Cost-effectiveness of the FindMyApps eHealth intervention vs. digital care as usual: results from a randomised controlled trial.

OBJECTIVES: Despite growing interest, the cost-effectiveness of eHealth interventions for supporting quality of life of people with dementia and their caregivers remains unclear. This study evaluated the cost-effectiveness of the FindMyApps intervention, compared to digital care-as-usual. FindMyApps aims to help people with dementia and their caregivers find and learn to use tablet apps that may support social participation and self-management of people with dementia and sense of competence of caregivers. METHOD: A randomised controlled trial (Netherlands Trial Register NL8157) was conducted, including people with mild cognitive impairment (MCI) or mild dementia and their informal caregivers (FindMyApps n = 76, digital care-as-usual n = 74). Outcomes for people with MCI/dementia were Quality-Adjusted Life-Years (QALYs), calculated from EQ-5D-5L data and the Dutch tariff for utility scores, social participation (Maastricht Social Participation Profile) and quality of life (Adult Social Care Outcomes Toolkit), and for caregivers, QALYs and sense of competence (Short Sense of Competence Questionnaire). Societal costs were calculated using data collected with the RUD-lite instrument and the Dutch costing guideline. Multiple imputation was employed to fill in missing cost and effect data. Bootstrapped multilevel models were used to estimate incremental total societal costs and incremental effects between groups which were then used to calculate Incremental Cost-Effectiveness Ratios (ICERs). Cost-effectiveness acceptability curves were estimated. RESULTS: In the FindMyApps group, caregiver SSCQ scores were significantly higher compared to care-as-usual, n = 150, mean difference = 0.75, 95% CI [0.14, 1.38]. Other outcomes did not significantly differ between groups. Total societal costs for people with dementia were not significantly different, n = 150, mean difference = €-774, 95%CI [-2.643, .,079]. Total societal costs for caregivers were significantly lower in the FindMyApps group compared to care-as-usual, n = 150, mean difference = € -392, 95% CI [-1.254, -26], largely due to lower supportive care costs, mean difference = €-252, 95% CI [-1.009, 42]. For all outcomes, the probability that FindMyApps was cost-effective at a willingness-to-pay threshold of €0 per point of improvement was 0.72 for people with dementia and 0.93 for caregivers. CONCLUSION: FindMyApps is a cost-effective intervention for supporting caregivers' sense of competence. Further implementation of FindMyApps is warranted.

Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations.

OBJECTIVES: To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). METHODS: Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. RESULTS: Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. CONCLUSION: Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.

The effects of psychosocial interventions using generic photos on social interaction, mood and quality of life of persons with dementia: a systematic review.

BACKGROUND: Although family photos are often used in the psychosocial care for people with dementia, little is known about the use and effectiveness of generic photos. This systematic literature review explored psychosocial interventions using generic photos for people with dementia, and the effects they have on their social interaction and/or mood and/or quality of life. In addition, it was investigated whether these interventions made use of technology in its implementation. METHODS: A systematic search on the following databases was performed: PubMed, Embase, APA PsychInfo, Cinahl, Web of Science, Scopus and Cochrane Central. Inclusion and exclusion criteria were based on the PICO model (Population, Intervention, Comparison, Outcome), and quality assessment was undertaken using the Weight of Evidence Framework. Narrative synthesis was undertaken to summarize study characteristics- settings and designs, type of psychosocial interventions identified, type of photos and technology used, outcome measures, and results. RESULTS: A total of 2,035 results were found, however after title, abstract and full-text screening, a total of 8 studies were included. The most common psychosocial intervention using generic photos was found to be reminiscence therapy, followed by art-viewing activities. In studies that used technology, it was reported that viewing digitalized photos were either similar or better to conventional printed photos. Despite photos being generic, it was found that generic photos could still hold personal significance to the person with dementia. Some positive and significant effects were found for the outcomes social interaction, mood and quality of life, though no study evaluated all three outcomes. Two studies were rated as having high overall quality, 4 were rated as fair, and 2 studies had a low quality assessment rating. CONCLUSION: Studies found using generic photos were limited, showing varying outcomes and methodological quality. Firm conclusions on the effectiveness of interventions using generic photos are not possible. However, the use of generic photos in psychosocial interventions is a promising area for future research. Researchers should consider studies with better methodological quality and larger samples; and qualitative studies where the intention is to get better insight into successful implementation and impact mechanisms of such psychosocial interventions. TRIAL REGISTRATION: n/a.

