The use of technology by seniors with neurocognitive disorders in long-term care: A scoping review

doi:10.21203/rs.3.rs-4095435/v1

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The use of technology by seniors with neurocognitive disorders in long-term care: A scoping review

https://doi.org/10.21203/rs.3.rs-4095435/v1

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Background

To investigate and describe the current state of knowledge about the use of technology with seniors with neurocognitive disorders in long-term care to foster interactions, wellness, and stimulation.

Methods

Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus); MEDLINE; PsycINFO; Embase and Web of Science were searched in eligible literature, with no limit of time, to describe the current use of technology by seniors with neurocognitive disorders in long-term care. All types of literature were considered except for theses, editorial, social media. Review Methods: This scoping review was built around the recommendations of Peters et al. (2020 version). Three researchers collaborated on the selection of articles and independently reviewed the papers, based on the eligibility criteria and review questions.

Results

The search yielded 3,605 studies, of which 39 were included. Results are presented in an overall description of the included studies encompassing study designs, population characteristics, and the current state of knowledge about different types of technologies used in long term care and the main findings on their use, objectives, and potential effects.

Conclusion

The study highlights different types and potential benefits of technology for long-term care residents with neurocognitive disorders, emphasizing the crucial need for additional research to refine interventions and their use.

Long term care

Technology

Neurocognitive disorder

Scoping review

older adults

According to the World Health Organization (WHO), the percentage of older adults aged 60 years and over will double by 2050 (1). Since neurocognitive disorders (NCD) occur in older age, their incidence and prevalence rates are thus on the rise. This trend is more common in low- and middle-income countries and regions (2). It is estimated that the number of individuals with NCD will double every 20 years and reach over 115 million worldwide, by 2050 (3).

A NCD is a degenerative disease that progresses over time as the individual becomes increasingly dependent in conducting daily and domestic activities. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a major NCD is mainly characterized by a cognitive decline from a previous level of performance in one or more cognitive areas, eventually interfering with the level of independence during everyday activities (4). This includes Alzheimer’s disease, frontotemporal lobar degeneration, Lewy body disease and vascular disease.

As the disease progresses, older adults with NCD may need to relocate to long-term care (LTC) homes to obtain the needed assistance and support in their daily activities. About 80% of LTC residents suffer from a NCD (5).

LTC homes are progressively integrating technology, including those oriented for the use of residents suffering from NCD. In their article, Gibson & al. identified three types of available technology for people with NCD. The first type represents all devices that are used on people with NCD, to improve provided care, such as telecare, fall detectors, GPS locators, key safes, etc. (6). Different literature reviews have explored these technologies. For example, a recent scoping review listed 54 studies on technologies linked to NCD care, fall detection, and ambient-assisted living technologies (7). Another systematic review studied the digital care technologies used in people with NCD living in LTC homes to prevent falls and manage the behavioral and psychological symptoms of NCD (8).

The second type includes devices that are used by people with NCD (6). This type of technology is usually used to provide some support for, and to facilitate their daily activities (e.g., medication dispensers, reminder alarms) (6).

Finally, there are devices that are used with people with NCD (6). This third type fosters technologies that promote interaction between a person with NCD and other people or between the person and the technology itself (e.g., telephones, puzzles and games, electronic games & apps).

People with Alzheimer’s disease and other NCD can suffer rapid and deleterious consequences from a lack of stimulation and contact with significant people (9). Recent studies found that videoconferencing helped seniors stay in contact with their families during the COVID-19 pandemic (9–11). Research has also examined the use of robotic pets to reduce neuropsychiatric symptoms as well as to improve on well-being and loneliness (12, 13). Even though the use of technology has greatly increased in LTC since the COVID-19 pandemic, there is a lack of knowledge synthesis (i.e., scoping review, systematic review, or literature review) on technology devices used with people with NCD. In fact, LTC home restrictions on visits and activities have led to the deployment of several technologies to stimulate residents with major NCD and preserve contact with family caregivers. This scoping review aims to map the available evidence on the use of technology in LTC by seniors with NCD by 1) Mapping the existing research on the use of technology by seniors with NCD in LTC. 2) Documenting, evaluating, and identifying potential existing gaps in knowledge. 3) Assessing whether future research on this field would be valuable.

Research question

The main question that will guide this scoping review is: What literature is available for the use of technology with seniors with major NCD in LTC to foster interactions, wellness, and stimulation?

Design

Considering our research objectives, this scoping review was conducted based on the recommendations of Peters & al.(14). It is a Nine-step method comprised of the following stages: 1) Defining and aligning the objectives and questions; 2) Developing and aligning the inclusion criteria with the objectives and questions; 3) Describing the planned approach to search for evidence, including selection, data extraction, and presentation of the evidence; 4) Searching for evidence; 5) Selecting evidence; 6) Extracting evidence; 7) Analysis of evidence; 8) Presentation of results; and 9) Summarizing evidence in relation to the purpose of the review, making conclusions and noting any implications related to the findings (14). A protocol for the study was developed and a comprehensive search conducted in electronic databases. The protocol was registered on the institutional repository CorpusUL (http://hdl.handle.net/20.500.11794/135363).

