This paper is in the following e-collection/theme issue:

Scoping Review Protocols (176) Dementia and Cognitive Decline (473) Home Care (170) Assistive Technologies (114) Reviews on Innovation in Rehabilitation and Assistive Technologies (49) Assisted Living for the Elderly and Nursing Home Care (160) Supporting Home Care and Family Caregivers (190) Reviews on Human Factors (52)

Published on in Vol 13 (2024)

This is a member publication of University of Toronto

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/57036, first published .
Assistive Technology to Support Dementia Management: Protocol for a Scoping Review of Reviews

Assistive Technology to Support Dementia Management: Protocol for a Scoping Review of Reviews

Assistive Technology to Support Dementia Management: Protocol for a Scoping Review of Reviews

Authors of this article:

Chaitali Desai1, 2 Author Orcid Image ;   Erica Dove1, 2 Author Orcid Image ;   Jarshini Nanthakumar3 Author Orcid Image ;   Emilia Main4 Author Orcid Image ;   Heather Colquhoun1, 3 Author Orcid Image ;   Arlene Astell1, 2, 3, 5 Author Orcid Image ;   Alex Mihailidis1, 2, 3 Author Orcid Image ;   Natasha Layton6, 7 Author Orcid Image ;   Amer M Burhan8, 9, 10 Author Orcid Image ;   Brian Chan1, 2, 11 Author Orcid Image ;   Rosalie H Wang1, 2, 3 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    Protocol

    1Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    2KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

    3Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    4Library and Information Services, University Health Network, Toronto, ON, Canada

    5Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom

    6Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    7Australian Rehabilitation and Assistive Technology Association (ARATA), Beaumaris, Australia

    8Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    9Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada

    10Toronto Dementia Research Alliance, Toronto, ON, Canada

    11Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Corresponding Author:

    Chaitali Desai, MSc, PEng

    Rehabilitation Sciences Institute

    Temerty Faculty of Medicine

    University of Toronto

    500 University Avenue

    Suite 160

    Toronto, ON, M5G 1V7

    Canada

    Phone: 1 416 946 8573

    Email: chaitali.desai@mail.utoronto.ca


    Background: In Canada, more than 60% of persons living with dementia reside in their own homes, and over 25% rely heavily on their care partners (ie, family members or friends) for assistance with daily activities such as personal hygiene, eating, and walking. Assistive technology (AT) is a key dementia management strategy, helping to maintain health and social support in home and community settings. AT comprises assistive products and services required for safe and effective use. Persons living with dementia and their care partners often require multiple types of AT to maintain their needs, dignity, and autonomy. AT for dementia management is rapidly developing with abundant scientific literature, which can present a challenge to efficiently navigate and extract insights for policy and personal decision-making.

    Objective: This scoping review aims to synthesize review-level evidence from published scientific literature on AT to support dementia management for persons living with dementia and their care partners in their homes and communities. Research gaps in knowledge and areas for further investigation into the use and access of AT will be identified. This review will provide an overview of AT types and characteristics and chart the outcomes and conclusions in review-level evidence.

    Methods: This review will follow the Joanna Briggs Institute’s framework for conducting scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 6 electronic databases will be searched. Articles will be screened according to the “Population-Concept-Context (PCC)” framework for eligible studies. Population includes persons living with dementia, their care partners, and health care professionals (eg, therapists or others who recommend AT). Concept includes AT and self-help devices of many types. Context includes homes and communities. A data charting template will guide data extraction, charting, and summarization. A descriptive numerical summary and an overview of the findings will be presented. Data, such as (1) article information (eg, author and year), (2) article characteristics (eg, review type), (3) AT types and characteristics, (4) setting and population characteristics, and (5) key review outcomes and conclusions, will be extracted.

    Results: A total of 10,978 unique citations were identified across the 6 electronic databases. This review is in the full-text screening stage, which is expected to be completed by October 2024.

    Conclusions: This review will provide a comprehensive understanding and documentation of the published scientific literature on AT to support dementia management. Findings from this review are expected to provide evidence-based insights on the complexities of AT types, uses, availability, and access. The author group’s diverse national and international perspectives may contribute to knowledge exchange and influence standards to improve the daily function, safety, and well-being of persons living with dementia.

    Trial Registration: Open Science Framework DKSM9; https://osf.io/dksm9

    International Registered Report Identifier (IRRID): PRR1-10.2196/57036

    JMIR Res Protoc 2024;13:e57036

    doi:10.2196/57036

    Keywords

    assistive technology; assistive products; dementia; care partners; caregivers; elderly 


    Background

    As the population ages, the number of older adults affected by dementia, most commonly being Alzheimer disease, is expected to triple by 2050 [1]. Age is a significant risk factor for dementia [1]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), dementia, a major neurocognitive disorder, refers to a significant decline over time in one or more cognitive domains (“executive function, complex attention, memory, language, learning perceptual-motor, social cognition”) [2]. The degree of dementia severity is determined by its impact on the ability of persons living with dementia to independently carry out activities of daily living [2,3]. In Canada, more than 60% of persons living with dementia reside in their own homes, and over 25% rely heavily on their care partners (ie, family members or friends) for assistance with daily activities such as personal hygiene, eating, and walking [4]. However, care partners face challenges in supporting persons living with dementia due to competing demands (eg, children and jobs), resulting in around two-thirds of care partners experiencing stress and depressive symptoms [5]. To effectively manage dementia at home and cope with symptoms, persons living with dementia and their care partners need diverse strategies and interventions beyond medication alone [1,6-8]. With an aging population, the risks of developing dementia pose a major public health concern. As such, there is heightened interest and urgency for strategies and interventions to maintain health and social support for persons living with dementia and their care partners. Assistive technology (AT) is a key dementia management strategy [9], enabling persons living with dementia to live at home longer [4,10] and contributing to maintained health and social services in home and community settings [11].

