Mapping Dementia Care Technology: Tailored Digital Solutions across Stages

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is not a research paper, although the authors seem to implicitly answer the question: does an infographic for health care staff caring for dementia patients in a specialised care facility guide them in the effective implementation of assistive technologies? 

The main issue is that the only study designed to answer questions of efficacy and efficiency are clinical trials. 

In this case it is a narrative review with a rudimentary methodology; even the bibliographic method is trivial (snowballing) with no search strategy.

With all these major limitations in mind, I will review the formatting issues:

1. 1. Acronyms should not go in the abstract: AT's, PwD: In the text assistive technologies (line 22) and PwD (line 56).

2. Clarify what is meant by dual ageing society (line 33). Does it mean that people over 60 are expected to double by 2050?

3. Figure 3 is missing

4. As I said before, the term efficiency should not be linked to this study (lines 76, 319).

Author Response

We would like to thank the reviewer for taking the time to review the paper and providing their valuable comments. Below we have addressed all the points:

This is not a research paper, although the authors seem to implicitly answer the question: does an infographic for health care staff caring for dementia patients in a specialized care facility guide them in the effective implementation of assistive technologies? 

The main issue is that the only study designed to answer questions of efficacy and efficiency are clinical trials. 

We agree that the intention of our work could have been more explicit, to make it clear that the current manuscript develops an infographic but does not yet test the efficacy of it. We have now made this more explicit in the manuscript:

“In this paper we do not intent to merely conduct a review on the implementation of as-assistive technology or compare our findings with past reviews on this topic. The aim of our work is to translate the results of the current review into an infographic that shows recommendations on when to implement an assistive technology. We hope that such an infographic can guide healthcare personnel when implementing various care technologies. Additionally, by interviewing people who have experience with the implementation of care technologies we aim to complement the findings of the review with practical experience of the implementation of assistive technology for people with dementia.”

In this case it is a narrative review with a rudimentary methodology; even the bibliographic method is trivial (snowballing) with no search strategy.

We agree that our review is not as comprehensive as a systematic review. However, by combining the review with interviews with implementation experts we aimed to validate the findings of the review based on experience of the care practice. 

In the revised manuscript we have included more information about our search strategy.

With all these major limitations in mind, I will review the formatting issues:

1. 1. Acronyms should not go in the abstract: AT's, PwD: In the text assistive technologies (line 22) and PwD (line 56).

Thank you for noticing this, the acronyms have now been written out in the abstract.

2. Clarify what is meant by dual ageing society (line 33). Does it mean that people over 60 are expected to double by 2050?

We agree that it was unclear what was meant by the term double aging. We have clarified this in the manuscript:

“Furthermore, independent living at home can be beneficial in making healthcare more resistant to global challenges related to the double-ageing society [2]. It is predicted that both the number of older adults will increase over the years as well as the average age of the people in our society [2].”

3. Figure 3 is missing

Figure 3 should be visible now in the manuscript, we have also referred to the figure in the text.

4. As I said before, the term efficiency should not be linked to this study (lines 76, 319).

We have removed the term efficiency and instead explained that the infographic is a tool to support care employees during the implementation of care technology:

“The improved infographic is intended for healthcare personnel to guide them when implementing various care technologies.”

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you very much for the opportunity to review this article about the Mapping Dementia Care Tech: Tailored Digital Solutions Across Stages. Overall I found it to be an article that offers a different approach and, therefore, may offer a valuable perspective.

However, some minor aspects are amenable to revision. These are as follows:

Please, clarify the aim of the manuscript in the main text and the abstract.

Revise the e.g. (21) on line 67 (page 2).

Revise the description of Figures 2 and 3 in the main text (as these are not provided like Figure 1 on line 68 of page 2).

Correct or edit the brackets of references 12 and 20 on line 293 (page 8), and reference 67 (lines 485 and 486 of page 12).

Standards for Reporting Qualitative Research. Ethical issues pertaining to human subjects: Documentation of approval by an appropriate ethics review board and participant consent, or explanation for lack thereof. Authors should report approval for the study from an appropriate institutional review board for research associated with human subjects. They should describe procedures used to protect participants, including data collection (e.g., recruitment and informed consent), analysis (e.g., data security and integrity), and reporting of findings (e.g., anonymization of excerpts). If researchers provided compensation or offered incentives to facilitate participation, this should be reported.

Author Response

We would like to thank the reviewer for taking the time to review the paper and providing their valuable comments. Below we have addressed all the points:

Thank you very much for the opportunity to review this article about the Mapping Dementia Care Tech: Tailored Digital Solutions Across Stages. Overall, I found it to be an article that offers a different approach and, therefore, may offer a valuable perspective.

