University College London, UK.
King's College London, UK.
Age Ageing. 2021 May 5;50(3):882-890. doi: 10.1093/ageing/afaa284.
The use of assistive technology and telecare (ATT) has been promoted to manage risks associated with independent living in people with dementia but with little evidence for effectiveness.
Participants were randomly assigned to receive an ATT assessment followed by installation of all appropriate ATT devices or limited control of appropriate ATT. The primary outcomes were time to institutionalisation and cost-effectiveness. Key secondary outcomes were number of incidents involving risks to safety, burden and stress in family caregivers and quality of life.
Participants were assigned to receive full ATT (248 participants) or the limited control (247 participants). After adjusting for baseline imbalance of activities of daily living score, HR for median pre-institutionalisation survival was 0.84; 95% CI, 0.63 to 1.12; P = 0.20. There were no significant differences between arms in health and social care (mean -£909; 95% CI, -£5,336 to £3,345, P = 0.678) and societal costs (mean -£3,545; 95% CI, -£13,914 to £6,581, P = 0.499). ATT group members had reduced participant-rated quality-adjusted life years (QALYs) at 104 weeks (mean - 0.105; 95% CI, -0.204 to -0.007, P = 0.037) but did not differ in QALYs derived from proxy-reported EQ-5D.
Fidelity of the intervention was low in terms of matching ATT assessment, recommendations and installation. This, however, reflects current practice within adult social care in England.
Time living independently outside a care home was not significantly longer in participants who received full ATT and ATT was not cost-effective. Participants with full ATT attained fewer QALYs based on participant-reported EQ-5D than controls at 104 weeks.
辅助技术和远程保健（ATT）的使用已被推广用于管理痴呆症患者独立生活相关的风险，但有效性的证据有限。
参与者被随机分配接受 ATT 评估，随后安装所有适当的 ATT 设备或对适当的 ATT 进行有限控制。主要结果是入住机构的时间和成本效益。关键次要结果是涉及安全风险的事件数量、家庭照顾者的负担和压力以及生活质量。
参与者被分配接受全 ATT（248 名参与者）或有限控制（247 名参与者）。在调整了日常生活活动评分的基线不平衡后，中位预机构化生存的 HR 为 0.84；95%CI，0.63 至 1.12；P=0.20。两组在健康和社会护理方面（平均 -£909；95%CI，-£5336 至 £3345，P=0.678）和社会成本方面（平均 -£3545；95%CI，-£13914 至 £6581，P=0.499）均无显著差异。ATT 组在 104 周时的参与者自评的健康调整生命年（QALYs）减少（平均 -0.105；95%CI，-0.204 至 -0.007，P=0.037），但在由代理报告的 EQ-5D 中 QALYs 没有差异。
ATT 评估、建议和安装方面的干预保真度较低，但这反映了英国成人社会护理中的当前实践。
接受全面 ATT 的参与者独立居住在养老院外的时间没有明显延长，ATT 也没有成本效益。在 104 周时，接受全面 ATT 的参与者根据自身报告的 EQ-5D 比对照组获得的 QALYs 更少。