    Assistive Technology

    AT is the umbrella term for the combination of assistive products and the services needed to ensure safe assessment, distribution, and use of assistive products [12,13]. As defined by the International Organization for Standardization (ISO), assistive products (ie, devices, software, equipment, or instruments) maintain or improve a person’s functionality and reduce disability [14]. The services associated with AT refer to the “human factors” necessary to fit the product to the person, environment, and task, and include the application of organized knowledge and skills to the provision, use, and assessment of assistive products [12,15,16]. AT is most effective when provided with “early intervention, careful assessment, the correct prescription, and home-based follow-up training in how to use AT” [17]. AT is closely associated with environmental interventions (eg, home modifications), forming a technology chain of supports [18]. There has been rapid development of technological supports for older people and people with disabilities, including for those with functional limitations due to dementia [19]. Persons living with dementia and their care partners often require multiple types of AT to meet their needs and maintain their dignity and autonomy. AT includes products such as a wheelchair, medication reminder, appliance monitor, wayfinding device, and mobile app for navigation assistance [17], involving both access to the product and assessment, trial, training, maintenance, and follow-up services [15].

    Rationale

    A growing body of research is focused on developing, evaluating, and understanding AT applications for dementia management to promote the well-being of persons living with dementia and alleviate the strain experienced by their care partners [10,11,20-22]. For example, monitoring technologies for persons living with dementia have been found to increase feelings of safety and security, promote their independence, and reduce care partner strain [10,23-27]. Reminder systems have been shown to increase the execution of daily activities such as taking medications, eating and drinking [10,28-31]. AT that target safety in the homes of persons living with dementia have been observed to reduce falls and accidents and decrease care partner strain [32]. Information and communication technologies (eg, mobile devices, apps, and the internet) have been used to support cognitive stimulation and emotional well-being in persons living with dementia and social support and education for care partners [10]. The abundance of diverse and broad-ranging published reviews, compounded by the rapid development of technological supports for older people and people with disabilities [19], presents a challenge for researchers, policy makers, persons living with dementia and their care partners, and health care professionals (eg, therapists) who recommend AT for dementia management, to efficiently navigate and extract valuable insights for policy and personal decision-making regarding AT to support dementia management. Therefore, a scoping review of reviews is warranted to comprehensively, systematically, and feasibly map the scientific literature in this field.

    Review Objectives

    This paper outlines a protocol for a scoping review of reviews that aims to synthesize review-level evidence from published scientific literature on AT to support dementia management for persons living with dementia and their care partners in their own homes and communities. This synthesis will identify research gaps in knowledge and areas for further investigation regarding the use and access of AT by persons living with dementia, their care partners, and health care professionals (eg, therapists) who recommend AT for dementia management. This review will also chart the key outcomes used and conclusions made in review-level evidence.


    Terminology, Definitions, and Classifications

    Dementia

    While age is a significant risk factor for dementia [1], cognitive decline can also impact younger individuals [2]. The recent versions of the Diagnostic and Statistical Manual of Mental Disorders (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] and DSM-5-TR) criteria have updated the definition to “major neurocognitive disorder,” offering a broader perspective [2] of the conditions that fall under the umbrella of major neurocognitive disorder (previously known as dementia). The evolving understanding of dementia in DSM-5-TR will guide the screening process, providing this review with more relevant and applicable articles. However, considering the term “dementia” continues to be used in society and medical literature [2,33], it will be used in this review.

    Assistive Technology

    AT for persons living with dementia has rapidly developed, and the scope of this field is broad, diverse, and extensive in Canada and beyond. Therefore, subjective interpretations may arise when defining, categorizing, or classifying AT for persons living with dementia. There is inconsistency in the terminology used in the literature and geographical regions in relation to AT [34]. The literature often uses vague and interchangeable terms such as AT, products, services, devices, technologies, equipment, aids, and supports. However, the term “assistive products” is now preferred and commonly used internationally, including the World Health Organization’s (WHO) [11] and ISO’s [14] definitions. In this protocol, we will substitute the term “AT” used in previous literature with “assistive products” when it is clear that only products, not services, are being referenced.

    Assistive Products—Classification and Terminology (ISO 9999:2022)

    There are several classifications for AT interventions for persons with disabilities, such as the global standardized nomenclature for medical devices (Global Medical Device Nomenclature [GMDN] and Systematized Nomenclature of Medicine [SNOMED]) [35], WHO’s International Classification of Functioning, Disability and Health (ICF) [36], and ISO 9999:2022 Assistive Products—Classification and Terminology [14]. Although standards are regularly updated, as in WHO ICF [37], and the definition of disability encompasses (ie, does not exclude) age and progressive conditions such as dementia, there is no focal sublist of classifications focused exclusively on dementia [38]. ISO 9999 is a related member of the WHO Family of International Classifications (FIC) [14], which provides high-quality classifications for relevant health sectors [37]. Therefore, it is most appropriate to use the ISO 9999 taxonomy in categorizing or classifying the types and characteristics of AT encountered in this review, providing this review with precise guidance [39].

    ISO 9999 defines 11 classes, subclasses, and divisions of assistive products that are most relevant to optimizing functioning and reducing disability [14] (refer to Table 1 for the 11 classes of assistive products). This approach proves especially valuable when many countries use varying names to refer to the same product category and help specify definitions and identify the conceptual boundaries [40,41] of the AT types and characteristics important to manage dementia at home. This approach also aligns with the work carried out in Australia by one of the coauthors of this review (NL), offering an international perspective.

