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Assistive Technology has an important role to play in supporting people living with dementia to stay safe and independent in their usual place of residence for as long as possible, and in pre-empting and avoiding crises that lead to escalation and hospital admission.
Examples of assistive technology that supports people in this way include alarms and detectors, GPS trackers, medication prompts, message reminders, door alarms, home activity sensors (for example, sleep and floor mats), falls detectors, smoke alarms and reminder clocks providing visual and audible clues or prompts. Further examples include mobile technologies for supporting self-care and daily activities; touchscreen and multimedia interventions and activities (such as digital life storybook) to improve mood; and technologies for social connection.
Consider developing a clear, documented strategy for the role that assistive technology will play specifically for those living with dementia and their care partners as part of a wider equipment and TEC strategy. This will help ensure that the opportunity and approach is visible and understandable to professionals delivering care and support. Ideally the strategy will include:
- considerations around ethical application, recognising the ability to consent and mental capacity
- achieving a joint approach and process for the procurement and management of assistive technology for people with dementia across the local area
- fostering close working relationships between professionals, so that they work together collaboratively in pinpointing opportunities for using assistive technology to meet individual needs and developing/delivering the offer
- a TEC team specifically skilled in the use of assistive technology for people living with dementia, that works closely with professionals to provide advice, guidance and training
- regular capture of feedback from service users enabling learning and improvements to take place specifically in relation to the use of assistive technology for people living with dementia
- recognition of the importance of achieving a balanced approach between digital and in-person care and a consideration of people’s preferences for how they like to be supported (including recognising that for people living with dementia, digital devices may be unsettling).
Point of Care testing
One of the key principles that underpins the HICM for dementia and delirium is the importance of care taking place in the person’s most familiar environment and reducing disruption to their usual routine, which can lead to confusion and anxiety.
Point of care testing (POCT); the process in which blood and/or urine testing takes place at or near the site of the patient and in which a medical decision can be made immediately based on the result, therefore presents an important opportunity for improving the care of people living with dementia, by supporting them at home.
POCT can be carried out in a wide range of settings, including the person’s usual place of residence, in primary care and community care in support of making an informed decision and delivering the right care at the right time.
Specific NHS England guidance also exists on incorporating POCT into urgent community response, ‘hospital at home’ services as part of avoiding unnecessary hospital admission and improving outcomes. For ICSs to optimise the use of POCT in this range of settings, the dementia and delirium pathways would need to define the specific requirements (i.e. what, when and why) for carrying out POCT for people with dementia and/or delirium in these settings, so that the right process, skills, roles and approach were in place, considering the specific needs of these groups.
Single shared digital care record
Whilst all ICSs aspire to develop a single, shared digital patient record, the nature, scale and progress of this ambition will vary depending on factors including legacy systems, local strategies and capability. It is implicit within the high impact change model for dementia and delirium that a single patient record, shared and accessible to all settings, would enable local areas to deliver better quality, well-coordinated care. For people living with dementia the ideal is that this single shared record is inclusive of each comprehensive geriatric assessment (CGA) undertaken and the ‘This Is Me’ plan (see below), including a crisis plan, an advanced care plan and a care partner plan. In other words, having all the information on the person and their care partner in one place. ICSs should consider what is achievable in this regard and set their ambition as part of developing a specific digital strategy for those living with dementia and/or delirium (which could form part of their digital strategy for older people and frailty more generally).
‘This is Me’ plan
The high impact change model outlines the requirement for a single, shared care plan for people with dementia and/or delirium that is their plan, not the professional’s plan. Ideally this plan will reflect the holistic care needs of the person, prioritising what and who is important to them, so that these things are prioritised in decisions about care. The ‘This is Me’ plan will also ideally incorporate a simple and straightforward crisis plan and the advance care plan decisions and wishes of the person within the same document. Ideally, this plan will be accessible in all settings so that wherever the person presents, the plan can be used to consistently inform holistic and nuanced decisions about care. Enabling access to this plan from the single point of access would be a recommended first step.
Supporting resources
- Alzheimer’s Society provide an outline of how assistive technology can support people and care partners living with dementia
- Integrating in point of care diagnostics: guidance for urgent community response and virtual ward services
- NHS England Virtual wards operational framework