FindMyApps compared with usual tablet use to promote social health of community-dwelling people with mild dementia and their informal caregivers: a randomised controlled trial.

Background: FindMyApps is a tablet-based eHealth intervention designed to help people learn to use a tablet and find easy-to-use apps. This study evaluated the effectiveness of FindMyApps for supporting social health of people living with dementia, and sense of competence of their informal caregivers. Methods: A single-centre, two-arm, non-blinded randomised controlled trial was conducted (Netherlands Trial Register NL8157). From 1st January 2020 to 31st July 2022, community-dwelling people in the Netherlands with a pre-established diagnosis of mild cognitive impairment (MCI) or dementia (Brief Cognitive Rating Scale 17-32), an informal caregiver and internet connection were allocated by block randomisation to receive FindMyApps or digital care-as-usual. Primary outcomes (measured at baseline and after three months) for people with dementia/MCI were self-management (Adult Social Care Outcomes Toolkit total score) and social participation (Maastricht Social Participation Profile frequency and diversity scores), and for caregivers, sense of competence (Short Sense of Competence Questionnaire total score). Between-group differences were tested by MANCOVA or ANCOVA (alpha = 0.05). Findings: 150 dyads were randomised (FindMyApps n = 76, care-as-usual n = 74). Follow-up data were available for 128 dyads (FindMyApps n = 64, care-as-usual n = 64), who were included in the analysis in the trial arm to which they were assigned. No harms of the intervention were identified. There were no statistically significant differences in outcomes for people with dementia/MCI at group level. Diagnosis and experiencing apathy appeared to be relevant effect modifiers of secondary outcomes (neuropsychiatric symptoms, positive affect, sense of belonging, and pleasurable activities). Caregivers who received FindMyApps had higher sense of competence at three months (F [1,123] = 7.01, p = 0.0092, η2 = 0.054). Interpretation: Overall we found no evidence that the FindMyApps intervention better supported social participation or self-management of people with MCI/dementia than digital care-as-usual. FindMyApps does seem to better support informal caregivers' sense of competence. For people with a diagnosis of mild dementia and older people, better tailored interventions, implementation and outcome measures may be needed. Funding: Marie Sklodowska Curie Actions Innovative Training Network H2020 MSCA ITN, grant agreement number 813196.

Potential Facilitators of and Barriers to Implementing the MINI Robot in Community-Based Meeting Centers for People With Dementia and Their Carers in the Netherlands and Spain: Explorative Qualitative Study.

BACKGROUND: Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation. OBJECTIVE: The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain. METHODS: Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described. RESULTS: Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies. CONCLUSIONS: The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD's preferences and demands and MC policies, which will contribute to the MINI robot's effective adoption and deployment.

Comparing the stigma experiences and comfort with disclosure in Dutch and English populations of people living with dementia.

OBJECTIVES: People living with dementia can feel hesitant disclosing their diagnosis to social networks, partly due to stigma. Little attention has been paid to the measurement of disclosure decisions and stigma, and few standardised stigma tools have been validated in languages other than English. We investigated the psychometric properties of Dutch translations of three stigma measures, and explored the stigma experiences of Dutch and English people living with dementia as well as patterns and predictors of comfort with disclosure. METHODS: Community-dwelling adults living with dementia in the Netherlands (n = 40) and England (n = 40) completed either the English versions or the Dutch translations of the Comfort with Disclosure scale and three stigma measures (Stigma Impact, Stigma Stress, and Secrecy Scale). We established the psychometric properties of the stigma measures and conducted correlation and regression analyses. RESULTS: Internal consistency was good to excellent for all measures in the Dutch sample. Small but significant differences were found between the Dutch and English samples on the total score of the Stigma Impact Scale and its subscale social isolation. Age was negatively associated with comfort disclosing to family, and desire for secrecy was negatively associated with comfort disclosing to both family and friends. CONCLUSIONS: The psychometric properties of the Dutch scales were satisfactory. Many people living with dementia would feel comfortable disclosing their diagnosis to family and friends, but stigma experiences can greatly affect this decision. Cross-cultural differences in stigma experiences in persons with dementia require further investigation.

FindMyApps eHealth intervention improves quality, not quantity, of home tablet use by people with dementia.