    Table 1. International Organization for Standardization (ISO) 9999:2022 classes of assistive products.
    CodeTitle
    04“Assistive products for measuring, stimulating or training physiological and psychological functions”
    06“Orthoses and prostheses”
    09“Assistive products for self-care activities and participation in self-care”
    12“Assistive products for activities and participation relating to personal mobility and transportation”
    15“Assistive products for domestic activities and participation in domestic life”
    18“Furnishings, fixtures and other assistive products for supporting activities in indoor and outdoor human-made environments”
    22“Assistive products for communication and information management”
    24“Assistive products for controlling, carrying, moving and handling objects and devices”
    27“Assistive products for controlling, adapting or measuring elements of physical environments”
    28“Assistive products for work activities and participation in employment”
    30“Assistive products for recreation and leisure”

    Scoping Review of Reviews

    The protocol design was initially informed by establishing the need for a scoping review of reviews (instead of a scoping review). The information specialists (Maureen Pakosh and EM) from the Department of Library and Information Services at the University Health Network, with the first author (CD), conducted an exploratory literature search on AT to support dementia management. Following this search, CD consulted with the principal investigators (RHW and BC) to clarify and establish the review question, Population-Concept-Context (PCC) framework for eligible studies [42,43], and design of this review. Due to the abundance of diverse and broad-ranging published reviews found in this topic area, a scoping review of reviews was selected to map the scientific literature comprehensively, systematically, and feasibly on AT to support dementia management.

    This review will follow the Joanna Briggs Institute (JBI) methodological framework and guidance for conducting scoping reviews [42] and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist for reporting results [42,43]. This review will use the PRISMA-ScR sections that are consistent with our review of reviews and justification for areas that are not reported will be presented in the final review article. The main elements of this scoping review framework include (1) review question, (2) search strategy, (3) inclusion and exclusion criteria, (4) sources of evidence selection, (5) data charting, and (6) analysis of the evidence and presentation of results. A consultation process with diverse interest-holder groups to validate and disseminate findings will be included in this review. Guidance for the exploratory review question and broad search for relevant studies will come from the PCC framework for eligible studies [42,43]. As the main objective of this review is to describe the state of the scientific literature, a quality assessment will not be conducted [40,42,44-46].

    This scoping review protocol is registered with the Open Science Framework (OSF) [47]. When conducting this review, any protocol amendments will be documented in the OSF and final paper. Once this review is complete, the results will be disseminated through publications and conferences on AT, health care policies, and dementia topics.

    Review Question

    This scoping review of reviews will be guided by the question, “What AT types and characteristics have been documented in the scientific literature to support dementia management for persons living with dementia and their care partners in their own homes and communities?”

    The review question is formulated using the PCC framework for eligible studies [42,43] (Table 2).

    Table 2. The Population-Concept-Context (PCC) framework for eligible studies.
    ConceptDeterminants
    Population (P)
    • Persons living with dementia
    • Care partners of persons living with dementia
    • Health care professionals (eg, therapists) who recommend ATa to persons living with dementia and their care partners for dementia management
    Concept (C)
    • AT types and characteristics to support dementia management
    Context (C)
    • Persons living with dementia and their care partners in their own homes and communities

    aAT: assistive technology.

    Search Strategy

    The search strategy will include a previous review of relevant literature by the first author (CD), informing the initial list of search terms and strategy. Subject matter experts (AA, AM, BC, HC, and RHW) and 2 information specialists (Maureen Pakosh and EM) will provide additional inputs and revisions. The search strategy, subject headings, and corresponding free-text terms will be informed by the priority assistive products list [13], the ISO 9999 classification and terminology standard for assistive products [14], and My AT Outcomes Framework (MyATOF) [8]. The priority assistive products list was introduced by the WHO as the first stage of implementing a global commitment to improve access to assistive products—the Global Cooperation on Assistive Technology (GATE) [13]. MyATOF is an Australian framework that integrates AT process principles and outcomes research, directing interest-holders in articulating AT usage through 6 dimensions (ie, supports, outcomes, costs, rights, service delivery, and consumer experience) [48].

    The search scope will remain broad by using 2 PCC concepts (population and concept) from the PCC framework in Table 2. As this scoping review will not compare AT interventions with other dementia management strategies (eg, medical devices and treatments for dementia) [49], no comparison terms will be incorporated into the search.

    The initial iterations of the search included synonyms of AT (eg, self-help devices) and terms related to technology (eg, computers and electronics). However, since AT is a broad concept, additional terms will be generated through review of the above sources and discussion among the research team to ensure comprehensive representation of AT products and functional abilities addressed by AT. In addition to types of products (eg, computers and wheelchairs), terms combining functional activities (eg, eating and drinking) and technology (eg, device, product, and tool) will provide additional sensitivity to the search (Multimedia Appendix 1). Using this strategy limits the need to include all potential products (eg, potato peelers), which would be impractical and unlikely to yield results in the scientific literature.

    The search process will be conducted in collaboration with Maureen Pakosh and EM. Maureen Pakosh will develop the initial draft search strategies in 6 electronic databases, including APA PsycINFO (Ovid), CINAHL Ultimate (EBSCOhost), Embase (Ovid), Emcare Nursing (Ovid), Medline ALL (Ovid), and Web of Science Core Collection. Decisions regarding the search terms and the search process will be resolved over multiple iterations of the search strategy through discussion among the research team (AA, AM, AMB, BC, CD, ED, EM, HC, JN, NL, and RHW).

    Following additional consultation with diverse interest-holder groups (refer to Consultation Process under the Methods section), EM will revise the initial MEDLINE search strategy, as necessary. The MEDLINE search strategy will be peer-reviewed by a third rehabilitation information specialist (Jessica Babineau) following PRESS (Peer Review of Electronic Search Strategies) guidelines [50]. A study design filter will be included to limit the results to reviews. No date or language restrictions will be imposed on the search; however, non-English results will be excluded during the title, abstract, and full-text screening stages.

    Based on the MEDLINE search strategy, EM will conduct corresponding searches in the 6 electronic databases above. The search will include articles from database inception to July 2023. Bibliographic duplicates will be removed by EM using EndNote 20 (Clarivate) [51] and an adapted Bramer method [52,53]. Deduplicated results will be uploaded into Covidence (Veritas Health Innovation Ltd), a software platform designed for screening and data extraction [54], by CD.