Eligibility criteria

To meet the aim of this scoping review, we selected the literature that meets the Population, Concept and Context (PCC) framework proposed by Peters & al. (14).

Population

For the population, we included individuals aged a) 65 years and older, of b) all genders, with c) NCD. The individuals most have a diagnosis of NCD as defined by the DSM-5 (4) and include many types of degenerative disorders, such as Alzheimer’s, frontotemporal lobar degeneration, Lewy body disease, and vascular disease.

Concept

In terms of the eligibility criteria for the Concept element, the core concept that was used is technology. The definition proposed by Neal & al. was selected, that is “any device or associated software that is able to communicate over a network or respond to the external environment” (p. 914) (15). This includes other associated concepts, such as computers, smartphones, phones, electronic tablets, robotic devices, and video games. The technology will need to be used, with or without assistance, by seniors, for recreational purposes, wellness or to foster interactions. All studies that included technologies in the service of care will be excluded.

Context

The last element of the framework, i.e., the context criteria, allowed the consideration of studies made in the LTC sector. Literature from all countries will be included.

Search strategy

The following databases were selected for their relevance to nursing, healthcare, and social care: Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus); MEDLINE; PsycINFO; Embase and Web of Science. A comprehensive search strategy was conducted in the databases by the authors in collaboration with an experienced librarian, using search terms based on the five concepts (see Table 1). Literature in English and French were considered for the database search, because those are the shared and mastered languages of authors. Databases were searched with no limit of time, to describe the current use of technology by seniors of NCD in LTC. All types of literature were considered except for theses, editorial, social media, personal blogs, conference proceedings, books or book chapters and study protocol.

Table 1

Database: Medline [OVID] – Search Strategy
1	"technolog"[Title/Abstract] OR "Computer"[Title/Abstract] OR "Electronic tablets"[Title/Abstract] OR "Cellphone"[Title/Abstract] OR "Phone"[Title/Abstract] OR "IPhone"[Title/Abstract] OR "Smartphone"[Title/Abstract] OR "touch screen"[Title/Abstract] OR "iPad"[Title/Abstract] OR "videoconferenc"[Title/Abstract] OR "video call"[Title/Abstract] OR "zoom meeting"[Title/Abstract] OR "Skype"[Title/Abstract] OR "App"[Title/Abstract] OR "Apps"[Title/Abstract] OR "application*"[Title/Abstract]
2	"Telephone"[MeSH Terms:noexp] OR "Cell Phone"[MeSH Terms] OR "Computers"[MeSH Terms] OR "Videoconferencing"[MeSH Terms] OR "Attitude to Computers"[MeSH Terms]
3	#1 AND #2 (2,354,837)
4	"long term care"[Title/Abstract] OR "nursing home*"[Title/Abstract] OR "residential care"[Title/Abstract] OR "Homes for the Aged"[Title/Abstract] OR "long term care"[MeSH Terms] OR "Nursing Homes"[MeSH Terms] OR "Homes for the Aged"[MeSH Terms] OR "Residential Facilities"[MeSH Terms:noexp] OR "Assisted Living Facilities"[MeSH Terms]
5	"alzheimer"[Title/Abstract] OR "Cognition decline"[Title/Abstract] OR "Cognitive decline"[Title/Abstract] OR "cognitive disorder"[Title/Abstract] OR "cognition disorder"[Title/Abstract] OR "Cognitive dysfunction"[Title/Abstract] OR "Cognitive disorder"[Title/Abstract] OR "Cognitive impairment"[Title/Abstract] OR "Dementia"[Title/Abstract] OR "Frontotemporal"[Title/Abstract] OR "Lewy Body"[Title/Abstract] OR "Neurocognitive decline"[Title/Abstract] OR "Neurocognitive dysfunction"[Title/Abstract] OR "Neurocognitive impairment"[Title/Abstract] OR "NCD"[Title/Abstract] OR "Dementia"[MeSH Terms:noexp] OR "Alzheimer Disease"[MeSH Terms] OR "dementia, vascular"[MeSH Terms] OR "Frontotemporal Dementia"[MeSH Terms:noexp] OR "Lewy Body Disease"[MeSH Terms]
6	#3 AND #4 AND #5 (654)

Data management

The literature that emerged from the search strategy was imported into EndNote 20™ software, then transferred to Covidence software. All duplicates were removed using Covidence to proceed with the selection process and to produce a PRISMA flow diagram presenting the search and selection process.

