Environmental Scan of Existing Digital Health Solutions for Older

Adults Living with Neurocognitive Disorders (Mild and Major) and

Their Informal Caregivers: Summary Report

Ambily Jose

, Maxime Sasseville

1,2 b

, Ellen Gorus

3,4 c

, Anik Giguère

1,5 d

Anne Bourbonnais

, Samira Abbasgholizadeh Rahimi

7,8 f

, Ronald Buyl

and Marie-Pierre Gagnon

1,2 h

VITAM Research Center in Sustainable Health, Quebec City, Canada

Faculty of Nursing Sciences, Université Laval, Quebec City, Canada

Frailty in Ageing Research Group, Department of Gerontology, Vrije Universiteit Brussel, Brussels, Belgium

Geriatrics Department, Universitair Ziekenhuis Brussel, Brussels, Belgium

Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada

Faculty of Nursing, Université de Montréal, Montreal, Canada

Department of Family Medicine, McGill University, Montreal, Canada

Mila-Quebec AI Institute, Montreal, Canada

Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy,

Vrije Universiteit Brussels, Belgium

anne.bourbonnais@umontreal.ca, samira.rahimi@mcgill.ca, ronald.buyl@vub.be, marie-pierre.gagnon@fsi.ulaval.ca

Keywords: Digital Health, Aging, Mild Cognitive Impairment, Dementia, Environmental Scan.

Abstract: Digital health has added numerous promising solutions to enhance the health and wellness of people living

with dementia and other cognitive problems and their informal caregivers. This work aims to summarize

currently available digital health solutions and their related characteristics to develop a decision support tool

for older adults living with mild or major neurocognitive disorders and their informal caregivers. We

conducted an environmental scan to identify digital health solutions from a systematic review and targeted

searches for grey literature covering the regions of Canada and Europe. Technological tools were scanned

based on a preformatted extraction grid. We assessed their relevance based on selected attributes. We

identified 100 available digital health solutions. The majority (56%) were not specific to dementia. Only 28%

provided scientific evidence of their effectiveness. Remote patient care, movement tracking and cognitive

exercises were the most common purposes of digital health solutions. Most solutions were presented as

mobility aid tools, pill dispensers, apps, web, or a combination of these platforms. This knowledge will inform

the development of a decision support tool to assist older adults and their informal caregivers in their search

for adequate eHealth solutions according to their needs and preferences, based on trustable information.

1 INTRODUCTION

The prevalence of mild or major neurocognitive

disorders (NCDs) is expected to increase to 70 million

https://orcid.org/0000-0002-9339-6854

https://orcid.org/0000-0003-1694-1414

https://orcid.org/0000-0003-0054-1520

https://orcid.org/0000-0001-9928-7395

https://orcid.org/0000-0002-6823-4044

https://orcid.org/0000-0003-3781-1360

https://orcid.org/0000-0002-6598-9505

https://orcid.org/0000-0002-0782-5457

by 2030 and 139 million by 2050 (World Health

Organisation, 2021). In this paper, we use the

terminology “major neurocognitive disorders” instead

of dementia and “mild neurocognitive disorders” for

216

Jose, A., Sasseville, M., Gorus, E., Giguère, A., Bourbonnais, A., Rahimi, S., Buyl, R. and Gagnon, M.

Environmental Scan of Existing Digital Health Solutions for Older Adults Living with Neurocognitive Disorders (Mild and Major) and Their Informal Caregivers: Summary Report.

DOI: 10.5220/0011975600003476

In Proceedings of the 9th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2023), pages 216-220

ISBN: 978-989-758-645-3; ISSN: 2184-4984

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

mild cognitive impairment, based on the DSM-5-TR

(American Psychiatric Association, 2022).

Over the past years, several digital health solutions

have been developed in Europe and Canada to enhance

the quality of life of older adults living with mild or

major NCDs (Ghani et al., 2022; Sixsmith, 2021).

Digital health solutions use information and

communication technologies to improve human health,

healthcare services, and wellness for individuals and

populations (Kostcova, 2015). They are mostly

behavioral-based health interventions delivered

through the Internet, mobile devices, electronic/digital

processes in communication, and related technologies

(Christie et al., 2018). These solutions mostly focus on

improving the independence and autonomy of people

living with NCDs, and providing knowledge and

assistance to primary caregivers. Thus, digital health is

considered a promising solution for older adults living

with mild or major NCDs (Hopwood et al., 2018). It is

important to get a comprehensive view of currently

available technologies and document their outcomes

and conditions of success to inform recommendations

regarding digital health solutions for this population.

