Assistive Technology for Persons with Alzheimer's Disease and Related Dementias and Their Caregivers (R43/R44 Clinical Trial Optional)

Background

Currently, it is estimated that over 5 million people in the U.S. are afflicted with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD), and this number is increasing. The extensive care needs of persons with AD/ADRD are variable, and care typically involves great demands on caregivers and care partners who are often spouses or other family members. Family caregivers may experience both adverse health consequences (e.g., disrupted sleep, anxiety, depression, and compromised immune function), and economic hardship because of lost work and care expenditures. Development and dissemination of effective, technology-based interventions is needed to reduce the burden of caregiving and delay nursing home placement for persons with AD/ADRD.

Research Objectives

A broad range of assistive technologies could help improve the lives of persons with AD/ADRD and their caregivers/care partners. These technologies include, but are not limited to, locator devices, sensors, reminders, and intelligent systems. Smartphones and tablets are becoming more widely used among elderly individuals, including persons with AD/ADRD and their caregivers/care partners. Applications for smartphones can be developed to provide automated auditory reminders based on calendar events, times of day, or geographic location. They may also be a suitable platform for a variety of telehealth technologies. Additionally, applications are encouraged to develop next-generation technology, including socially-assistive robots (SARs), to enhance health and well-being, reduce illness and disability, and improve quality of life for persons with AD/ADRD and their caregivers/care partners.

Assistive technologies are used by many persons with physical or cognitive disabilities or diseases. Although assistive technologies do not cure disease, they may promote independence and enhance quality of life. The NIA is particularly interested in applications that include developing assistive technologies on any device, software or system, from smartphone applications to robotics, that supports an individual with AD/ADRD or her/his caregiver/care partner to maintain or improve independence, quality of life, safety and well-being.

To be appropriate to this FOA, the assistive technology must be targeted toward individuals with AD/ADRD and/or their caregivers/care partners, and have potential for rapidly going into the market to address at least one of the following areas:

• Facilitating independent decision making;
• Allowing a longer duration of independent living;
• Improving safety and security, both inside and outside the home;
• Reassuring family members about the level and quality of care received by persons with AD/ADRD;
• Developing/adapting alternative technology that allows aging in place and that is cost effective compared to skilled care or other alternatives;
• Designing/developing speaker systems with artificial intelligence (AI) capabilities;
• Developing/adapting remote in-home monitoring systems to assist persons with AD/ADRD and/or their caregivers/care partners;
• Designing personal voice prompts with AI capabilities that allow for visual reminders, medical aids and communication aids;
• Developing artificial intelligence to assist families in caring for family members with AD/ADRD and to assist formal care providers helping such families;
• Designing/validating autonomous architecture, including robotics, for persons with AD/ADRD and other forms of cognitive impairment or apathy;
• Assessing the feasibility, acceptability and tolerance of the technology-mediated intervention;
• Designing/developing platforms (including robotics) that quickly adapt to changes in persons with AD/ADRD and to changes in their caregivers/care partners;
• Developing intelligent assistive technology, including SARs, for patient-care management (e.g., dispensing medications, monitoring vital signs, and communicating with informal and formal care providers);
• Enabling and supporting persons with AD/ADRD in living independently and safely in different environments (e.g., urban versus rural homes or in assisted-living facilities);
• Using technology (e.g., SARs) to promote social interaction and engagement and reduce loneliness among persons with AD/ADRD and their caregivers/care partners;
• Developing technology to motivate persons with AD/ADRD, and their caregivers/care partners, to be physically active;
• Assisting care providers/care partners in carrying out (and completing) awkward, unsafe, and/or physically stressful caregiving tasks;
• Providing mobility assistance to persons with AD/ADRD;
• Developing technologies that are culturally acceptable in diverse populations.

Design requirements for the FOA:

Interoperability between systems: As home automation and assistive technologies become more prevalent, there is an increasing need to integrate data from multiple systems and devices. Persons with AD/ADRD and their caregivers/care partners may benefit from multiple types of assistive technologies, which ideally would communicate with one another to promote optimal outcomes. However, most assistive technologies are developed in relative isolation. Although interoperability and communication between systems may be overlooked by developers, it may enhance the effectiveness of multiple types of assistive technologies.

Personalization: Persons with AD/ADRD and their caregivers/care partners have different needs. Cognitive impairment manifests in a variety of ways and ranges in severity both across individuals and within individuals over time. Assistive technologies should be personalized to the needs of the end user(s). Moreover, assistive technologies would ideally adjust themselves over time to meet the changing needs of the end user(s).

User-centered design: A recent review found that only 40 percent of assistive technologies related to AD/ADRD developed between 2000 and 2015 were explicitly designed through user-centered approaches, such as cooperative and participatory models throughout the design process. Similarly, a 2005 focus group comprising 15 individuals aged 65 and older reported concerns that future development of assistive technologies may follow technological trends rather than be designed specifically to address the needs of persons with AD/ADRD and their caregivers/care partners. Incorporating end users earlier in the design process of future technologies may lead to products that are more effective or adopted more readily by the target audience.

Artificial emotional intelligence: Today, most assistive technologies related to AD/ADRD provide physical or cognitive support. However, patients with dementia often face emotional and social challenges such as anxiety, depression, and agitation. Assistive technologies that incorporate artificial emotional intelligence could ease the burden on caregivers/care partners and provide emotional support to persons with AD/ADRD when they are alone.   

See Section VIII. Other Information for award authorities and regulations.