Selection process

All titles and abstracts identified in the literature search were screened by the authors (MSH, CS, CF), independently. The full text of articles selected by either author in the initial screening stage were reviewed to select the final list of articles. During the selection process, any disagreements or conflicts between the primary reviewers (CS, CF) were resolved by the principal researcher (MSH). Moreover, references for all the considered articles were hand-searched to identify any relevant reports that may have been missed in the search strategy.

Data extraction and synthesis

Data were extracted independently by two authors (CS, CF) and checked by comparing extracted data between both authors to reduce errors and bias (14). Data extraction templates included information on the first authors and date of the publication; title; country where the studies were conducted; study design; population; type of technology; description of intervention and key findings. Extracted data was reported narratively and summarized in tables. A precise description was made of the link between the data obtained from the eligible articles and our research objective and questions (14). The process of data extraction was iterative, which means that elements were added as needed as the articles were read. The quality of included studies was not formally assessed, as this is a scoping review. Indeed, Munn & al. note that “an assessment of methodological limitations or risk of bias of the evidence included within a scoping review is generally not performed.” (p. 3) (16).

A total of 3,605 studies were identified after removal of duplicates (Fig. 1). After exclusion of non-relevant results by title and abstract screening, 132 articles were screened by full text and 39 studies were included. Most studies were excluded for not following inclusion criteria on the type of literature, providing nonspecific results or the unavailability of the studies’ full texts.

Overview of included studies characteristics:

Many of the included studies took place in Australia (11 studies), followed by the United States of America (10 studies) (Table 1) while the rest took place in Europe and Asia. Of the 39 studies included, 24 were quantitative studies, 5 qualitative studies, and 6 mixed methods studies in addition to 2 systematic reviews and 2 scoping reviews. Most participants in the included studies were LTC residents aged over 65 years old with major NCDs and were predominately women. Few studies recruited LTC staff or relatives.