However, some minor aspects are amenable to revision. These are as follows:

Please, clarify the aim of the manuscript in the main text and the abstract.

We agree that we should address the aim more explicit, therefore we've added the following text segments to our manuscript:
“Therefore, the aim of this paper was to conduct a literature review. Based on the results of this review an infographic was designed showing recommendations on when to implement an assistive technology. The infographic was evaluated during interviews with experts on the implementation of care technology for people with dementia.”

“In this paper we do not intend to merely conduct a review on the implementation of as-assistive technology or compare our findings with past reviews on this topic. The aim of our work is to translate the results of the current review into an infographic that shows recommendations on when to implement an assistive technology. We hope that such an infographic can guide healthcare personnel when implementing various care technologies. Additionally, by interviewing people who have experience with the implementation of care technologies we aim to complement the findings of the review with practical experience of the implementation of assistive technology for people with dementia.”

Revise the e.g. (21) on line 67 (page 2).

This has now been changed.

Revise the description of Figures 2 and 3 in the main text (as these are not provided like Figure 1 on line 68 of page 2).

Thank you for pointing this out, we have now referred to both figures in the main text.

Correct or edit the brackets of references 12 and 20 on line 293 (page 8), and reference 67 (lines 485 and 486 of page 12).

We have adjusted the brackets for references 12 and 20, however reference 67 was in the correct brackets, so we were not sure what should be changed for this reference.

Standards for Reporting Qualitative Research. Ethical issues pertaining to human subjects: Documentation of approval by an appropriate ethics review board and participant consent, or explanation for lack thereof. Authors should report approval for the study from an appropriate institutional review board for research associated with human subjects. They should describe procedures used to protect participants, including data collection (e.g., recruitment and informed consent), analysis (e.g., data security and integrity), and reporting of findings (e.g., anonymization of excerpts). If researchers provided compensation or offered incentives to facilitate participation, this should be reported.

We have added this information in the manuscript:

“Institutional Review Board Statement: For this study we did not obtain an institutional review board statement as the study was mainly a review of the literature and the interviews did not contain sensitive questions or information. The interviews were conducted in accordance with the Declaration of Helsinki. Prior to the start of the interviews participants were informed about the aim of the study and that the results would be anonymous.

Informed Consent Statement: There was no need to obtain written consent from participating professionals, since the participants cannot be identified. We asked oral permission to use the transcription function of Microsoft teams. Participants were informed that all the results would be anonymized and that only the projects members knew their identities. The transcripts and notes of the interviews were anonymized and stored on a secure server. In the case that participants indicated that sentences were off record, these were removed from the notes and transcripts. Participants had the right to refuse or withdraw from the interviews at any point of study. Participants did not receive any incentives for their participation in the interviews”

Reviewer 3 Report

Comments and Suggestions for Authors

Comments for author File: Comments.pdf

Author Response

We would like to thank the reviewer for taking the time to review the paper and providing their valuable comments. Below we have addressed all the points:

The researchers tackled the difficulties of deploying assistive technology (AT’s) for dementia care by updating an existing infographic. The original infographic was based on the authors' experiences and has now been enhanced with information from literature and expert interviews. They intend to enhance the recommendations for the optimal timing of introducing assistive technologies at various stages of dementia by using a wider array of research in the area.

Comment 1: The abstract lacks the findings of the author, precisely the result and conclusion. The authors should present the abstract in a concise manner. The explanation on the problem seems to elaborate for an abstract. Clear statements of the methodology are also required. The abstract needs to be properly written.

We agree that the abstract is missing information about the method, results and conclusion. We have rewritten the abstract and included the proposed information:

“Over the years there has been an increase in the development of assistive technologies. To date, it has been underexplored during which stages of dementia these technologies can be best implemented. Previous work has developed an infographic providing guidance on when best to introduce assistive technologies for people with dementia. Although this infographic is relevant, it was based solely on the experience of the authors during various national and international projects. However, various studies have been conducted on the use and implementation of technology for people with dementia, providing information on when care technology should be implemented. Therefore, the aim of this paper was to conduct a literature review. Based on the results of this review an infographic was designed showing recommendations on when to implement an assistive technology. The infographic was evaluated during interviews with experts on the implementation of care technology for people with dementia. Results propose earlier implementation for several technologies. As well as the importance of considering contextual factors such as personal characteristics, background and technical experience when implementing technology. The designed infographic can support in facilitating the digital transition for healthcare institutions and personnel by offering information into the implementation process of care technology.”