Introduction: FindMyApps is a tablet-based eHealth intervention, designed to improve social health in people with mild dementia or mild cognitive impairment. Methods: FindMyApps has been subject to a randomized controlled trial (RCT), Netherlands Trial Register NL8157. Following UK Medical Research Council guidance, a mixed methods process evaluation was conducted. The goal was to investigate the quantity and quality of tablet use during the RCT, and which context, implementation, and mechanisms of impact (usability, learnability and adoption) factors might have influenced this. For the RCT, 150 community dwelling people with dementia and their caregivers were recruited in the Netherlands. For the process evaluation, tablet-use data were collected by proxy-report instrument from all participants' caregivers, FindMyApps app-use data were registered using analytics software among all experimental arm participants, and semi-structured interviews (SSIs) were conducted with a purposively selected sample of participant-caregiver dyads. Quantitative data were summarized and between group differences were analyzed, and qualitative data underwent thematic analysis. Results: There was a trend for experimental arm participants to download more apps, but there were no statistically significant differences between experimental and control arm participants regarding quantity of tablet use. Qualitative data revealed that experimental arm participants experienced the intervention as easier to use and learn, and more useful and fun than control arm participants. Adoption of tablet app use was lower than anticipated in both arms. Conclusions: A number of context, implementation and mechanism of impact factors were identified, which might explain these results and may inform interpretation of the pending RCT main effect results. FindMyApps seems to have had more impact on the quality than quantity of home tablet use.

Challenges of using a Fitbit smart wearable among people with dementia.

OBJECTIVES: Limited research on using smart wearables such as Fitbit devices among people with dementia has shown favourable outcomes. The aim of this study was to explore the acceptability and feasibility of using a Fitbit Charge 3 among people with dementia, living in the community, who took part in the physical exercise component of the Comprehensive REsilience-building psychoSocial intervenTion pilot study. METHODS: A mixed methods study was conducted; Quantitative data relating to wear rates for the Fitbit were recorded and qualitative data were collected by group and individual interviews with the people with dementia and their caregiver about their experience of wearing/using the Fitbit in the study. RESULTS: Nine people with dementia and their caregiver completed the intervention. Only one participant wore the Fitbit consistently. Supporting set-up and use of the devices was time consuming and caregiver involvement was essential for day-to-day support: none of the people with dementia owned a smartphone. Few of them engaged with the Fitbit features, primarily only using it to check the time and only a minority wanted to keep the device beyond the intervention. DISCUSSION: When designing a study using smart wearables such as a Fitbit among people with dementia, consideration should be given to the following: the possible burden on caregivers supporting the use of the device; a lack of familiarity with this technology in the target population; dealing with missing data, and the involvement of the researcher in setting up and supporting use of the device.

Read and accepted? Scoping the cognitive accessibility of privacy policies of health apps and websites in three European countries.

Objective: Trust and accessibility are vital to adoption of health and wellness apps. This research scoped three elements of cognitive accessibility of health app privacy policies: availability, ease of navigation, and readability. Methods: For this cross-sectional study, quantitative data collected in the Netherlands, Sweden, and the United Kingdom included: whether privacy information was in a country's official language (availability); number of distracting visual elements (ease of navigation); word count and Common European Framework of Reference (CEFR) reading level (readability). Health app privacy policies were compared to policies from a purposively selected sample of websites, and to benchmarks, including CEFR reading level B1. Results: Health app privacy policies were less often available in countries' official languages compared to sampled websites (Chi-Square [1, 180] = 57.470, p < 0.001) but contained fewer distracting visual elements. More UK privacy policies were in the country's official language, whereas Swedish privacy policies contained fewest words and fewest potentially distracting design elements. Only one privacy policy met the CEFR reading level benchmark. Conclusions: Lack of privacy information in non-Anglophone app-users' native languages and high reading levels may be major barriers to cognitive accessibility. Web and app developers should consider recommendations arising from this study, to stimulate trust in and adoption of health and wellness apps.

Validity and reliability of the Danish version of QUALIDEM.