    Inclusion and Exclusion Criteria

    The screening process will be guided by the PCC inclusion and exclusion criteria (Textbox 1).

    Textbox 1. Inclusion and exclusion criteria.

    Inclusion criteria

    • Population
      • Persons living with dementia (dementia, as a major neurocognitive disorder, is defined as cognitive decline over time in one or more cognitive domains [“executive function, complex attention, memory, language, learning, perceptual-motor, social cognition”] [2] and interference with independence in daily activities such as managing finances or medication [2]. Dementia may be due to a range of subtypes such as “Alzheimer’s disease, frontotemporal degeneration, Lewy body disease, vascular disease, traumatic brain injury, substance or medication use, HIV infection, prion disease, Parkinson’s disease, Huntington’s disease” [2].)
      • Care partners (ie, family members or friends) of persons living with dementia
      • Health care professionals (eg, therapists) who recommend assistive technology (AT) to persons living with dementia and their care partners for dementia management
      • Persons living with dementia and care partners of any age, gender, or ethnicity, living in any country or region
    • Concept
      • AT, that is, assistive products (devices, software, equipment, or instruments) and associated services that maintain or improve a person’s functioning and independence [14]
      • AT that falls under the 11 classes of assistive products classified by International Organization for Standardization (ISO) 9999 [14] (Table 1)
    • Context
      • Persons living with dementia living in their own home and community (a home and community is where an individual can live safely, independently, and comfortably [55] as they age, with access to health and social support [56].)

    Exclusion criteria

    • Population
      • Persons living without dementia
      • Persons living with cognitive decline not due to dementia
      • Persons living with cognitive decline exclusively due to mild cognitive impairment or mild neurocognitive disorder (mild cognitive impairment, or mild neurocognitive disorder, is defined as a modest impairment in several cognitive domains and not interfering with independence in daily activities [2].)
      • Persons living with cognitive decline exclusively due to delirium (delirium is defined as “disturbance in attention (ie, reduced ability to direct, focus, sustain, and shift attention)” [2], with reduced environmental awareness, over a short period of time [2].)
      • Persons living with cognitive decline exclusively due to another mental disorder such as major depressive disorder, schizophrenia, etc [2]
    • Concept
      • AT used for prevention, assessments, monitoring, diagnosis, and treatment will not be included unless the AT is used to help persons living with dementia maintain or improve functioning and independence in their daily lives
    • Context
      • Persons living with dementia living exclusively in a shared communal environment (shared communal environments offer 24-hour, 7-day-a-week supervised on-site care, including health care, personal care, meals, laundry, and housekeeping [57]. Among these are long-term care homes and facilities, known within Canada as “nursing homes, personal care facilities, residential continuing care facilities, etc.” [55])
      • Hospitals, primary care ambulatory or outpatient clinics and doctor’s offices

    Types of Evidence Sources

    Articles of any type of review methodology (eg, scoping review, systematic review, and narrative review) published in peer-reviewed journals will be included. Therefore, researchers with expertise in both quantitative and qualitative methodologies will contribute to the development of the narrative. Non–peer-reviewed articles, protocols, theses or dissertations, editorials, conference abstracts, gray literature, and non-English articles will be excluded.

    Source of Evidence Selection

    Title and Abstract Screening

    A total of 3 reviewers (CD, ED, and JN) will be involved in the title and abstract screening process. The first author (CD) will independently screen all eligible articles in Covidence [46] to determine their suitability for a full-text review according to the PCC inclusion and exclusion criteria. Subsequently, each secondary reviewer (ED and JN) will screen a subset of articles independently. CD will monitor the level of agreement between the reviewers throughout the screening process. Covidence will export the agreement proportion to Microsoft Excel. Designating each article into yes, no, or maybe categories and the reasons for these designations will be recorded in Covidence [54]. Predefined tags in Covidence will be created to ensure ease of recording reasons for exclusion throughout the screening process. The reviewers will meet throughout the process to discuss their decisions and reasons for including or excluding articles. Any discrepancies will be resolved in discussion with the principal investigators (BC and RHW). The JBI recommended procedure for pilot testing will be used for the title and abstract screening stage [42]. CD, in collaboration with the research team, will critically analyze the final sample of articles sent to full-text screening to inform the creation of the data charting template. The data charting template will be developed in Microsoft Excel [58].

    Full-Text Screening

    In total, 3 reviewers (CD, ED, and JN) will be involved in the full-text screening process. The first author (CD) will independently conduct the screening in Covidence [54] to determine their inclusion in the scoping review. Subsequently, each secondary reviewer (ED and JN) will screen a subset of full-text articles independently. CD will critically analyze the final sample of studies, and all reviewers will be involved in the charting process. At the full-text screening stage, the reviewers may request further details about an article directly from the corresponding author. The number of articles reviewed and included will be outlined in a PRISMA-ScR flow diagram [59], with reasons for exclusion at the full-text level. The reviewers will continue to meet throughout to discuss their decisions and reasons for including or excluding articles. Discussions with the principal investigators (BC and RHW) will occur to resolve any discrepancies. The JBI-recommended procedure for pilot testing will be used for the full-text screening stage [42]. CD, in collaboration with the research team, will critically analyze the final sample of articles sent for data charting to inform the revision of the data charting template if necessary.

    Data Charting

    Once the articles are fully reviewed, the data will be extracted, charted, and integrated into a comprehensive format (ie, table). The data charting template will be used to capture relevant data from included articles to meet the objectives of this scoping review. An example of the data to be extracted is described in Table 3.