Table 2

Description of the included studies
Authors	Date	Title	Country	Study design	Participants	Intervention	Technology type	Key findings
Abraha & al. (17)	2020	Simulated presence therapy for dementia	Australia, United States	Systematic review	Three (3) studies with a total of 144 residents, predominantly women, mean age over 70 years.	Audio or videotape recordings that include positive experiences from the resident’s past life and shared memories involving family or close friends.	Video/Audiotape	No conclusions about the efficacy for treating behavioural and psychological symptoms and improving quality of life.
Barrett & al.(18)	2019	Evaluation of a Companion Robot for Individuals With Dementia: Quantitative Findings of the MARIO Project in an Irish Residential Care Setting	Ireland	Quantitative	Ten (10) residents, mean age of 83 years. Seven (7) of the subjects are women.	A robot MARIO that was used by residents to navigate through and engage in its applications.	Robotics	Residents can have positive social interactions with MARIO, which alleviate boredom and stimulate sustained engagement. This resulted in increased interactions between residents, care staff, family members, and other residents.
Blindheim & al.(19)	2022	Promoting activity in long-term care facilities with the social robot Pepper: A pilot study	Norway	Qualitative	Three (3) residents aged between 79 and 93 years.	Pepper, a programmable semi-humanoid robot, explored for its potential contributions to residents’ communal activity and physical exercise.	Robotics	Communal activities involving the social robot in terms of physical exercise, joint interaction and social stimulation, and communication between residents, and between residents and employees have increased.
Budak & al.(20)	2021	Can technology impact loneliness in dementia? A scoping review on the role of assistive technologies in delivering psychosocial interventions in long-term care	Australia, New Zealand, Europe	Scoping review	Twenty (20) studies. Sample sizes ranged from 4 to 415 participants.	Social robots, including robotic animals, humanoid robots and telepresence robots and multimedia computer systems.	Multiple	Communication and interaction through robotic animals, such as PARO and JustoCat, have been shown to have the potential to improve quality of life. Multimedia computer systems were found to improve engagement and communication. Nintendo Wii facilitated social engagement and, despite physical and technical limitations, people with dementia were able to use the technology and improve their physical fitness.
Caserta & al. (21)	2002	Video Respite in an Alzheimer’s care center: Group versus solitary viewing	United States	Quantitative	Twelve (12) residents, average age of 83.2 years. Ten (10) of the subjects were women.	A videotape that reminisces about growing up in the 1920s and 1930s.	Video/Audiotape	Residents showed an increase in verbal and nonverbal responses during the intervention.
Chiu & al.(22)	2023	Effects of incorporating virtual reality training intervention into healthcare on cognitive function and wellbeing in older adults with cognitive impairment: A randomized controlled trial	Taiwan	Quantitative	Sixty (60) residents, mean age of 80.3 years. 34 were women.	Virtual Reality Cognitive Training Intervention utilizing immersive underwater world fish simulation on global cognitive abilities, general cognitive functioning, and quality of life in older adults with cognitive impairment in long-term care facilities.	Virtual Reality	The intervention has significantly improved general cognitive functioning and quality of life.
Chu & al.(23)	2017	Service innovation through social robot engagement to improve dementia care quality	Australia	Quantitative	One hundred and thirty-nine (139) residents aged between 65 and 90 years.	Two (2) robots, Sophie and Jack, designed for emotional and intentional communication and interaction purposes with the residents.	Robotics	The intervention has significantly improved social engagement and fostered positive interactions.
D’Cunha & al.(24)	2021	Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study	Australia	Mixed methods	Ten (10) residents, mean age of 86.1 years. Eight (8) residents were female.	Recorded footage for a virtual cycling environment intervention presented to residents on a projector screen.	Virtual Reality	Residents responded positively to the intervention. The intervention promoted opportunity for physical exercise, a reduction in social isolation and increased self-efficacy.
Dinesen & al.(25)	2022	Use of a Social Robot (LOVOT) for Persons With Dementia: Exploratory Study	Denmark	Mixed methods	Forty-two (42) residents, mean age of 83,5 years.	A social robot LOVOT built with artificial intelligence, to interact with residents in real time and act like a human being.	Robotics	The intervention had entertaining and calming effects on the residents and promoted communication and social interactions.
Feng & al.(26)	2022	Context-Enhanced Human-Robot Interaction: Exploring the Role of System Interactivity and Multimodal Stimuli on the Engagement of People with Dementia	Dutch	Quantitative	Sixteen (16) residents, mean age of 85.2 years. 12 of the subjects were women.	LiveNature is an interactive system design aiming to connect residents to the outdoors through an indoor interactive experience, due to their limited contact with real nature.	Virtual Reality	The intervention has significantly impacted participants’ engagement, attitude, valence, verbal communications, visual and social engagement.
Ford & al.(27)	2019	Evaluating the Impact of Music & Memories Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study	United States	Quantitative	Thirty-five (35) residents.	iPods and iPads used by residents for their app–driven activities such as games, reminiscing about life stories with music, viewing Web-based images or using Google Earth, dabbling in art, and reactivating lifelong learning interests.	Tablet	The intervention led to a decrease in residents’ agitation and medication use and improved their quality of life.
Garland & al.(28)	2007	A comparison of two treatments of agitated behavior in nursing home residents with dementia: Simulated family presence and preferred music	Australia	Quantitative	Thirty (30) residents, mean age of 79.0 years. 63% were women.	Audiotapes of simulated family presence and preferred music.	Video/Audiotape	The intervention has significantly decreased residents’ physical and verbal agitated behaviors.
Hamel & al.(29)	2016	Memory Matters A Mixed-Methods Feasibility Study of a Mobile Aid to Stimulate Reminiscence in Individuals With Memory Loss	United States	Mixed methods	Eighteen (18) residents, mean age of 84 years. Predominately women.	Memory Matters was designed to stimulate long-term memories through “cognitive exercise” in which residents physically tap on-screen tiles.	Interactive screen	The intervention has potentially led to enjoyable and beneficial activity for residents, family members, and professional caregivers.