INTRODUCTION: QUALIDEM is a dementia-specific QoL instrument that allows a proxy-based Quality of Life rating in all stages of dementia. It was originally developed in The Netherlands and has later been translated into English and German. This study endeavoured to translate, cross-culturally adapt and test important psychometric properties of a Danish version in a cross-sectional validation study with a nested test-retest design. METHOD: All items underwent forward and backward translation by bilingual academics. Persons with dementia were recruited from 28 healthcare units in a Danish municipality. The severity of dementia was determined using a pragmatic approach allowing the site team to trichotomise the disease (mild, moderate-severe and very severe) before scoring the QUALIDEM. Psychometric properties for QUALIDEM were determined for item characteristics, construct validity, internal consistency, test-retest reliability, measurement error and floor and ceiling effects. The study was approved by The Danish Data Protection Agency. RESULTS: A total of 169 persons with dementia, aged 51-103, were included. The construct validity testing showed that the overall proportion of correctly hypothesised correlations was 83%. Testing for internal consistency, Cronbach's α ranged from 0.65 to 0.85 in mild-severe dementia with three out of nine subscales having values below 0.7. For very severe dementia, Cronbach's α ranged from 0.44 to 0.81, with three out of six subscales having insufficient values. For test-retest reliability, the intra-class correlation coefficients ranged from 0.56 to 0.86. The 'scale width' method revealed a marked ceiling effect in all subscales ranging from 30.6% to 87.7%. DISCUSSION: The QUALIDEM was successfully translated and cross-culturally adapted into Danish. Most subscales show acceptable internal consistency and test-retest reliability. However, a substantial measurement error and ceiling effect was present in most subscales. CONCLUSION: With few exceptions, the subscales of the Danish version of QUALIDEM have acceptable validity and reliability. Future research should address the limitations of the ceiling effects.

Information on advance care planning on websites of dementia associations in Europe: A content analysis.

OBJECTIVE: To gain insight into the advance care planning (ACP) content provided on dementia associations' websites in Europe. METHODS: We conducted a content analysis of dementia associations' websites in Europe regarding ACP information, using deductive and inductive approaches and a reference framework derived from two ACP definitions. RESULTS: We included 26 dementia associations' websites from 20 countries and one European association, covering 12 languages. Ten websites did not mention ACP. The information on the remaining 16 varied in terms of themes addressed and amount of information. Four explicitly define ACP. Several websites made multiple references to legal frameworks (n = 10, 705 excerpts), choosing legal representatives (n = 12, 274 excerpts), and care and treatment preferences (n = 14, 89 excerpts); while themes such as communication with family (n = 9, 67 excerpts) and professionals (n = 9, 49 excerpts) or identifying personal values (n = 9, 73 excerpts) were mentioned on fewer websites or addressed in fewer excerpts. CONCLUSION: ACP content is non-existent in 10 out of 26 dementia associations' websites. On those that have ACP content, legal and medical themes were prominent. It would be beneficial to include more comprehensive ACP information stressing the importance of communication with families and professionals, in line with current ACP conceptualisations framing ACP as an iterative communication process, rather than a documentation-focused exercise.

Impact of the FindMyApps program on people with mild cognitive impairment or dementia and their caregivers; an exploratory pilot randomised controlled trial.

PURPOSE: FindMyApps is a web-based selection-tool and errorless learning training program to help people with mild dementia/Mild Cognitive Impairment (MCI) and caregivers find user-friendly apps. In preparation of a definitive trial, the impact and feasibility of the FindMyApps intervention on self-management and engagement in meaningful activities, including social participation, was explored. MATERIALS AND METHODS: An exploratory pilot randomised controlled trial (trial registration approval number: NL7210) with pre/post measurements was conducted with community-dwelling people with mild dementia/MCI and their caregivers (n = 59) in the Netherlands. Dyads in the experimental group (n = 28) received training to use the tablet and FindMyApps, and the errorless learning method was taught to their caregivers. Control group dyads (n = 31) received a tablet (without FindMyApps), instructions on tablet-use and links to dementia-friendly apps. Validated instruments were used to assess person with dementia's self-management, meaningful activities and social participation, caregiver's sense of competence and both their quality of life. RESULTS AND CONCLUSIONS: No statistical significant group differences on the outcomes were found. Small to moderate effect-sizes in favour of the FindMyApps group were found for self-management and social participation. Caregivers tended to have more positive care experiences. Subgroup analyses showed that people older than 70 benefitted more from FindMyApps regarding self-management and higher educated people benefitted more regarding social participation. FindMyApps is feasible for the target group and may have potential to improve self-management and social participation. For a future definitive effectiveness trial a larger sample size is recommended, as well as taking into account the possible impact of education and age.IMPLICATIONS FOR REHABILITATIONThe FindMyApps program is feasible for people with dementia/MCI and may have potential to improve their self-management and social participation.Informal caregivers may develop a more positive care experience when utilizing FindMyApps to find suitable apps for self-management and social participation for the person with dementia/MCI.