    Table 3. Data extraction template.
    Type of dataDescription of data
    Article informationAuthor, publication year, country, journal name, and location of publication.
    Article characteristicsReview type, number of studies included in the review, and reported time period of studies included.
    ATa types and characteristicsAll AT types and characteristics described in the review, and the purpose of AT described for and used by persons living with dementia, their care partners, and health care professionals (eg, therapists) who recommend AT to persons living with dementia and their care partners.
    Setting and population characteristicsCountry or region, type of home and community setting described where AT is used, available or recommended.
    Age, sex, gender, or ethnicity. Given women’s higher risk for dementia [60] and increased likelihood to be care partners [61], participants’ sex and gender, and gender-related factors influencing AT use and access, will be collected [60,61].
    Key review outcomes and conclusions Main findings, outcomes, and conclusions drawn from each article.

    aAT: assistive technology.

    The JBI-recommended procedure for pilot testing will be used for data extraction [42]. A total of 3 reviewers (CD, ED, and JN) will independently conduct a pilot test to extract data from at least 3 full-text articles. The pilot test findings will be refined and adjusted through team discussions. The pilot test will continue until reviewers adequately understand the data charting template, context, and process of data extraction.

    Following the completion of the pilot test, reviewers will proceed to extract data from all full-text articles using the data charting template. If specific information is unavailable, reviewers may contact the study authors to obtain it. As the review progresses, the reviewers may extract additional information of relevance to address the scoping review objectives and revise the data charting template accordingly [42]. In conducting this scoping review, the focus is on synthesizing and analyzing existing reviews. Therefore, the scope of this review will not include an in-depth analysis of individual primary studies.

    Analysis of the Evidence and Presentation of Results

    After extracting the data from included full-text articles, the data will be synthesized using descriptive analysis (eg, frequencies, means, and ranges). A descriptive numerical summary and overview of the findings will be presented in tabular format.

    Consultation Process

    The Project Advisory Committee (PAC), comprising persons living with dementia, care partners, researchers, partner and network organization representatives, and knowledge user partners who have a direct interest in the outcomes of this research [62], will be consulted for their inputs. They will also provide resources to complete this scoping review and assist in knowledge dissemination strategies and activities. The PAC convenes every 4 to 6 months. PAC members will also be consulted individually on matters where there is expertise in content, methodology, analyses, and knowledge mobilization and dissemination.

    Ethical Considerations

    This review does not involve collecting any data from human or animal participants; therefore, research ethics approval is unnecessary.


    Across the 6 electronic databases (APA PsycINFO [Ovid], CINAHL Ultimate [EBSCOhost], Embase [Ovid], Emcare Nursing [Ovid], Medline ALL [Ovid; includes PubMed non-MEDLINE records], and Web of Science Core Collection), 21,747 results were retrieved. After deduplication, 10,978 unique citations were retained. A search strategy for MEDLINE is provided in Multimedia Appendix 1. This review is in the full-text screening stage, which is expected to be completed by October 2024.


    Anticipated Findings

    This review will provide a comprehensive understanding and documentation of the published scientific literature on AT to support dementia management. Findings from this review are expected to provide evidence-based insights to diverse groups of interest-holders to facilitate discussions on the complexities of current AT types, uses, availability, and access for persons living with dementia and their care partners. Furthermore, the author group’s diverse national and international perspectives may contribute to knowledge exchange and influence standards to improve the daily function, safety, and well-being of persons living with dementia.

    Findings from this review will also lay the groundwork for a larger Canadian Institute of Health Research (CIHR)–funded project to examine the creation and economic evaluation of combining different AT into effective bundles or packages [15,63-67] for dementia management in Canada and beyond. This work aligns with national initiatives such as the Canadian Dementia Strategy [68] and global recommendations by the WHO regarding the formulation of a comprehensive “Package of Interventions for Rehabilitation” for health conditions, including dementia [69].

    The field of AT for dementia management continues to grow [10,11,19-22], with an abundance of diverse and broad-ranging published reviews focused on developing, evaluating, and understanding AT applications. Despite its considerable impact on the field, there are still challenges to efficiently navigate and extract valuable insights regarding AT for policy and personal decision-making. This scoping review of reviews is therefore warranted to map the scientific literature in this area comprehensively, systematically, and feasibly.

    Limitations

    This scoping review may have limitations. First, this review does not incorporate searches of gray literature and other non–peer-reviewed academic resources. As the development of AT is rapidly progressing, these advancements may not be documented in the existing scientific literature. In addition, only review articles will be considered for inclusion, and if there are AT interventions reported exclusively in primary reports, they may not be captured in this review. An independent environmental scan will be conducted by members of the research team (CD, BC, JN, and RHW) as a separate review, encompassing various documents and resources not typically accessible through scientific databases. These documents and resources may include organizational websites, policy documents, reports, magazine articles, newsletters, and blogs. Second, the search strategy may miss relevant reviews due to the selected databases lacking coverage of all published literature, inaccuracies in database indexing, and the broad scope of AT and complexity and limitations of terms used [70]. This limitation is addressed by searching multiple bibliographic databases and using a comprehensive set of search terms covering both products and relevant functional abilities. In addition, to mitigate these risks, a hand-search of the reference lists of relevant articles will be considered to identify any further citations that may have been overlooked during the initial electronic database search. However, the reviews may exclude other languages as well. It is also possible that the search strategy may limit the types of AT that appear in the results because the search terms are based on established terminology and categories of AT. Finally, only studies written in English will be included, which may exclude relevant reviews from non–English-speaking countries or regions, limiting our findings’ generalizability and applicability.

    Although limitations may exist, this scoping review will enable a comprehensive understanding and documentation of the types and characteristics of AT to support dementia management for persons living with dementia and their care partners in their own homes and communities.

    Conclusions

    The knowledge synthesized from this review may broadly serve as a framework to create greater insights into dementia management using AT [61] among persons living with dementia; their care partners; and various other interest-holders groups, such as health care professionals (eg, therapists) who recommend AT to persons living with dementia and their care partners, policy makers, researchers, partner organizations, and networks. It is also anticipated that the research community may benefit from the generated knowledge from this review to formulate new research inquiries and approaches for larger-scale studies on AT use and access by persons living with dementia and their care partners for dementia management.