Hence, this environmental scan is designed to identify

existing digital health solutions relevant for people

with mild or major NCDs and their informal caregivers

in Canada and Europe.

2 OBJECTIVES

This environmental scan aims to identify digital

health solutions for older adults living with mild or

major NCDs and their informal caregivers and to

document their characteristics to inform the

implementation of such solutions in Europe and

Canada. The specific objectives are to:

 Inventory digital health solutions for the targeted

populations available in Europe or Canada.

 Summarize the characteristics of these digital

health solutions, including their features and

outcomes, implementation factors, and

conditions of success.

3 METHODS

To achieve these objectives, we performed an

environmental scan. Although environmental scans

are gaining popularity in health research as a

methodological approach to examining a specific

health issue, there is no gold standard for this method

(Charlton et al., 2021). Environmental scan is

considered as an effective assessment and data

collection tool to analyze multifaceted issues, explore

a policy, appraise current evidence, and for planning

and decision making. For instance, an environmental

scan can identify the knowledge-to-action gap

meaningfully (Robinson et al., 2021). Several studies

have described the usefulness of environmental scans

for assessing community needs for program and

policy development (Kebede et al., 2021).

3.1 Search Strategy

We performed comprehensive bibliographic searches

to identify recent digital health solutions for older

people with mild or major NCD or dementia and their

informal caregivers. Initial data searches were done

through a systematic review by Dequanter et al.

(2021), and were updated (until September 2022) by

two research assistants (one in Quebec and one in

Flanders) by gathering all available digital health

solutions in their respective jurisdictions (Canada and

Europe) through databases and web searches. We

identified solutions that were then reviewed by

experienced investigators (MPG, MS, RB).

3.2 Inclusion and Exclusion Criteria

Included digital health solutions have the purpose to

support and/or improve health and well-being in the

daily life of the targeted populations such as apps

providing information about health or services, mental

exercises and games, virtual assessments, etc.; are

produced within the last five years (so as of January

2018 up to the date of the search in 2022) and are

available in Europe or Canada. We included relevant

solutions provided by any public or private entity, free

of charge or those requiring some payment.

Digital health solutions that are not currently

available or for which we cannot confirm availability

were excluded. Solutions that are only available in

languages other than English, French or Dutch were

also excluded.

3.3 Data Extraction

We used an extraction grid to document the

characteristics of digital health solutions, based on the

main attributes identified through the qualitative

component of the larger research project (Dequanter

et al., 2021). Collected information included:

solution’s name, purpose, software used, target

population, domain, features, geographic availability,

summary of the invention, scientific evidence of

impacts and evidence details, primary author or

Environmental Scan of Existing Digital Health Solutions for Older Adults Living with Neurocognitive Disorders (Mild and Major) and

Their Informal Caregivers: Summary Report

217

company contact information (email and phone

number). We piloted the extraction grid on a sample

of five solutions. Then, one author (AJ) did the

extraction for all identified technologies, and another

author (MS or MPG) checked for accuracy.

3.4 Data Analysis

We gathered detailed information based on selected

attributes and listed all available digital health

solutions for the targeted populations in Europe and

Canada. This provided data for the first objective.

Then, we analyzed each technology based on the

selected attributes, synthesized quantitative and quali-

tative data, and triangulated the results to understand

implementation factors and conditions of success.

4 RESULTS

We used a narrative approach with charts and figures

to summarize the results according to the key

characteristics of the technological solutions.

Classifying digital health solutions based on their

main function reveals their importance for patients

and informal caregivers and their documented

advantages, implications, and potential drawbacks.

4.1 Geographical Availability

We identified 100 distinct digital solutions available

in Canada, Belgium, the UK, Germany, the

Netherlands, Norway, and Sweden (Figure 1). A

larger proportion of solutions in our sample are from

Belgium and Canada.

Figure 1: Distribution of the countries where digital health

solutions are available.

4.2 Target Population

Most digital health solutions target older adults in

general (56%), while 17% of the solutions are

specifically for older people with NCDs and their

informal caregivers. However, 23% of solutions are

applicable to all age groups.

4.3 Available Evidence

We considered scientific evidence supporting digital

health interventions and found that most solutions do

not have any evidence of their effectiveness. Only 28

of the 100 solutions identified present scientific

evidence of their effectiveness, most often based on

clinical trials. Other types of evidence, such as media

releases, awards and recognitions, user reviews, and

feedback are available for 34 solutions. However, no

supporting scientific or non-scientific evidence is

reported for the remaining 38 solutions.