Hardy & al. (9)	2022	Acceptability of videoconferencing to preserve the contact between cognitively impaired long-term care residents and their family caregivers: A mixed-methods study	Canada	Mixed methods	Thirteen (13) residents, mean age of 82 years. Ten (10) were women.	Videoconference meetings through tablets so participants can communicate with their family caregivers.	Tablet	The intervention had a good acceptability by residents, increased communication, and positive feelings.
Hensel & al.(30)	2007	Videophone communication between residents and family: A case study	United States	Qualitative	Resident 78 years old and her niece 52 years of age.	Videophone used by participant to communicate with a relative.	Phones	The intervention was enjoyable and increased communication between the participant and his/her family member.
Hoel & al.(31)	2022	Social Health among German Nursing Home Residents with Dementia during the COVID-19 Pandemic, and the Role of Technology to Promote Social Participation	Germany	Quantitative	Four hundred and seventeen (417) nursing home representatives.	Different digital devices to facilitate social participation for residents such as digital music therapy, mobile apps, video games, videoconference, social robots, virtual reality others.	Multiple	Different digital devices used to facilitate social participation for residents with dementia, but there was an apparent preference for digital music therapy.
Ke & al.(32)	2020	Changes in technology acceptance among older people with dementia: The role of social robot engagement	China	Quantitative	One hundred and three (103) residents, mean age of 87.2 years.	A humanoid robot, Kabochan, to promote communication and engage with residents.	Robotics	The intervention has potential for changing perceived ease of use but not for other beliefs and attitudes towards technology.
Kerssens & al.(33)	2014	Managing Dementia Symptoms and Needs Using Technology	United States	Quantitative	Thirty-three (33) residents, mean age of 87 years. Twenty-one (21) of the subjects were women.	The Companion is a touch screen computer that delivers psychosocial interventions, such as reminiscence, simulated presence, and orientation to place and time to residents.	Interactive screen	The intervention has potentially improved difficulties with activities of daily living, sleep, and participation. Health status was perceived as stable.
Khosla & al.(34)	2017	Human Robot Engagement and Acceptability in Residential Aged Care	Australia	Quantitative	One hundred and fifteen (115) residents aged between 65 and 90 years.	Mathilda, a humanoid robot with different application for entertainment and engaging activities.	Robotics	The intervention has significantly improved residents’ emotional engagement, positive emotion reaction and attitude toward social robots. Improvements in verbal engagement were not statistically significant.
Lancioni & al.(35)	2013	Self-regulated music stimulation for persons with Alzheimer’s disease: Impact assessment and social validation	Italy	Quantitative	Ten (10) residents, aged between 78 and 84 years. Eight (8) of the subjects were women.	A microswitch, laptop computer, and interface to facilitate active music stimulation, allowing residents to use a simple response and a microswitch to activate music periods during active sessions.	Multimedia Computer systems	The intervention has potentially increased positive participation.
Libin & al.(36)	2004	Therapeutic robocat for nursing home residents with dementia: Preliminary inquiry	United States	Quantitative	Nine (9) relatives of nursing home residents. All were female, mean age of 90 years.	A robotic cat, NeCoRo, used to interact with residents.	Robotics	The intervention has significantly increased residents’ pleasure, lowered the level of agitation. The level of cognitive functioning was significantly related to the duration of engagement during the intervention.
Lu & al.(37)	2021	Effectiveness of Companion Robot Care for Dementia: A Systematic Review and Meta-Analysis	China	Systematic Review	Thirteen (13) studies with 20 to 214 residents, predominately women.	All different kind of socially assistive robots.	Robotics	The intervention has significantly exhibited changes in agitation. However, no significant changes in depression and quality of life were noticed.
Mannion & al.(38)	2020	Introducing the social robot MARIO to people living with dementia in long term residential care: Reflections	Ireland	Qualitative	Seven (7) residents, 4 women and 3 men, aged between 70 and 89 years.	A social robot MARIO used by residents to navigate through its applications.	Robotics	Overall, residents showed positive interest in the intervention, which had a positive effect on their well-being. Residents who had more advanced dementia had greater difficulty using the robot.
McAllister & al.(39)	2020	Memory Keeper: A prototype digital application to improve engagement with people with dementia in long-term care (innovative practice)	Australia	Qualitative	Three (3) residents aged 83.76 and 87 years. Two (2) men and 1 woman	The Memory Keeper is a prototype digital application created to present personalised prompts to the person with dementia to stimulate reminiscences.	Tablet	The intervention was enjoyable and created meaningful engagement between the residents and their family members while supporting their relationship. Increased communication between the participant and his/her family member.
Moyle & al(40)	2017	Use of a Robotic Seal as a Therapeutic Tool to Improve Dementia Symptoms: A Cluster-Randomized Controlled Trial	Australia	Quantitative	Four hundred and fifteen (415) residents, predominantly women, mean age of 86 years old.	A therapeutic pet robot PARO used to improve residents’ dementia symptoms.	Robotics	The intervention has significantly impacted participants’ engagement. It helped reduce agitated behaviors. No significant difference detected when it was measured with the Cohen-Mansfield Agitation Inventory Short Form.
Moyle & al.(41)	2018	Effect of a robotic seal on the motor activity and sleep patterns of older people with dementia, as measured by wearable technology: A cluster-randomised controlled trial	Australia	Quantitative	One hundred and seventy-five (175) residents for the daytime analyses, and 280 residents for the nighttime analyses. Twenty-eight (28) facilities.	A Therapeutic pet-type robotic seal, PARO, has been used as a promising alternative to animal-assisted therapies.	Robotics	The intervention has helped reduce motor activity. No evidence that it was effective in improving sleep patterns.
