What’s the evidence base for digital assistive technology?
LOTI’s been working with Anneliese Levy, a Health Researcher at Thoughtful Content, to develop a library of case studies where Assistive Technologies (AT) have been used to deliver outcomes for residents.
While assistive technology can refer to any device, software, or equipment that helps people work around their challenges, LOTI’s primary interest is in digital ATs. For example, text-to-speech software, voice assistants like Amazon Alexas, smartwatches, Internet of Things-enabled fall-alarms, motion detectors, and so on.
Many local authorities are looking at how these technologies can be used to support residents in need, with a significant recent rise in interest as a result of Covid. We hope this research will help to inform the design and delivery of boroughs’ future AT projects, enabling them to learn from and build on the existing evidence base.
Below, Anneliese shares a few of the key highlights from her research. The full case study library will be published on the LOTI website in the next few weeks. In the meantime, you can read Anneliese’s report, which summarises what is currently known about the impact and evidence on the effectiveness of different ATs.
View a presentation from Anneliese here and a short video here.
What is the evidence base for digital assistive technology?
Digital assistive technology is often promoted as an essential way to enhance social care in the UK. Voice assistants, smart watches, Internet of Things-enabled fall-alarms and motion detectors seem to hold promise to support independent living, reduce the strain on a stretched system and the burden on carers. The coronavirus pandemic has meant that new ways of delivering services involving technology have been implemented at a rapid pace: remote medical consultations becoming the norm.
As part of LOTI’s assistive technology project, we have reviewed the research in this area. This is a quick tour through some of the headline results.
What we found
There is some good research evidence to support the use of digital assistive technology in social care, but the quality is varied and spans ‘gold standard’ systematic reviews and randomised control trials, through to anecdotal case studies.
There is a mixed evidence base for ‘telehealth.’
Smart home technology and remote health monitoring can improve physical and mental health outcomes for older people. There is also strong evidence for the use of telehealth in supporting people with digestive disorders and stomas.
But the evidence for ‘telehealth’ in other conditions is not as strong and in 2013 the Whole System Demonstrator trial found no evidence of the positive effect of telecare on health service use. Further randomised controlled trials are needed and next-generation telecare and telehealth may result in different outcomes.
Digital assistive technology may not always improve staff satisfaction or reduce burden.
There can be a steep learning curve when using new tech, and it might not initially make things easier. Adequate access to computers and smartphones for staff can be a barrier, but greater investment, facilitation and training may support adoption.
Electronic and mobile health interventions such as smartphone apps can help people take their medications.
Electronic pillboxes can also improve treatment adherence, but further testing of newer digital or smart pillboxes that are connected to smartphones or tablets is needed.
Medication adherence is not straightforward and so often requires nuanced solutions: technology is used most successfully as part of ‘multi-component’ intervention and rarely on its own. Education and access to health care professionals are also key.
Sensors and alarm technology can help monitor falls and improve safety in both residential and community settings.
However, problems with false alarms and ‘alarm fatigue’ can lead to slow response times and alarms being ignored or switched off. The soon to report, ATILA study should give a clearer picture on whether telecare can safely extend the time people with dementia can continue to live independently in their own homes.
‘Social robots’ can improve emotional, behavioural and communication outcomes for people with dementia.
In particular, the robotic seal ‘PARO’ has the most empirical evidence of being therapeutic. However, robotics can be high cost and there has been no studies of cost-effectiveness or reduction. There are also issues with staff training and practical problems like storing, charging and general upkeep of this tech.
The evidence that digital assistive technology can improve hydration and nutrition in social care is limited.
Find out more in our full report on smart water bottles and hydration reminders.
Telecare alarm systems may help older adults maintain their independence.
This type of technology as well as socially assistive robots can improve daily life and social outcomes, particularly for people with dementia.
‘Off the shelf technology’ like voice assistants are now used in social care.
For example, in Hampshire, the use of Amazon Echo had a positive impact on feelings of isolation, independence, and connectedness for care users.
Digital technology via smartphone and computers may improve social support, connectedness, and isolation, particularly for older people.
However, older and disabled people are more likely to be digitally excluded, so access needs to be supported.
Will digital assistive technology make a difference in the real world?
Unfortunately, there is a lack of scrutiny of cost and return on investment in most of the research. Digital assistive technology can be high cost, for example using multiple sensors and robotics, which may result in slow technology adoption.
There are examples of low-cost off-the-shelf technology being used, but these may need to be delivered as part of a more complex system and additional investment into staff training and ongoing support can increase costs.
Other issues to plan for when implementing new technology are lengthy installation and configuration processes, tech failure, connectivity issues and recharging opportunities.
Usability is important for technology adoption and simple technology is often preferred. Involvement of users and staff typically results in greater uptake, as what is delivered will better meet needs.
It seems clear that digital technology alone is not enough, it needs to be implemented alongside adequate staff training, resources and buy-in, a ‘system-wide approach.’ It’s vital that any technology fits in with the workforces’ existing demands in order for it to be effective.
For more information on LOTI’s work on Assistive Technology, please view our project page.