avenues in which architects can apply their skills to maximize aging-in-place possibilities for our elderly in the context of British Columbia. Constraints by building codes, health care regulations, real estate market expectations and the aging characteristics of British Columbia's elderly are also highlighted to bring context to the discussion. In the issue of assistive technology, given the huge range of product development, the thesis focuses on one particularly interesting communication device - the Videophone. The Videophone is discussed to explore its potential impact for elderly independence, especially for the future.

碩士
國立臺北教育大學
數位科技設計學系(含玩具與遊戲設計碩士班)
100
The change of social environment had great influence on both families and society. Due to the birth rate declination and the approach of aging society, it gave different generations more chances to know each other better. In reality, the aged rarely had chances to interact with other generations. First, this project concluded the demand of the aged from the existing theory and social phenomenon. Next, with U-E learning system, it also analyzed the market trend of related industries and the products we had seen or had used so far. Then it showed that the products could be better-developed after the analysis of comparing the market supply with the market demand. The interactive education assistive technology devices for the aged we had nowadays are skilled games which were also combined with adult rules. With different cases, it showed that the interaction between humans is one of the design elements. The features are as followings: 1. The bonus of the significance in human nature: Human cooperation leads to social communication, which enhances the group identity and interworks the sense of accomplishment and co-identity. Besides, instant face-to-face involvement is stronger and more various than other forms of interaction. 2. Freedom of creativity: To provide user create elements freely and the importance of rule making. 3. Rule- making: The interaction itself, in some degree, is based on rule making. Sometimes it conflicts with the creativity, and it must be handled with care. 4. Unpredictability: The influence on interest, if we extend this item, it relatively affects the playable degree. 5. Try and explore: Try and explore the regularity of the process to increase interaction and playable degree. After analyzed the existing design strategy, it found that the demand was rarely reflected on the design process and strategy. Therefore, we should put priority on these demands while designing the interactive education assistive technology devices. Furthermore, it also provided some suggestion about the design process to researchers who were going to design new devices for the aged in the future.

碩士
東海大學
企業管理學系碩士班
104
According to United Nations ' Declaration of disability affirmative action in 1993, which mentioned that “In technological service, making people to get the assistive technology devices they need is important. Including getting the information and service about assistive technology devices, relevant subsidies from government, repair problems, as well as aids to assess suitability. In this study, home care services started to investigate the case in the main home environment, the interaction between daily activities and assistive devices, coupled with the quality of service analysis, is intended to meet the service quality improvement, aids the development of more effective, higher utilization of aids effect. Most important concept in this study want to emphasize “What assistive device represent is not only products but one should be considered in service system. The studying process starts with using SERVQUAL to estimate the quality of home care service. After getting the Person-centred data as main sources of demand, analyzing with IPA method and HAAT model. Furthermore the information from literature, expert interview will be a derivation mechanism to analyze the needs of the future health of assistive technology products. SERVQUAL questionnaire designed using the original 22 questions, applying to home services, and via expert review and reliability analysis, the questions is cut it down to 19 items. Study subjects are choosing who accepting the home care service and have used assistive devices from the welfare institution engaged in home care service, called Taichung Q uan-Cheng Social Welfare Foundation, and finally collected 54 elder over 60 years old as sample. The results show that the propositions in this study is all correct. The relationship between home care service quality and assistive device needs is opposite. While the physiological deterioration conditions and home environment safe is subject to the premise and aids can be a positive relationship between the assistive devices demand.

