Chan Daniel Kam Yin, Chan Luke Kar Man, Kuang Ye Min, Le Mai Nhat Vi, Celler Branko
University of New South Wales, Sydney, NSW 2052 Australia.
Department of Aged Care and rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, NSW 2200 Australia.
Eur J Ageing. 2021 May 15;19(3):309-323. doi: 10.1007/s10433-021-00627-5. eCollection 2022 Sep.
Fall prevention and management of behavioural and psychological symptoms of dementia (BPSD) in long-term care (LTC) facility is a major challenge. The objective of this systematic review is to assess the evidence of digital technology in their management. All studies of English-language excluding case-reports were eligible for review. Databases chosen were MEDLINE, EMBASE, Scopus, Web of Science and PSYCINFO from January 2000 to June 2020. Downs and Black checklist was used to check for risk of bias. Papers with a focus in LTC setting, using digital technology as intervention for older adults with dementia, and with measurable outcomes (outcomes that are quantified, not descriptive) were included in the final review. Seventeen original papers (8 RCTs, 8 quasi-experimental and 1 mixed method) were included. Three articles examining position-sensor technology for fall prevention showed mixed results. Two showed no difference and 1 showed small reduction in fall after alarm removal but the positive effect might be due to bias. Overall, the sample sizes were too small to draw meaningful conclusion. Fourteen studies (9 pet robots of which 8 were robotic seal/PARO) were identified for BPSD and results were mixed. Overall, PARO might have modest benefit in BPSD compared to usual care but might be no better than plush toy with more hallucinations or delusions seen in advanced dementia. However, the significant heterogeneity in methodology (intervention intensity, lack of record in psychoactive drug use), clinical tools used (different BPSD scales, different digital technologies) and variability in outcomes made it difficult to draw clear-cut conclusion. Studies involving other digital technologies are scarce and in pilot phases; hence, conclusion is premature. One limitation of the review was that only 9 out of 17 studies were of good quality. The limited research work in position-sensors meant insufficient evidence to prove efficacy for their use in LTC setting. The possible modest benefit of PARO in BPSD (e.g. in agitation, apathy or reduction in psychoactive drugs) was off-set by possible adverse events such as delusions or hallucinations in advanced dementia.
The online version contains supplementary material available at 10.1007/s10433-021-00627-5.
在长期护理（LTC）机构中预防跌倒以及管理痴呆症的行为和心理症状（BPSD）是一项重大挑战。本系统评价的目的是评估数字技术在其管理中的证据。所有排除病例报告的英文研究均符合纳入评价的标准。选取的数据库为2000年1月至2020年6月期间的MEDLINE、EMBASE、Scopus、科学网和PSYCINFO。采用唐斯和布莱克清单来检查偏倚风险。最终评价纳入了聚焦于长期护理环境、将数字技术用作痴呆症老年人干预措施且具有可测量结果（量化而非描述性结果）的论文。共纳入17篇原创论文（8项随机对照试验、8项准实验和1项混合方法研究）。三项研究跌倒预防位置传感器技术的文章结果不一。两项研究显示无差异，一项研究显示在移除警报后跌倒略有减少，但这种积极效果可能是由于偏倚。总体而言，样本量过小，无法得出有意义的结论。针对BPSD识别出14项研究（9项宠物机器人研究，其中8项是机器海豹/PARO），结果不一。总体而言，与常规护理相比，PARO在BPSD方面可能有适度益处，但可能并不比毛绒玩具更好，在晚期痴呆症中会出现更多幻觉或妄想。然而，方法学（干预强度、精神活性药物使用记录缺失）、所用临床工具（不同的BPSD量表、不同的数字技术）的显著异质性以及结果的变异性使得难以得出明确结论。涉及其他数字技术的研究很少且处于试点阶段；因此，结论尚不成熟。本评价的一个局限性是17项研究中只有9项质量良好。位置传感器方面的研究工作有限，意味着没有足够证据证明其在长期护理环境中的有效性。PARO在BPSD方面可能的适度益处（如在激越、淡漠或减少精神活性药物使用方面）被晚期痴呆症中可能出现的不良事件（如妄想或幻觉）所抵消。
在线版本包含可在10.1007/s10433-021-00627-5获取的补充材料。