Comment 2: The authors should provide the meaning of PwD in line 16 before the use of the abbreviation.

We have removed all abbreviations in the abstract as suggested by reviewer 1

Comment 3: Instead of using insights gained, results would have been appropriate.

We have changed the terms insights into more appropriate terms such as results and findings.

Comment 4: Include the search string used for snowballing and search from google scholar in Sub-Section 2.1. Provide the total number of papers used to give the ratio of white papers and scientific papers used. Provide the summary of these papers in a tabular format.

We agree that the paper requires more information about our literature search. We have now added this information to the manuscript. We have also included a table which summarizes the outcomes that were used for the revision of the infographic. This table has been placed in the supplementary materials:

“Snowballing was used to find papers, including the use of literature reviews. This search was conducted in 2022. Additionally, google scholar was used as well as the internet to search for whitepapers. For the search, the following key words were used: assistive technology, implementation, care technology, use of care technology, use of assistive technology, stages dementia. Additionally, the key words use, implementation and stages dementia were combined with the labels of the categories of each technology, for example, use of a GPS tracker. A total of 45 papers that were found through the literature review were used as input for the revision of the infographic. A summary of the outcomes used to revise the infographic can be found in the supplementary materials. It is important to note that some results were applicable to multiple categories of AT's and were therefore used as input for several categories of AT’s.

The researchers also looked at scales for determining the stages of dementia in order to get results into the possibilities and conditions per stage of dementia in terms of cognitive decline [23]. In total two sources were used as input for the results, the GDS scale [23] and the information provided by Alzheimer society [24].”

 

Comment 5: Change the referencing style to the approved style by the journal.

Thank you for pointing this out. We have changed the referencing style according to the style proposed by the journal.

Comment 6: Highlight the contribution of the paper in the introduction section.

We have made this more explicit in the introduction

“In this paper we do not intent to merely conduct a review on the implementation of as-assistive technology or compare our findings with past reviews on this topic. The aim of our work is to translate the results of the current review into an infographic that shows recommendations on when to implement an assistive technology. We hope that such an infographic can guide healthcare personnel when implementing various care technologies. Additionally, by interviewing people who have experience with the implementation of care technology we aimto complement the findings of the review with practical experience of the implementation of assistive technology for people with dementia.”

Comment 7: Spell out COVID-19 before you start the use of the abbreviation.

As far as we know it is correct to use COVID-19, could you therefore please clarify your comment a bit more? Thanks in advance.

Comment 8: The authors should state what makes their work different from other studies, preferably via a table.

Our intention was not to conduct a new review on the implementation of technology or compare our findings with past reviews. The aim of our work was to translate the results of the current review into an infographic that can be used directly by care professionals and designers for implementation and design of assistive technology. Additionally, by also conducting interviews with experts in the implementation of care technology for people with dementia we aimed to complement the findings of the review with practical experience and increase the validity of the infographic.

We have made this more explicit in the introduction of the manuscript:

“In this paper we do not intend to merely conduct a review on the implementation of as-assistive technology or compare our findings with past reviews on this topic. The aim of our work is to translate the results of the current review into an infographic that shows recommendations on when to implement an assistive technology. We hope that such an infographic can guide healthcare personnel when implementing various care technologies. Additionally, by interviewing people who have experience with the implementation of care technology we aim to complement the findings of the review with practical experience of the implementation of assistive technology for people with dementia.”

Comment 8: The authors should improve on the conclusion by providing a brief introduction to the work and the method used. The results obtained from the study also need to be clearly summarized in the conclusion. The authors should include the limitations of the study and future work.

We thank the reviewer for these valuable suggestions. We have extended our conclusion with the suggested points:

“A literature review and interviews were conducted to gather results on when assistive technology can be best implemented for PwD. Results suggest that for several care technologies earlier implementation would be beneficial. As the AT’s could be beneficial in earlier stages of dementia as well as enhancing the user’s familiarity with the device before the onset of dementia. Moreover, this work highlights the importance of considering that the effectiveness of the implementation of care technology depends on various contextual factors, such as personal characteristics, background and technical experience. The current infographic does not address these contextual factors in the proposed timing for implementation of the AT’s. Nevertheless, this infographic holds important value in facilitating the digital transition for healthcare institutions and personnel by offering information into the implementation process of healthcare technology. It is essential to deploy care technologies at the right timing and dementia stage, and as such, this infographic can serve as a valuable support resource for healthcare professionals. For future work it would be valuable to design an infographic that visualizes the needs of PwD and the available AT’s that could support in fulfilling these needs. Thereby focusing on the PwD rather than their decease.”