abstract: Some disabled users of assistive technologies (AT) have expressed concerns that their use of those AT devices brings particular attention to their disability and, in doing so, stigmatizes them in the eyes of their peers. This research studies how a wide range of design factors, influence how positively or negatively users of wearable technologies are perceived, by others. These factors are studied by asking survey respondents to estimate the degree to which they perceive disabilities in users of various products. The survey was given to 34 undergraduate Product Design students, and employed 40 pictures, each of which showed one person using a product. Some of these products were assistive technology devices, and some were not. Respondents used a five-bubble Likert scale to indicate the level of disability that they perceived in this person. Data analysis was done using SPSS software. The results showed that the gender of the respondent was not a significant factor in the respondent's estimation of the level of disability. However, the cultural background of the respondent was found to be significant in the respondent's estimates of disability for seven of the 40 pictures. The results also indicated that the size of AT, its familiarity to the mainstream population, its wearable location on the user's body, the perceived power of the user, the degree to which the AT device seemed to empower the user, the degree to which the AT device was seen as a vehicle for assertion of the user's individuality, and the successfulness of attempts to disguise the AT as some mainstream product reduced the perceived disability of the user. In contrast, symbols or stereotypes of disability, obstructing visibility of the face, an awkward complex design, a mismatch between the product's design and its context of use, and covering of the head were factors that focused attention on, and increased the perception of, the user's disability. These factors are summarized in a set of guidelines to help AT designers develop products that minimize the perceived disability and the resulting stigmatization of the user.
Dissertation/Thesis
M.S.D. Design 2014

Dementia compromises older people’s ability to maintain good nutrition, which in turn hinders their capacity to live in their homes for longer. Thus, they need significant support to maintain their nutritional health, often through care workers, especially when living with limited or no family support. However, with the rapid growth of the older population, the burden on care workers continues to increase, resulting in an urgent need to consider ways to assist people with dementia to maintain their nutritional health as well as their care workers to provide better support for their clients. Through a cross-disciplinary study, this thesis investigates how technologies can be used to promote nutritional health in older people with dementia living in their own homes. This involves an in-depth qualitative descriptive study and two technology development demonstrations. Understanding needs prior to technology development is crucial for technologies to be effective, accepted by users and able to reach their desired maturity; however, this necessitates greater research investment. This thesis presents, for the first time to the best of the researcher’s knowledge, a qualitative descriptive study with the aim of obtaining an holistic perspective of needs for technologies promoting nutritional health in older people with dementia living in their own home, involving focus groups with 27 care workers who provide care to older people with dementia, recruited from four leading aged care providers. Eight categories emerged from synthesising the care workers’ voices. These categories provide deep, reliable insights useful for designing nutritional health-promoting technologies. In particular, nutritional health challenges faced by older people with dementia and challenges faced by care workers when providing nutritional health assistance to their clients demonstrate the demand and need for technological assistance and opportunities for developing technologies to promote nutritional health for the target cohort. Furthermore, this thesis proposes important elements need to be considered in technology development in the form of eleven technology design considerations. Based on the formulated design considerations, two technology development demonstrations are presented. Firstly, poor fluid intake is identified as a significant problem and therefore, recognising fluid intake related primitive human motions using batteryless Radio Frequency Identification (RFID) technology is investigated. To this end, a smart cup to collect fluid intake data is designed and experiments are conducted with young (30.7 ± 1.6 years) and old (69.0 ± 4.6 years) participants. The promising results demonstrate the feasibility and efficacy of recognising short distance, short duration natural fluid intake gestures using batteryless RFID technology for the first time to the best of researcher’s knowledge. Secondly, a study that focuses on an architecture, Home of Things for Ambient Assisted Living—HoTAAL, suitable for facilitating the development of a collaborative environment, having heterogeneous technologies that can have seamless integration with each other as well as humans is conducted. It is expected that such an infrastructure would allow the development of a broad range of innovative technological applications to promote the nutritional health of older people with dementia. A demonstration of providing meal preparation assistance employing HoTAAL with three kitchen appliances was conducted. Additionally, possible technological applications based on HoTAAL architecture are described for several scenarios extracted from the focus group findings.
Thesis (Ph.D.) -- University of Adelaide, School of Computer Science, 2017.