    Acknowledgments

    We would like to thank Maureen Pakosh and Jessica Babineau, information specialists from Library and Information Services at the University Health Network, for supporting the development of the Medline search strategy.

    We would also like to thank the Project Advisory Committee (PAC) members for providing feedback on the initial research question, methodology, and the Population-Concept-Context (PCC) framework for eligible studies described in the protocol.

    CD is supported by the Alzheimer Society Research Program (ASRP), Doctoral Award (Application 32). This research is supported by a Canadian Institute of Health Research Project Grant (Fund PJT 183816) held by RHW and BC.

    Authors' Contributions

    CD contributed to conceptualization, methodology, writing—original draft, reviewing, and editing. ED contributed to writing—original draft, review, and editing. JN contributed to methodology and writing—original draft, review, and editing. EM, HC, and NL contributed to methodology and writing—review and editing. AA, AM, and AMB contributed to writing—review and editing. BC and RHW contributed to supervision, resources, conceptualization, methodology, writing—original draft, review and editing.

    Conflicts of Interest

    None declared.

    Multimedia Appendix 1

    MEDLINE search strategy.

    DOCX File , 16 KB
    1. Landmark Study report #1: navigating the path forward for dementia in Canada. Alzheimer Society of Canada. Sep 6, 2022. URL: http://alzheimer.ca/en/research/reports-dementia/landmark-study-report-1-path-forward [accessed 2023-07-12]
    2. American Psychiatric Association. Neurocognitive disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC. American Psychiatric Association; 2022.
    3. What is dementia? Alzheimer Society of Canada. URL: http://alzheimer.ca/en/about-dementia/what-dementia [accessed 2023-07-12]
    4. Dementia in home and community care. CIHI. URL: https:/​/www.​cihi.ca/​en/​dementia-in-canada/​dementia-care-across-the-health-system/​dementia-in-home-and-community-care [accessed 2023-07-13]
    5. Papastavrou E, Kalokerinou A, Papacostas SS, Tsangari H, Sourtzi P. Caring for a relative with dementia: family caregiver burden. J Adv Nurs. 2007;58(5):446-457. [CrossRef] [Medline]
    6. Dixon E, Piper AM, Lazar A. "Taking care of myself as long as I can": how people with dementia configure self-management systems. Proc SIGCHI Conf Hum Factor Comput Syst. 2021;2021:656. [FREE Full text] [CrossRef] [Medline]
    7. Thyrian JR, Hertel J, Wucherer D, Eichler T, Michalowsky B, Dreier-Wolfgramm A, et al. Effectiveness and safety of dementia care management in primary care: a randomized clinical trial. JAMA Psychiatry. 2017;74(10):996-1004. [FREE Full text] [CrossRef] [Medline]
    8. Poon NY, Ooi CH, How CW, Yoon PS. Dementia management: a brief overview for primary care clinicians. Singapore Med J. 2018;59(6):295-299. [FREE Full text] [CrossRef] [Medline]
    9. Canada's elder care crisis: addressing the doubling demand. Canadian Medical Association. URL: https://www.cma.ca/latest-stories/demand-elder-care-set-double-10-years-new-report-commissioned-cma [accessed 2023-07-13]
    10. Pappadà A, Chattat R, Chirico I, Valente M, Ottoboni G. Assistive technologies in dementia care: an updated analysis of the literature. Front Psychol. 2021;12:644587. [FREE Full text] [CrossRef] [Medline]
    11. Assistive technology. World Health Organization. Jan 2, 2024. URL: https://www.who.int/news-room/fact-sheets/detail/assistive-technology [accessed 2023-07-12]
    12. Global report on assistive technology. World Health Organization. May 15, 2022. URL: https://www.who.int/publications-detail-redirect/9789240049451 [accessed 2023-10-10]
    13. Priority assistive products list. World Health Organization. Feb 1, 2016. URL: https://www.who.int/publications-detail-redirect/priority-assistive-products-list [accessed 2023-10-10]
    14. ISO 9999:2022. International Organization for Standardization. 2022. URL: https://www.iso.org/standard/72464.html [accessed 2023-07-12]
    15. de Witte L, Steel E, Gupta S, Ramos VD, Roentgen U. Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology. Disabil Rehabil Assist Technol. 2018;13(5):467-472. [FREE Full text] [CrossRef] [Medline]
    16. Khasnabis C, Mirza Z, MacLachlan M. Opening the GATE to inclusion for people with disabilities. Lancet. 2015;386(10010):2229-2230. [CrossRef] [Medline]
    17. Connell J, Grealy C, Olver K, Power J. Comprehensive scoping study on the use of assistive technology by frail older people living in the community. Analysis & Policy Observatory. Feb 8, 2011. URL: https://apo.org.au/sites/default/files/resource-files/2011-02/apo-nid23803.pdf [accessed 2023-10-10]
    18. MacLachlan M, Cho HY, Clarke M, Mannan H, Kayabu B, Ludolph R, et al. Web annex F: report of the systematic review on potential benefits of accessible home environments for people with functional impairments. World Health Organization. 2018. URL: https://apps.who.int/iris/bitstream/handle/10665/275844/WHO-CED-PHE-18.07-eng.pdf [accessed 2024-09-28]
    19. Global disabled and elderly assistive technologies industry. ReportLinker. URL: https://www.reportlinker.com/p05988003/Global-Disabled-and-Elderly-Assistive-Technologies-Ind [accessed 2023-07-12]
    20. Zeisel J, Bennett K, Fleming R. World alzheimer report 2020: design, dignity, dementia: dementia-related design and the built environment. Alzheimer's Disease International. 2020. URL: https://www.alzint.org/resource/world-alzheimer-report-2020/ [accessed 2023-07-12]