Moyle & al. (42)	2018	Effectiveness of a virtual reality forest on people with dementia: A mixed methods pilot study	Australia	Mixed methods	Ten (10) residents, mean age of 89 years.	The “Virtual Reality Forest” is a sensory experience, utilizing a large interactive screen designed to immerse the user in the virtual environment, accompanied by a background soundtrack.	Virtual Reality	The intervention has significantly increased residents’ pleasure and alertness. However, half of the residents also expressed greater levels of anxiety/fear during the Virtual Reality Forest experience. Not all residents found the Virtual Reality Forest experience to be positive.
Neal & al.(15)	2020	The use of technology to promote meaningful engagement for adults with dementia in residential aged care: A scoping review	Australia	Scoping review	Twenty (20) studies with 4 to 415 participants. Three (3) studies not reporting the sample size.	Different social robots explored for their potential benefit to facilitate residents’ leisure activities.	Robotics	The intervention has provided enjoyable experience for the residents, improving their well-being and preventing negative outcomes such as agitation or distress.
Nishiura & al.(43)	2018	Use of a parametric speaker for older people with dementia in a residential care setting: A preliminary study of two (2) cases	Japan	Quantitative	Two (2) residents. A 78-year-old man and 90-year-old female.	A parametric speaker received input from a personal computer to play participant’s favorite pieces of music.	Multimedia Computer systems	The intervention has significantly decreased residents’ behavioral and psychological symptoms of dementia.
Obayashi & al.(44)	2020	Measuring the impact of age, gender, and dementia on communication-robot interventions in residential care homes	Japan	Quantitative	Seventy-eight (78) residents, mean age of 86.5 years. 68 of subjects were women.	Robots Cota and Palro communicate and interact with people more freely, with a greater degree of freedom and vocabulary.	Robotics	Improvement in quality of life. People with moderate/severe dementia showed greater improvement than those with mild dementia.
O’Sullivan & al.(45)	2022	A tablet-based intervention for activating nursing home residents with dementia: Results from a cluster-randomized controlled trial	Germany	Quantitative	One hundred and sixty-two (162) residents with a mean age of 85 years.	Tablet-based applications targeting cognitive and functional abilities of residents.	Tablet	The intervention had no effect on apathy. Improvements in quality of life of residents and a reduction of PRN psychotropic medication were observed.
Pu & al.(46)	2020	The Effect of Using PARO for People Living With Dementia and Chronic Pain: A Pilot Randomized Controlled Trial	Australia	Quantitative	Forty-three (43) residents, mean of 86 years.	A pet robot PARO designed to interact with residents and stimulate them.	Robotics	The intervention has shown significant difference in the observational pain change score and significant decrease in PRN medication use. However, no significant difference was observed in staff-rated pain, agitation, anxiety, depression, and regularly scheduled medication.
Robinson & al.(47)	2013	Suitability of healthcare robots for a dementia unit and suggested improvements	New Zealand	Quantitative	Ten (10) residents aged between 71 and 93 years. Five (5) were women.	A pet robot PARO designed to interact with residents and stimulate them.	Robotics	Residents exhibited verbal and non-verbal reactions during the intervention. It was perceived as useful because it is comforting, entertaining, creates interest, and interacts with residents.
Sautter & al.(48)	2021	Benefits of Computer Engagement in Older Adults with Dementia	United States	Quantitative	Twenty-eight (28) residents.	Touch-screen computer platform “It’s Never Too Late” providing the opportunity to personalize computer applications to enhance social connection, facilitate entertainment, and implement cognitive training through various brain fitness programs.	Interactive screen	The intervention has significantly improved residents’ well-being and significantly decreased their systolic blood pressure. No significant challenging behaviors or the use of antipsychotic medications were observed.
Scerri & al.(49)	2021	Formal caregivers’ perceptions and experiences of using pet robots for persons living with dementia in long-term care: A meta-ethnography	Malta	This meta ethnography included 8 studies conducted with LTC care employees working with residents with dementia	Eight (8) studies conducted with LTC staff.	A pet robot designed to interact with residents and stimulate them.	Robotics	The intervention was perceived as useful in reducing agitation, restlessness and associated behavioural symptoms, as well as to initiate social connectedness and to evoke old memories and reduce loneliness.
Sultana & al.(50)	2021	Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series	Canada	Quantitative	Twenty-four (24) residents, mean age of 85.8 years. Most of them were female.	Virtual reality experience intervention providing interactive and immersive customized three-dimensional visual and auditory experiences.	Virtual Reality	No significant changes in depression or agitation were observed. The dose of prescribed psychotropic drugs was reduced for 8 out of 24 residents after the end of intervention.
Tak & al.(51)	2015	Computer Activities for Persons with Dementia	United States	Mixed methods	Twenty-seven (27) residents, mean age of 85 years. Predominantly women and Caucasian.	Computer activities sessions included email, internet search, computerized games, and slideshow modules.	Multimedia Computer systems	Residents have expressed enthusiasm about the intervention. They exhibited satisfaction and enjoyment through verbal and nonverbal responses.
Tak (52)	2020	Engaging in Preferred Computer Activities and Cognitive Outcome	United States	Quantitative	Twenty-six (26) residents, mean age of 85.2 years. Predominantly women.	Different computer activities through a touch screen and different accessories.	Multimedia Computer systems	The increase of time spent during the intervention was significantly correlated with greater improvement in residents’ cognitive function.
Tulsulkar & al.(53)	2021	Can a humanoid social robot stimulate the interactivity of cognitively impaired elderly? A thorough study based on computer vision methods	Singapore	Quantitative	Fourteen (14) residents.	A humanoid robot, Nadine, used to interact with residents. inactive/passive for a long time.	Robotics	Residents have shown differences in the emotions experienced during the intervention with a predominance of neutral expressions.