4.4 Purpose

As seen in Figure 2, classification based on their main

purpose shows most digital health solutions are for

remote patient care (23), cognitive exercise (20) or

tracking movements (17). Twelve solutions aim at

fall prevention, and 10 offer alert and security

functions. The other types of solutions offer decision

support (2) and robotic interactions (2).

Figure 2: Purpose of digital health solutions.

4.5 Technological Support

This parameter defines the technology platforms the

solutions are based on. There are 6 main categories of

platforms (Table 1) that are shortly described below.

Table 1: Types of platforms and number of solutions.

Type of platform used Number of solutions

Mobility aid tool 25

Mobility aid tool + App 10

App 21

Pill dispenser + App 14

Web 9

Web + App 17

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Mobility Aid Tool: Healthcare mobility support is

used for neuromuscular rehabilitation of patients with

mobility challenges. It uses wearable technology

solutions and walker sensors for neuromuscular

rehabilitation for patients with brain injury,

neurological disorders, or mobility challenges. They

function autonomously using their sensory capability,

thus not requiring external input. These solutions are

user-friendly, affordable, and relevant for people with

dementia.

Mobility Aid Tool and App: This category is an

extension of the former and includes Aid tool and

App. These are useful for older adults who require

personalized rehabilitation plans. They help in early

complication identification as app is useful for daily

remote medical care. Exercise videos with a system

to provide feedback are also included in this category.

App: This category includes mobile systems that help

to ensure client safety, for instance by keeping track

of the person’s movements. An example is an

electronic door opener that is activated by a key app

to allow easy access to the person’s home for

caregivers and family members. These solutions are

generally easy to use, safe and acceptable as the client

determines who gets access to their information.

Pill Dispenser and App: Electronic pill dispenser

technology helps people with cognitive problems

who require regular medicine by providing helpful

reminders through chimes and lights, and phone or

text alerts to remind the person of any delay in taking

their medication. This is facilitated by the

coordination with pharmacy and care teams by pre-

set pill bottles to alert and message medication

schedules. It also allows integration with healthcare

professionals and pharmacies for real-time tracking

and updates. No technical skills are required for easy

usage. However, this solution is specific to pills and

will not work with injections, drops, inhalers, etc.,

and is available only through partner pharmacies.

Web: Remote patient monitoring can be performed

by using secure web tools. For these types of

solutions, a case manager often coordinates the care

plan and ensures the proper functioning of the

network. Supporting functions for patients and their

relatives are coordinated through a web portal for

primary care coordination and support service for

palliative care.

Web and App: The addition of mobile apps to the

previous category allows for extended coverage and

functionalities. Tracking is facilitated and

coordination of care is improved. These solutions are

notably useful to support mobility of people with

cognitive problems.

5 DISCUSSION

Studies often mention that eHealth technology

utilization has changed the way people live in and out

of their homes. For older people with mild or major

NCDs, supporting cognitive functions, activities of

daily living, and safety can promote their autonomy

and independence (Malinowski et al., 2010; Irazoki et

al., 2020). Based on the available technology

reviewed, pill dispensers and apps remind people

with dementia to take their medications on time, offer

cognitive exercises that can limit memory problems,

and mobile applications that may assist in activities

like cooking or self-management skills. Other digital

health solutions offer safety or social support by

connecting the person with family members and

caregivers. Interactive devices such as socially

assistive robots, may offer time orientation, stimulate

alertness, communication and entertainment, and

alleviate feelings of loneliness.

Although digital health technologies offer many

benefits, they can also sometimes challenge and

trouble some older adults with NCDs (Guisado-

Fernández et al., 2019). Some technologies do not

exactly meet these people's needs although they claim

effectiveness. In fact, no study clearly analyzed how

the technology is used by people with NCDs in their

daily activities. Therefore, more studies are required

to monitor usage, usability, effectiveness and barriers

related to the uptake of these solutions by people with

dementia or other NCDs and their informal

caregivers.

6 CONCLUSIONS

This environmental scan allowed identifying current

digital health solutions for older adults with mild or

major neurocognitive disorders and their informal

caregivers. Based on the features of these solutions, it

seems possible to design an effective decision-

making tool that could support them when deciding

to use such technology. Findings from the

environmental scan highlight the need for additional

approaches to strengthen digital health interventions

for the well-being of dementia patients and their

informal and formal healthcare providers.

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Their Informal Caregivers: Summary Report

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