The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: A randomised controlled trial
Date
2021-01-23Author
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
Gray, Richard
Metadata
Show full item recordCitation
Howard, R., Gathercole, R., Bradley, R., Harper, E., Davis, L., Pank, L., Lam, N., Talbot, E., Hooper, E., Winson, R., Scutt, B., Ordonez Montano, V., Nunn, S., Lavelle, G., Bateman, A., Bentham, P., Burns, A., Dunk, B., Forsyth, K., Fox, C., Poland, F., Leroi, I., Newman, S., O'Brien, J., Henderson, C., Knapp, M., Woolham, J. & Gray, R. (2021) The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: A randomised controlled trial. Age & Ageing, 50(3), pp. 882-890.
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 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.