Title: Assistive Technology and Telecare to maintain Independent Living At home for people with dementia: The ATTILA Trial
Funder: Department of Health and Social Care

Abstract: Design: A randomised controlled multi-centre clinical trial. We will compare the effects of an assessment followed by access to a suite of assistive technology and telecare (ATT) services with assessment and a control intervention; limited to the fitting and checking of smoke detectors; on the time that people with dementia who are at high risk of institutionalisation can be maintained in independent living. Target population: Participants will be patients with all dementia diagnoses and will include individuals with young-onset dementias. Health Technologies being assessed: Commercially available ATT devices that we and others have successfully piloted to promote independent home-living for people with dementia. All participants will undergo a full assessment of home safety and risk and the potential for ATT intervention to monitor and manage risk. Following assessment, participants randomised to receive ATT would be provided with elements from a dementia-specific menu to include: 1. Monitored sensors; including smoke detectors, gas detectors, temperature extremes sensors, carbon monoxide detectors, property exit sensors, bed exit sensors, movement detection and pager systems. 2. System to augment assessment; using Just Checking. 3. Non-monitored (stand-alone) systems; including automatic lights (motion activated or dawn to dusk, battery or mains), motion/door contact to activate previously recorded message, gas isolation switch, carer alerting devices (including stand-alone pager activated by door contacts or passive infra-red (PIR), PIR/door contacts linked to small electrical devices). 4. Peripheral systems; including a keysafe for emergency access. 5. Associated environmental adaptation; including non-toxic fire retardent spray for furniture and clothing. Participants randomised to the control arm will be supplied with battery operated smoke detectors if assessment of home safety and risk has identified that this is indicated. Measurement of cost and outcomes: The co-primary trial outcomes will be (i) Time in days from randomisation to institutionalisation and (ii) Cost-effectiveness.

Lay abstract: There are approximately 700,000 people with dementia in the UK, many of whom will require nursing or residential care home accomodation when their illness has progressed to the point at which they can no longer live independently in their own homes with safety. The losses of independence and quality of life associated with the transition to living in a Care Home are apparent, and NHS and Social Services support of sufferers to live safely in their own homes for as long as possible are beneficial to this. Assistive Technology and Telecare, when individually tailored to a patient's needs and integral to their careplan, offer a way in which the home of a person with dementia can be made safer for them by reducing the specific risks associated with the memory and orientation difficulties that accompany the illness. While it might seem obvious that such interventions are beneficial, only a well conducted clinical trial can provide high quality evidence that these technologies really do help to maintain independent living for people with dementia. For example, it is possible that use of these technologies might worsen the anxieties of caregivers because they highlight the vulnerability of dementia sufferers, act as a constant reminder of the risks that they are exposed to and may identify risky incidents that would otherwise have been unreported. We want to examine the effect of having access to these technologies upon the length of time that dementia patients who are vulnerable can remain safely in their own homes. Our hypothesis is that these technologies will significantly increase the amount of time that patients can live independently compared with those who are randomised to receive standard care.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: NEUROLOGICAL