Technology types and aim of use

Table 3

Count of studies per technology type
Technology type	Count of Study
Robotics	17
Virtual Reality	5
Tablet	4
Multimedia Computer systems	4
Video/Audiotape	3
Interactive screen	3
Multiple	2
Videophone	1
Total	39

We categorised the technology used in different interventions into 10 major types, as shown in Table 3. Most of the selected studies utilized robotics. This category encompasses mainly 2 types of social robots that were employed in these studies: Humanoid or pet robot. These robots were used mainly to stimulate the cognitive and physical abilities of residents through integrated applications. They were also used to provide therapeutic emotional and intentional communication through motion recognition, vocalization, gestures, emotive expressions, singing, or dancing.

Virtual reality was the second most popular technology. Five studies employed software and hardware to create interactive immersive environments presented through video games or 3D videos/images that can be accompanied by music. This technology was used to stimulate residents and improve their cognitive functions, such as psychomotor abilities and memory; to promote physical activity; to reduce responsive behaviors; to increase pleasure or visual and social engagement, especially in a COVID-19 context, as showcased in one of the studies.

Tablets such as iPads were also commonly used. Four studies employed tablet software app–driven activities such as games, music, images, etc. to stimulate reminiscences; to increase pleasure and engagement and to permit residents to communicate with their families and loved one’s through videoconferences.

Four studies used multimedia computer systems that consisted of computer-based interventions with the integration of other software and hardware parts and accessories. Computer activities included email, internet search, games, and slideshow modules or simply broadcasting music played on a laptop through a speaker. They aimed to promote cognitive stimulation and positive emotions for residents, or simply exposing residents to music.

Video/Audiotapes, multimedia computer systems and interactive screens were reported in three studies, each. Video/Audiotapes consisted of personalized audio or videotape recordings of either simulated family presence, preferred music to treat behavioural and psychological symptoms and improve quality of life of residents with NCD or to stimulate their reminiscence and memory. Interactive screens consisted of the use of computers or projecting screens without the use of keyboard or mouse by the resident to take part in different in-app activities, such as games or audiovisual programs and shows, to stimulate reminiscence and memory and improve or enhance social connection, facilitate entertainment, and implement cognitive training through various brain fitness programs. A scoping review focused on assistive technologies, primarily social robots, and computer systems, to deliver psychosocial interventions; and another study explored social participation among residents with NCD through various digital devices, including mobile apps, video games, video conferencing, social robots, VR technology, and more.

One study utilized a videophone, a telephone device transmitting and receiving a visual image, as well as the sound through the handset, to permit residents to communicate with their family and loved ones, on a weekly basis.

Summary of study results

Most studies have noted an increase in positive interactions among residents, staff, family caregivers, or the technologies themselves. Several authors report reduced isolation and loneliness, highlighting the beneficial effects on the social well-being and quality of life of the residents in LTC. Thirteen (13) studies have reported results related to the residents’ level of engagement and pleasure with the use of devices aimed at promoting interactions. Residents’ verbal and non-verbal responses were most frequently examined.

The assessment of psychological and behavioral symptoms of NCD was collected in 12 studies, without, however, showing significant results in each case. Five (5) studies have investigated medication consumption, particularly the use of antipsychotic medication prescribed as needed. Finally, 4 studies focus on the acceptability of LTC residents for the use of device, 2 studies have examined the effects on cognitive functions, and 2 studies have investigated the effects on pain and blood pressure, respectively.

This comprehensive scoping review delves into the landscape of technological interventions in LTC for older adults with NCD. Among 3,605 screened articles, 39 met the selection criteria, offering a diverse array of insights. These studies’ geographical distribution indicates a predominant focus on the North American and Australian continents, notably in the United States and Australia, compared to fewer studies originating from Europe and Asia. The emergence of Australia and the United States as key locations for research raises intriguing questions that require further exploration to ascertain the underlying factors driving this concentration. Potential factors such as the origins of authors, research infrastructure, funding availability, and regional expertise may contribute to this trend, but a conclusive determination remains elusive, without more detailed investigation. However, a significant disparity becomes apparent in the underrepresentation of low-income countries, even considering the extensively documented increase in the prevalence of NCD in low-income and middle-income countries (54). This presents a notable ethical concern within research, as well as an opportunity to advance future research endeavors for the development and use of universally applicable technological interventions.