碩士
國立彰化師範大學
工業教育與技術學系
106
With the rapid growth of the global population of aging population, Taiwan has officially entered an aging society. In addition, under the limited medical resources and the rise of the Chinese people's self-healthy health care culture, the Chinese people no longer rely on professional medical personnel for self-health management. With the civilization and progress of science and technology, wearable products have rapidly become the mainstream of self-medical care for middle-aged and older ethnic groups. In the aging society of advanced technology and civilization, it is necessary to understand the adaptation and acceptance of new technology products by middle-aged and older people. In view of this, this study is based on the UTAUT and incorporates the " Health Cognition " as an indepandant variable to construct an extended technology acceptance model and a questionnaire survey method was used to collect a total of 326 valid questionnaires for the domestic middle-aged and senior citizens over 45 years old, adopting a structural equation model (SEM) to conduct confirmatory factor analysis and path analysis;to explore the acceptance of wearable devices for the medical care of middle-aged and older ethnic groups. The results of the study show that " Health Cognition " has a positive effect on "Behavioral Intention"; "Behavioral Intention" has a positive effect on "Use Behavior"; "Social Influence" has a positive effect on "Behavioral Intention" and "Use Behavior" through mediating effects. In addition, the adjustment variable "experience" has a regulating effect on " facilitating conditions".

For older adults, functional independent mobility is essential to well-being. Many care home residents have physical and cognitive impairments and use wheelchairs. Residents with difficulty self-propelling manual wheelchairs may benefit from power mobility; however, those with cognitive impairments may be precluded because of the potential for injury. My research goals were to apply novel power wheelchair technology to enable safe, independent mobility. Technology was developed to examine the value and implications of power mobility for residents with restricted mobility and mild or moderate cognitive impairments. The first study tested a prototype anti-collision wheelchair with a contact sensor skirt. Six single subject studies were completed. Distances travelled in manual and anti-collision wheelchairs were compared. Observational and interview data were collected. Focus groups (37 staff) and interviews (18 staff, six other residents, one spouse) were performed. Three of six residents were able or had potential to operate the prototype. One resident chose to use it beyond the study, and his mobility and well-being improved. Case analyses showed factors limiting prototype acceptance. Residents were unsatisfied with the appearance and slow speed, and found the interface frustrating to operate because of inadequate feedback. Social isolation and reduced autonomy restricted independence achievable with technology. Socialization and affective benefits of mobility were demonstrated in one case where prototype use was continually assisted. Residents and staff supported the anti-collision concept. On observation, the prototype compensated for absent or delayed responses of residents to obstacles below sensors and decreased injury risk. However, full sensor coverage of the environment was needed. The second study addressed acceptance and interface usability issues. A simulated collision-avoidance wheelchair with a multimodal feedback interface was evaluated. The interface provided audio, visual and haptic feedback to guide navigation away from obstacles. Through observations, interviews and questionnaires, five residents evaluated the device. High device acceptance and usability were found. The device was easy to use and assisted with performance of indoor mobility goals. Further research is necessary before power wheelchairs with new features are available for users; however, these results could play a fundamental role in shaping technology development and mobility interventions for this neglected population.

yes
Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.