Expert appraisal and prioritization of barriers to mHealth use for older adults living with Alzheimer's disease and related Dementias: A Delphi study.

INTRODUCTION: Older adults living with Alzheimer's disease and related dementias (ADRD) can benefit from mHealth innovations in (daily) care. However, successful implementation and adoption of such innovations can be hindered by a lack of inclusive design. Inclusive design can be challenging, due to the variety of ADRD- and aging-related symptoms that can pose barriers to using mHealth. Previously, a literature-based model with 53 barriers to mHealth use for this population has been developed ("MHealth for OLder adults living with DEMentia - USability" or MOLDEM-US). In this study, we aim to prioritize these through a Delphi study with ADRD experts (case managers, informal caregivers, hospital healthcare professionals, district nurses, and researchers). METHODS: In the first round, participant characteristics and potentially new insights into barriers to mHealth use for older adults living with ADRD were gathered. The consensus questionnaire was submitted in the second round, containing barriers to mHealth use for this population (from MOLDEM-US) with questions inquiring its impact and frequency. In the third round, participants rejudged those barriers for which no consensus (<51 %) or minor consensus (51 % - 60 %) was reached. RESULTS: Thirty-seven participants completed the three rounds of the study. Consensus was reached for eleven barriers after the second round, all having major impact and frequency: integration of functions during daily activities, perceived complexity, efficiency in seeing benefits, trust in own ability, restlessness and agitation, computer literacy, self confidence in using wearables, learnability, working memory, and visual acuity. CONCLUSION: After round three, consensus was achieved for all 53 barriers. Twenty-six barriers are considered to majorly affect mHealth use, most of which relate to cognition and frame of mind. This study contributes to the development of mHealth design guidelines that take into account the progressive and diverse ADRD- and aging-related symptoms negatively affecting mHealth implementation and adoption.

The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites.

BACKGROUND: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. OBJECTIVE: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. METHODS: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to "older adults," "dementia," and "institutional care" and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. RESULTS: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. CONCLUSIONS: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets.

Known in the nursing home: development and evaluation of a digital person-centered artistic photo-activity intervention to promote social interaction between residents with dementia, and their formal and informal carers.

BACKGROUND: To address the lack of social interaction and meaningful activities for persons with dementia (PWD) in nursing homes an artistic Photo-Activity was designed. The present study aims to develop a digital version of the Photo-Activity and to investigate its implementation and impact on nursing home residents with advanced dementia, and their (in)formal carers. METHODS: First, within a user-participatory design, a digital-app version of the Photo-Activity will be developed and pilot-tested, in co-creation with (in)formal carers and PWD. Next, the feasibility and effectiveness of the Photo-Activity versus a control activity will be explored in a randomized controlled trial with nursing home residents (N=90), and their (in)formal carers. Residents will be offered the Photo-Activity or the control activity by (in)formal carers during one month. Measurements will be conducted by independent assessors at baseline (T0), after one month (T1) and at follow up, two weeks after T1 (T2). Qualitative and quantitative methods will be used to investigate the effects of the intervention on mood, social interaction and quality of life of the PWD, sense of competence of informal carers, empathy and personal attitude of the formal carers, and quality of the relationship between the PWD, and their (in)formal carers. In addition, a process evaluation will be carried out by means of semi-structured interviews with the participating residents and (in)formal carers. Finally, an implementation package based on the process evaluation will be developed, allowing the scaling up of the intervention to other care institutions. DISCUSSION: Results of the trial will be available for dissemination by Spring 2023. The digital Photo-Activity is expected to promote meaningful connections between the resident with dementia, and their (in)formal carers through the facilitation of person-centered conversations. TRIAL REGISTRATION: Netherlands Trial Register: NL9219 ; registered (21 January 2021); NTR (trialregister.nl).

Randomized controlled feasibility study of FindMyApps: first evaluation of a tablet-based intervention to promote self-management and meaningful activities in people with mild dementia.