A detailed examination of the technologies used reveals a diverse array of devices used with people to foster interactions, wellness, and stimulations. Robotics, encompassing social humanoid and pet robots, emerged as the most frequently studied technology. The pre-eminence of robotics in the studied interventions indicates a growing interest in leveraging advanced technologies. These social robots were mainly used to provide cognitive and physical stimulation, emotional communication, and therapeutic engagement. A recent scoping review has presented growing evidence that supports the potential of these technologies to improve the well-being of elderly individuals living in assisted care (55). Virtual reality’s prominence as the second most reported technology indicates the revolutionary potential of immersive environments for residents with NCD living in LTC to enable them to experience the world. The varied applications, from enhancing cognitive functions to promoting physical activity, showcase this technology’s versatility. For instance, a study highlighted the potential of virtual reality interventions in mitigating social isolation among LTC residents (56). The immersive and interactive nature of virtual reality experiences, as suggested by Hung & al. (56), could offer a novel approach to enhance social engagement and alleviate feelings of loneliness. Additionally, the study emphasizes the importance of considering the specific needs and cognitive abilities of residents when implementing such technologies, especially since a lot of people living with NCD have shown great interest in using this technology (56). Tablets, with their user-friendly interfaces and portability, emerged as valuable tools to stimulate reminiscence and facilitate communication with families. The adoption of tablets in LTC settings aligns with the broader trend of integrating consumer technologies into healthcare.

The main findings of the objective and effects of the use of technology with seniors with NCD in different studies align with the broader goals of LTC, emphasizing positive interactions, reduced isolation, and increased engagement. While most studies report positive effects, the limited quantity and quality of available research requires caution in drawing overarching conclusions. The diverse study designs and outcomes challenge direct comparisons, emphasizing the need for standardized methodologies and outcome measures for future research. For instance, the focus on residents’ engagement and pleasure aligns with the person-centered care approach, recognizing the importance of individual experiences and preferences (57). The call for more comprehensive research on the impact of various technologies in reducing isolation and loneliness among residents in LTC facilities echoes the growing recognition of technology as a potential solution to address the social and emotional well-being of older adults (58). A systematic review has acknowledged the positive effects of technology in improving the overall quality of life for older individuals (59). However, a literature gap persists concerning the optimal selection of technology, its recommended duration of use, and the appropriate mode of utilization, considering the characteristics of the residents and stages of NCD. To bridge this gap, forthcoming research should prioritize investigating the intricate relationships between technology use and the effects on residents. It is crucial to consider the distinct challenges associated with various stages of NCD, particularly found in individuals with major NCD. This clientele, which is prevalent in LTC, is often excluded from research studies, due to ethical concerns (60). This creates a knowledge void in understanding the specific needs of these residents and the care required to meet them. The ethical considerations surrounding research involving LTC residents with NCD cannot be overstated. This population’s vulnerability requires a thoughtful and ethical approach to ensure their well-being (60).

Implications for Future Research

This scoping review identifies several gaps and areas for future research in the realm of technological interventions with LTC residents with NCD. The limited geographical diversity of studies calls for broader global representation to account for cultural and contextual variations.

The predominance of robotics in the current literature highlights the need for research exploring the optimal integration of different technologies. Studies assessing the feasibility and effectiveness of various technological modalities with residents at different stages of NCD could further guide LTC managers and practitioners in the selection of technologies and orient their use to achieve desired outcomes.

Further investigations into the effects of these technologies among LTC residents are imperative through standardized methodologies and outcome measures to provide direct comparison.

The use of technology with residents in LTC facilities shows promise in enhancing socialization, reducing loneliness, and improving quality of life. However, further research may be needed to fine-tune and adjust the interventions. In-depth studies addressing the specific needs of individuals at different stages of NCD, coupled with robust ethical considerations, would not only contribute to academic discussions, but also offer valuable guidance in the LTC field for the well-being of seniors.

DSM

Diagnostic and Statistical Manual of Mental Disorders

LTC

Long term Care

NCD

Neurocognitive Disorders

Virtual Reality

Ethics approval and consent to participate.

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Data supporting the findings of this study are available in the article.

Competing interests

The authors declare that they have no conflict of interest.

Funding

Not applicable.

Authors' contributions

All authors conceptualized and designed the study. All authors carried out the initial search, selection of titles and abstracts. CF and CS performed data extraction and analyses. MSH provided methodological expertise and critical intellectual content during the research process and manuscript writing. CS drafted the first version of the manuscript. All authors read and provided critical comments on the manuscript. The final version of the manuscript has been approved by all authors.

Acknowledgements

We wish to acknowledge Mrs. Marie-Claude Laferrière, M.S.I., Librarian, Laval University, for her valuable support and help in designing the search strategy. We also want to thank Mrs. Micheline Harvey, translator, for the English language review.

Authors information

Marie-Soleil Hardy¹, Chaimaa Fanaki¹, Camille Savoie¹

¹Faculty of Nursing science, Université Laval, Québec, QC, G1V 0A6, Canada

Correspondence should be addressed to Marie-Soleil Hardy: [email protected]

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No competing interests reported.

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The use of technology by seniors with neurocognitive disorders in long-term care: A scoping review

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Results

Overview of included studies characteristics:

Technology types and aim of use

Summary of study results

Discussion

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