    21. Ienca M, Fabrice J, Elger B, Caon M, Scoccia Pappagallo A, Kressig RW, et al. Intelligent assistive technology for Alzheimer's disease and other dementias: a systematic review. J Alzheimers Dis. 2017;56(4):1301-1340. [CrossRef] [Medline]
    22. de Joode E, van Heugten C, Verhey F, van Boxtel M. Efficacy and usability of assistive technology for patients with cognitive deficits: a systematic review. Clin Rehabil. 2010;24(8):701-714. [CrossRef] [Medline]
    23. Pot AM, Willemse BM, Horjus S. A pilot study on the use of tracking technology: feasibility, acceptability, and benefits for people in early stages of dementia and their informal caregivers. Aging Ment Health. 2012;16(1):127-134. [FREE Full text] [CrossRef] [Medline]
    24. Olsson A, Engström M, Åsenlöf P, Skovdahl K, Lampic C. Effects of tracking technology on daily life of persons with dementia: three experimental single-case studies. Am J Alzheimers Dis Other Demen. 2015;30(1):29-40. [FREE Full text] [CrossRef] [Medline]
    25. White EB, Montgomery P, McShane R. Electronic tracking for people with dementia who get lost outside the home: a study of the experience of familial carers. Br J Occup Ther. 2010;73(4):152-159. [CrossRef]
    26. Williams K, Arthur A, Niedens M, Moushey L, Hutfles L. In-home monitoring support for dementia caregivers: a feasibility study. Clin Nurs Res. 2013;22(2):139-150. [FREE Full text] [CrossRef] [Medline]
    27. Nijhof N, van Gemert-Pijnen LJEWC, Woolrych R, Sixsmith A. An evaluation of preventive sensor technology for dementia care. J Telemed Telecare. 2013;19(2):95-100. [CrossRef] [Medline]
    28. McGoldrick C, Crawford S, Evans JJ. MindMate: a single case experimental design study of a reminder system for people with dementia. Neuropsychol Rehabil. 2021;31(1):18-38. [FREE Full text] [CrossRef] [Medline]
    29. Nishiura Y, Nihei M, Nakamura-Thomas H, Inoue T. Effectiveness of using assistive technology for time orientation and memory, in older adults with or without dementia. Disabil Rehabil Assist Technol. 2021;16(5):472-478. [CrossRef] [Medline]
    30. Hackett K, Lehman S, Divers R, Ambrogi M, Gomes L, Tan CC, et al. Remind me to remember: a pilot study of a novel smartphone reminder application for older adults with dementia and mild cognitive impairment. Neuropsychol Rehabil. 2022;32(1):22-50. [FREE Full text] [CrossRef] [Medline]
    31. Kamimura T, Ishiwata R, Inoue T. Medication reminder device for the elderly patients with mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2012;27(4):238-242. [FREE Full text] [CrossRef] [Medline]
    32. Brims L, Oliver K. Effectiveness of assistive technology in improving the safety of people with dementia: a systematic review and meta-analysis. Aging Ment Health. 2019;23(8):942-951. [CrossRef] [Medline]
    33. Emmady PD, Schoo C, Tadi P. Major neurocognitive disorder (dementia). StatPearls. Nov 19, 2022. URL: https://www.ncbi.nlm.nih.gov/books/NBK557444/ [accessed 2024-01-17]
    34. Elsaesser LJ, Layton N, Scherer M, Bauer S. Standard terminology is critical to advancing rehabilitation and assistive technology: a call to action. Disabil Rehabil Assist Technol. 2022;17(8):986-988. [CrossRef] [Medline]
    35. Global Medical Device Nomenclature Agency. SNOMED International. URL: https://www.snomed.org/standards-partnerships/global-medical-device-nomenclature-agency [accessed 2023-10-11]
    36. International Classification of Functioning, Disability and Health (ICF). World Health Organization. URL: https:/​/www.​who.int/​standards/​classifications/​international-classification-of-functioning-disability-and-health [accessed 2024-02-13]
    37. WHO Family of International Classifications Network. World Health Organization. URL: https://www.who.int/groups/who-family-of-international-classifications-network [accessed 2023-10-11]
    38. Senjam SS, Mannan H. Assistive technology: the current perspective in India. Indian J Ophthalmol. 2023;71(5):1804-1809. [FREE Full text] [CrossRef] [Medline]
    39. Bernd T, van der Pijl D, de Witte LP. Existing models and instruments for the selection of assistive technology in rehabilitation practice. Scand J Occup Ther. 2009;16(3):146-158. [CrossRef] [Medline]
    40. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. [CrossRef]
    41. Tricco AC, Lillie E, Zarin W, O'Brien K, Colquhoun H, Kastner M, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16:15. [FREE Full text] [CrossRef] [Medline]
    42. Peters M, Godfrey CM, McInerney P, Munn Z, Tricco A, Khalil H. Chapter 11: scoping reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Adelaide, Australia. JBI Global; 2020.
    43. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. Oct 02, 2018;169(7):467-473. [FREE Full text] [CrossRef] [Medline]
    44. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. [FREE Full text] [CrossRef] [Medline]
    45. Colquhoun HL, Levac D, O'Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291-1294. [CrossRef] [Medline]
    46. O'Brien KK, Colquhoun H, Levac D, Baxter L, Tricco AC, Straus S, et al. Advancing scoping study methodology: a web-based survey and consultation of perceptions on terminology, definition and methodological steps. BMC Health Serv Res. 2016;16:305. [FREE Full text] [CrossRef] [Medline]
    47. Open Science Framework (OSF). URL: https://osf.io/ [accessed 2023-07-13]
    48. Layton N, Callaway L, Wilson E, Bell D, Prain M, Noonan M, et al. My assistive technology outcomes framework: rights-based outcome tools for consumers to 'measure what matters'. Assist Technol. 2023:1-9. [CrossRef] [Medline]
    49. Goering S. Rethinking disability: the social model of disability and chronic disease. Curr Rev Musculoskelet Med. 2015;8(2):134-138. [FREE Full text] [CrossRef] [Medline]