碩士
國立成功大學
老年學研究所
104
Background: Increasing literature indicated that the usage of information computer technology has positive results in decreasing older adults’ isolation and increasing the quality of life along with psychological well-being. However, few studies have evaluated the impact of ICT (Information and Computer Technology) for older adults living in long-term care facility. Objective: This study evaluated the extent to which quality of life, social support and psychological well-being changed for participants receiving ICT intervention. Methods: This study was conducted a quasi-experimental research design using ICT teaching intervention to 54 institutionalized residents 50 years and older, able to comply, clear consciousness and not agitated from three comparable long-term care facilities located in Southern Taiwan. This research assessment constituted randomizing three long-term care facilities into groups. Group 1 recruited 19 participants and received communication technology instructional training using the program Line, teaching them how to make video phone calls, send out text messages with attached emoticon stickers. Group 2 had 18 participants and received multi-media instructional training using the program YouTube, teaching how to search for their favorite karaoke song, news or television soap opera then how to view them. Group 3 consisted of 17 participants recruited as an observation group with usual care. Groups using Line and YouTube received intervention instructions once a week for 90 minutes each group, teaching and twice a week for 20-30 minutes/per person one on one tutorship for four weeks. Instructional sessions included visual demonstrations with hands on intervention where needed. The participants were evaluated on the measures of health-related factors such as, quality of life, well-being, social support, depression CES-D, cognitive functioning SPMSQ, physical functioning ADL and IADL at pre- and post-interventions along with post-test satisfaction survey and an open questionnaire. SPSS vision 23 was selected to conduct Kruskal Wallis test, Mann-Whiney test and Wilcoxon Signed Ranks for descriptive and inferential statistical analyses. Results: Enrolled were 57 participants, three participants dropped out (Completed rate 94.74%). The remaining 54 participants who completed the study had a mean age of 73 years (SD=11.4), 50% were male, 70.4% had below elementary school education, 53.7% were the average financial status, 87% never obtained any computer training, the average length of stay in a long term care facility was 36.2%, the average ADL Score was 40.2, IADL Score was 6.6, cognitive score was 9.6, the average chronic disease count was 2.3, diabetes had the highest incident rate of 44.4%, the second was hypertension 16.7% and 61% had an average self-rate health status. Comparing the Kruskal Wallis test of the three groups data, the YouTube group was rated as the most significant on the QOL SF12 in physical component summary (PCS, P=.002), mental component summary (MCS, P=.000), social support in health care worker related (P=.002), satisfaction in social support (P=.008), happiness (P=.033), along with depression CES-D (P=.000) were illustrated significant positive changes. Mann-Whiney test post hoc at pre- and post-test changes revealed positive increasing in YouTube 〉 Line 〉 Usual Care. Happiness and Quality of life along with psychological well-being were significant improving the Information Computer Technology usage among residents living in long-term care facilities. Especially searching a reminiscence song using YouTube as a karaoke sing along. Conclusion: The communication application Line was not as significant as the entertainment application YouTube among long-term care residents. However, Line is positively increasing in health related quality of life in mental component summary (MCS), social support in family/friend related and psychological well-being. Our findings demonstrated that using YouTube’s simple operation and groups or an individualized entertainment features as a karaoke sing along could be an excellent stimulus for reminiscence and social support. Singing with family, friends, other residents and health care workers through this entertainment application produces a profound effect on their quality of life and the residents mingling among each other helps maintain their social support and psychological well-being.

The thesis discusses how information and communication technologies (ICT or IT), nowadays transforms the form of health and social services. The specific arguments and social events are described, that leads today's health and social services closer to the use of ICT, influence and changes it. The work describes the latest trends linking ICT and social and health services in the areas of e-health, telemedicine, mobile health and assistive technologies. Specific tools and equipment and their practical use are presented. The practical part focuses on the introduction of specific- gadgets tablet care in caring for the elderly. Through direct interviews with caregivers and seniors is investigated how new technology is perceived by caregivers and seniors, how new technology equipment to care are introduced, and what positive and negative impact are the ICT has for facilities and the elderly. Key words assistive technology; eHealth; mHealth; patient engagement; population ageing; senior activation; senior care; telemedicine; touch tablets

Health Technology Assessment is an important factor for decision making in the healthcare sector in Sweden. It helps to curtail the rising costs associated with the healthcare sector and aids in the efficient allocation of scarce public health resources. This thesis investigates the cost-effectiveness and the effectiveness in general of two health technologies, addressing the following research objectives: i) assessing the cost-effectiveness of mobile health (mHealth) interventions designed for older adults diagnosed with mild cognitive impairment, and ii) assessing the effectiveness of peritoneal dialysis (PD) treatment on labor market outcomes in comparison with institutional hemodialysis (IHD) treatment in Swedish settings. Study I and Study II are related to the first research objective. In Study I, we summarized and critically assessed the current evidence on the cost-effectiveness of mHealth interventions focusing on older adults; we found some evidence supporting the cost-effectiveness of these interventions. In Study II, we conducted a within-trial cost-effectiveness analysis of the software application Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD) from a healthcare perspective for a period of six months. A total of 345 Swedish dyads (MCI patient and informal caregiver) participated in this study. For a short time period of six months, we found that SMART4MD is not cost-effective for MCI patients (statistically insignificant); however, a trend was observed that indicated that it might be cost-effective for informal caregivers, although results remained statistically insignificant (p > 0.05). Study III is related to the second research objective. In Study III, we investigated the effect of PD on labor market outcomes (employment rate, work income, and disability pension) in comparison to IHD. We found that PD is associated with a treatment advantage over IHD in terms of increased employment, work income, and reduced disability pension in the Swedish population after controlling for non-random selection for the treatment.