Systematic review of digital self-management interventions in dementia care: Exploring the impact of wearable technology, smart homes, and mobile applications on patient outcomes (Preprint)
Authors: Cornelius Gary , Hodgson William , Maguire Roma , Egan Kieren 
Published: September 2024

BACKGROUND

The dementia landscape has evolved significantly, with earlier diagnoses, better understanding of prevention (e.g. modifiable factors), and new treatments. Emerging digital technologies (e.g. wearables, smart home technologies and apps) offer novel self-management opportunities, but critical knowledge gaps remain regarding their holistic integration into the care needs and preferences of people with dementia. Broader gaps also exist in intervention design, adaptation, and implementation, including effectiveness, study quality, and accessibility.

OBJECTIVE

This study aims to collate and appraise current literature on digital technologies, such as wearables, smart home technologies and apps, optimised to enhance self-management, reduce dementia-associated behaviours, and improve the quality of life for people with dementia. The review includes information on study design, intervention characteristics, evaluated outcomes, accessibility, and overall study quality.

METHODS

We conducted a ten-year search across nine databases using terms related to dementia, quality of life, associated behaviours, self-management, and digital technologies. Studies were appraised based on design, hardware, and purpose. Outcomes were mapped using the Nursing Outcomes Classification (NOC) and needs benchmarked using NICE Quality Standard (QS184). Accessibility was assessed by availability, cost, and ease of use. Study quality was evaluated using the Mixed Methods Appraisal Tool (MMAT), Critical Appraisal Skills Programme (CASP), and a custom characterisation table.

RESULTS

Our search yielded 835 unique articles, with 24 meeting inclusion criteria. Interventions included 13 wearables, 7 smart home technologies and 19 apps, primarily for people with dementia and their carers. Mapping to Nursing Outcomes Classification (NOC) showed common outcomes: neurocognitive (n=24), self-care measures (n=17), and health behavioural (n=13). Needs benchmarking revealed common addressed needs, such as managing distress (n=15) and supporting carers (n=15). Despite the use of widely available technologies (e.g. activity monitors, healthcare wearables and digital prompters), accessibility was poor due to complex configurations and support needs. Overall, study quality was good to excellent, with six high-quality randomized controlled trials and excellent qualitative studies.

CONCLUSIONS

Research on digital technologies for dementia self-management demonstrates significant benefits, particularly with off-the-shelf devices and flexible mobile apps that offer person-centred outcomes. Nevertheless, the literature also highlights critical weaknesses, such as limited participant diversity (e.g. atypical dementias, minority groups) and the absence of high-quality research in key outcomes (e.g., symptom status, self-control). To address these issues, innovative approaches must be developed to enhance accessibility and usability, focusing on complex configurations, training, and support mechanisms.