OBJECTIVES: We tested the feasibility, implementation strategy and mechanism of impact of FindMyApps. FindMyApps is a tablet intervention consisting of a selection tool to help people with dementia find usable apps for self-management and meaningful activities, including training to support informal carers in employing errorless learning principles to help people with dementia learn tablet and tool usage. METHODS: We conducted an exploratory, pilot randomized controlled trial with a mixed-methods design. Twenty persons with mild dementia and carer dyads were randomly assigned to the FindMyApps group (n = 10), receiving either the FindMyApps training and selection tool, or a control condition (n = 10), receiving only a short tablet training. Pre- and post-test measurements at a three month follow-up, consisted of questionnaires and post-test semi-structured interviews. RESULTS: The FindMyApps tool was mostly perceived as useful and easy to use. Persons with dementia were generally able to learn how to use the tool, though they regularly needed support from informal carers. Persons with dementia found apps through the tool, which they used regularly. Persons with dementia and informal carers were positive about the training and support they received. No significant differences were found on outcome measures of persons with dementia, but based on effect sizes FindMyApps is a promising intervention. CONCLUSIONS: Qualitative results indicate that the FindMyApps intervention has the potential to positively influence the self-management abilities and engagement in meaningful activities of people with dementia. Remarks are made to improve the intervention and recommendations are given for future effectiveness studies.Implications for rehabilitationThe person-centred tablet intervention FindMyApps has the potential to positively influence the self-management and engagement in meaningful activities in people with dementia.Based on the input of persons with dementia and informal carers, the FindMyApps intervention and study procedure will be further improved and evaluated in terms of effectiveness in an RCT.

Cost-effectiveness of exergaming compared to regular day-care activities in dementia: Results of a randomised controlled trial in The Netherlands.

The growing number of people living with dementia will result in increased costs of dementia worldwide. The e-Health intervention 'Exergaming' may improve health and quality of life of people with dementia, but the cost-effectiveness is unknown. We assessed the cost-effectiveness of exergaming compared to regular activities from a societal perspective in day-care centres (DCC) for people with dementia and their informal caregivers (IC) alongside a cluster randomised controlled trial. We included 112 dyads (person with dementia and IC) from 20 psychogeriatric DCCs (11 exergaming, 9 control) across the Netherlands. Exergaming consisted of interactive cycling at least twice a week for 6 months. Measurements were conducted at baseline (T0), after 3 (T1) and 6 (T2) months. Primary outcomes were minutes of physical activity, mobility of the participants with dementia (Short Physical Performances Battery, SPPB), and Quality-Adjusted Life-Years (QALYs) of participants with dementia and ICs. ICs filled out cost diaries to measure healthcare and informal care utilisation during the study. There were no statistically significant differences in outcomes or costs between the groups at the level of participants with dementia, the ICs or the dyad. With regard to QALYs and SPPB, the probability that exergaming is cost-effective compared to control was low for all possible willingness-to-pay (WTP) thresholds. However, for physical activity at WTP thresholds of 0, 50 and 250 Euros per additional minute of physical activity, the probability of cost-effectiveness is 0.46, 0.84 and 0.87, respectively. Exergaming in DCC was not cost-effective compared to usual activities. However, considering the small sample size and the large number of missing observations, findings should be interpreted with caution. Future studies with larger samples are recommended to obtain definitive answers on the cost-effectiveness of exergaming. This trial was registered in the Netherlands Trial Register (NTR5537/NL5420).

Value of Personalized Dementia-Specific Quality of Life Scales: An Explorative Study in 3 European Countries.

Measuring Quality of Life (QOL) can be difficult due to its individual character. To explore the value of personalized QOL measurement for people with dementia, personalized versions of two dementia-specific QOL scales (Dementia quality of Life (DQoL) and Quaility of Life in Alzheimer's Disease (QoL-AD)) were constructed. This study investigated whether the personalized measures are more valid to detect variations in QOL than their standard versions for people with mild to moderate dementia, with sufficient internal consistency. Moreover, the relationship between the personalized QOL measures and severity of dementia was investigated. Finally, the study explored the differences between countries regarding the personalized overall QOL and differences in the importance of QOL domains. This explorative one-group design study used baseline data from the MEETINGDEM study into the implementation of the Meeting Centres Support Programme in Italy, Poland and the UK. The personalized versions of the DQoL and QoL-AD were reliable, but not more valid than their standard versions. No relationship between severity of dementia and personalized QOL was found. While no differences were found between countries for the overall QOL score, some QOL domains were valued differently: people with dementia from the UK rated self-esteem, mood, physical health, energy level and the ability to do chores around the house significantly less important than people from Italy and Poland. The personalized versions of the DQoL and QoL-AD may offer dementia care practice important insights into what domains contribute most to an individual's QOL.