    50. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40-46. [FREE Full text] [CrossRef] [Medline]
    51. Product details. EndNote. URL: https://endnote.com/product-details [accessed 2023-07-12]
    52. Bramer WM, de Jonge GB, Rethlefsen ML, Mast F, Kleijnen J. A systematic approach to searching: an efficient and complete method to develop literature searches. J Med Libr Assoc. 2018;106(4):531-541. [FREE Full text] [CrossRef] [Medline]
    53. Main E. Extending the Bramer method with EndNote 20: deduplicating with DOI. In: Journal of the Canadian Health Libraries Association Journal De l’Association Des bibliothèques De La Santé Du Canada. 2023. Presented at: CHLA 2023 Conference/Congrès de l’ABSC 2023; June 3, 2023:48-63; Halifax, NS. URL: https://doi.org/10.29173/jchla29720 [CrossRef]
    54. Covidence. URL: https://www.covidence.org/ [accessed 2023-07-12]
    55. CanAge. Submission to the call for contributions on older persons and the right to housing 2022 General Assembly Report. United Nations, Office of the High Commissioner for Human Rights. URL: http:/​/www.​ohchr.org/​sites/​default/​files/​documents/​issues/​olderpersons/​2022-report-right-housing/​ngos-csos/​2022-08-03/​submissions-older-persons-right-to-adequate-housing-Can-Age-en.​pdf [accessed 2023-10-10]
    56. Employment and Social Development Canada. Thinking about your future? Plan now to age in place – a checklist. Government of Canada. URL: https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/aging-checklist.html [accessed 2016-10-03]
    57. Long-term facilities-based care. Government of Canada. URL: https:/​/www.​canada.ca/​en/​health-canada/​services/​home-continuing-care/​long-term-facilities-based-care.​html [accessed 2003-04-03]
    58. Microsoft Excel spreadsheet software. Microsoft. URL: https://www.microsoft.com/en-ca/microsoft-365/excel [accessed 2023-07-12]
    59. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021;18(3):e1003583. [FREE Full text] [CrossRef] [Medline]
    60. Mielke MM. Sex and gender differences in Alzheimer's disease dementia. Psychiatr Times. 2018;35(11):14-17. [FREE Full text] [Medline]
    61. Dementia. World Health Organization. Mar 15, 2023. URL: https://www.who.int/news-room/fact-sheets/detail/dementia [accessed 2023-07-12]
    62. Boaz A, Hanney S, Borst R, O'Shea A, Kok M. How to engage stakeholders in research: design principles to support improvement. Health Res Policy Syst. 2018;16(1):60. [FREE Full text] [CrossRef] [Medline]
    63. MacLachlan M, Scherer MJ. Systems thinking for assistive technology: a commentary on the GREAT summit. Disabil Rehabil Assist Technol. 2018;13(5):492-496. [CrossRef] [Medline]
    64. MacLachlan M, Banes D, Bell D, Borg J, Donnelly B, Fembek M, et al. Assistive technology policy: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit. Disabil Rehabil Assist Technol. 2018;13(5):454-466. [FREE Full text] [CrossRef] [Medline]
    65. Savigny DD, Adam T. Systems thinking for health systems strengthening. World Health Organization. 2009. URL: https://apps.who.int/iris/handle/10665/44204 [accessed 2023-07-12]
    66. Layton N, Irlam C, National Aged Care Alliance. Assistive technology for older Australians: rapid evidence review and economic pathway analysis. Analysis & Policy Observatory. Jun 20, 2018. URL: https://apo.org.au/node/262176 [accessed 2023-07-12]
    67. Layton N. Economic pathway analysis for assistive technology: a pilot study from Australia. RESNA. 2018. URL: https://www.resna.org/sites/default/files/conference/2018/outcomes/Layton.html [accessed 2024-09-28]
    68. A dementia strategy for Canada: together we achieve - 2020 annual report. Government of Canada. URL: https:/​/www.​canada.ca/​en/​public-health/​services/​publications/​diseases-conditions/​dementia-strategy-annual-report-parliament-june-2020.​html [accessed 2023-07-12]
    69. Package of Interventions for Rehabilitation. World Health Organization. URL: https:/​/www.​who.int/​teams/​noncommunicable-diseases/​sensory-functions-disability-and-rehabilitation/​rehabilitation/​service-delivery/​package-of-interventions-for-rehabilitation [accessed 2023-10-10]
    70. Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):245. [FREE Full text] [CrossRef] [Medline]

    ‎
    AT: assistive technology
    CIHR: Canadian Institute of Health Research
    DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
    DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
    FIC: Family of International Classifications
    GATE: Global Cooperation on Assistive Technology
    GMDN: Global Medical Device Nomenclature
    ICF: International Classification of Functioning, Disability and Health
    ISO: International Organization for Standardization
    JBI: Joanna Briggs Institute
    MyATOF: My AT Outcomes Framework
    OSF: Open Science Framework
    PAC: Project Advisory Committee
    PCC: Population-Concept-Context
    PRESS: Peer Review of Electronic Search Strategies
    PRISMA-ScR: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews
    SNOMED: Systematized Nomenclature of Medicine
    WHO: World Health Organization

    Edited by A Mavragani; submitted 14.02.24; peer-reviewed by B Davis, S Thankam Varghese, A Rahgozar, A Hall; comments to author 13.06.24; revised version received 28.07.24; accepted 11.09.24; published 11.11.24.

    Copyright

    ©Chaitali Desai, Erica Dove, Jarshini Nanthakumar, Emilia Main, Heather Colquhoun, Arlene Astell, Alex Mihailidis, Natasha Layton, Amer M Burhan, Brian Chan, Rosalie H Wang. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.11.2024.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.