Acceptance and Use of Innovative Assistive Technologies among People with Cognitive Impairment and Their Caregivers: A Systematic Review

Table 2

Acceptance and adherence to innovative assistive technology (IAT).

First author, year	Type of technology	Outcome(s)	Facilitators	Barriers
Tech generation^1
(1) Boise et al 2013[19]; 2^nd generation	Sensor technology to detect cognitive changes and other health problems.	Willingness to share health- or activity data.	Acceptance of in-home monitoring and willingness to share data with one's doctor or family members.	Concerns related to privacy or security after one year of participation.
(2) Cahill et al 2007[20]; 1^st generation	The Automatic Night & Day Calendar; The Lost Item Locator; The Automatic Night Lamp; The Gas Cooker Device; The Picture Button Telephone	Use and usefulness of assistive technologies; Possible refinement and financially viable on the open market.	Familiarity may influence use and usefulness. Low level of technical demands means high level of acceptance and adherence. Informal caregiver was willing to pay for useful technology	Products should be more fully refined and pre-tested on a sample of cognitively intact people before being trialled in the homes of people with dementia. High level of technical demands means low level of use/ acceptance and adherence.
(3) Cavallo et al 2015[21]; 2^nd generation	A modular technological system to help caregivers monitor the health status, safety, and daily activities of patients with Alzheimer Disease.	Acceptability and usability features.	To support caregivers, not replace them, to guaranty suitability and thereby acceptance and adherence.	No information was given on the time frame of the experimental phase
(4) Chen et al 2012[22]; 1^st generation	Lost seeking devices	Actual needs of the elders in using the lost seeking devices and the problems they encountered.		The choice of lost seeking device depends on the education level of the caregivers. Support in that respect is needed to overcome barriers.
(5) Engström et al 2009[23]; 2^nd generation	Alarms, fall detectors, sensor-activated night-time illumination of the lavatory, and communication technology: Internet communication and additional computers.	Staff members' perceptions of an information and communication technology (ICT) support package during the process of implementation.	“Moving from fear of losing control to perceived increase in control and security”; Improvements in both formal and informal care.	“Struggling with insufficient/deficient systems”
(6) Granata et al 2013[24]; Robot; (4th generation)	Social assistive robot providing grocery shopping list and an agenda application.	Usability of robot interface.	Younger participants and those with previous computer experience were faster at completing the tasks.	More errors among participants with neurocognitive disorder (NCD). Being slower at completing tasks than peers contributed to less adherence
(7) Hattink et al 2016[25]; 3^rd generation	The Elderly Day Navigator; The Early Detection System; and The Unattended Autonomous Surveillance -; Advanced Awareness and Prevention System.	Usefulness and user-friendliness of the Rosetta system.		The user-friendliness of the system was not rated highly. Further development is needed.
(8) Hebesberger et al 2017[26]; Robot; (4th generation)	Long-term autonomous robot able to navigate and function independently over a longer period of time without any intervention by technicians.	Usability, social acceptance.		Interacting modalities have to meet the very needs of specific end-user. Perceived utility of a robot is very much tied to its tasks and proper functioning. Social acceptance was ambivalent.
(9) Imbeult et al 2013[27]; 3^rd generation	Virtual assistance system with cameras and motion sensors.	Workload reduction for prof caregivers, user satisfaction, acceptance and engagement for older people.	Positive results in terms of the satisfaction of the elderly and interaction in event handling, despite progression of the disease.
(10) Karlsson et al 2015[28]; 3^rd generation	The device consists of two parts: support memory, social contact, daily activities; and enhance the feeling of safety. Adjustable to meet the needs of the individuals using them.	Acceptance and usage of a new digital assistive device		Participant needs encompassed occupation, safety, social interaction, and memory support together with the receipt of general support. Requirement for both participants was a need to maintain their self-image. When the digital assistive device did not correspond with the participants’ expectations or view of themselves, their interest in using it faded.
(11) Kerkhof et al 2015[29]; 3^rd generation	Digital planning boards	To improve the use of these devices from the users’ perspectives.	The majority of the residents were happy with the use and function of the memory aid.	The occurrence of errors limits ease of use and lack of knowledge on function and use among user’s prevented adherence
(12) Kerssens et al 2015[30]; 3^rd generation	Touchscreen computer using audio-visual programs (“shows”).; Menu created based on Life Story and Care Needs interviews.	Usability, feasibility, and adoption	The technology was easy to use and significantly facilitated meaningful and positive engagement, and simplified daily lives.
(13) Khosla et al 2017[31]; Robot	Reminder on daily schedule, weather, news, date, and time. The robot can also make skype calls.	Acceptability while interacting with a social robot.	By using engagement assessment methods and robot acceptance model, the post-trial survey verified acceptance of and adherence to the interaction with social robots.
(14) Lazar et al 2015[32]; 3^rd generation	Touchscreen- a variety of applications	Perception of intervention - qualitative design.	By being aware of interests and limitations, facilitate participation and acknowledge emotions and individual barriers to adoption, and fitting technology into an establish routine, the informal caregiver was able to benefit from using the technology.
(15) Lazar et al 2016[33]; 3^rd generation	Same as above.	Perception of intervention - quantitative design.	The technology facilitated enjoyment, interactions, connections and mental stimulation.
(16) Lim et al 2013[34]; 3^rd generation	Tablet IAT	Usability of tablet as a source of leisure.	When clients were able to use the tablet computer independently, it proved to be helpful to their informal caregivers.	Adherence needs further exploration (only 7-day-in-home trial).
(17) Lindquist et al 2013[35]; 3^rd generation	Mobile phone, item locator, information panel, reminder, electronic calendar, alarm, digital note taker.	What the use of IAT came to mean to these users and their significant others.	How the initial decision was made, how routines to incorporate the IAT were adjusted, whether the participants trusted the IAT, and whether the participants felt an increased sense of capacity when using the IAT.	The user has to be able to identify difficulties and needs and be motivated to become a user.
(18) Lindquist et al 2015[36]; 3^rd generation	Mobile phone, item locator, information panel, reminder, electronic calendar, alarm, digital note taker	Experienced usability of features in AT to support users in desired goals in everyday activities.	Constant visible information.; User's sense of control was promotional for achieving user goals.	Lack of clarity and feedback of the IAT prompted uncertainty and ineffectiveness. The users has to see the need to become a user
(19) Magnusson et al 2014[37]; 3^rd generation	Extended safety and support (ESS).	Complexity surrounding the implementation of advanced electronic tracking communication and emergency response	The clients were more independent. Half of the formal caregivers considered that nearly half of their clients could remain living at home with the ESS.; Informal caregivers were less stressed or anxious	Informal caregivers did not have more time for their own activities.
(20) Mitseva et al 2012[38]; 2^nd generation	Platform of personalized home telecare for intelligent home support services.	The informal caregiver user acceptance satisfaction	The most successful adoption of the services can happen when they are offered as early as possible in the history of the disease	Decrease in quality of life among informal caregivers.
(21) Niemeijer et al 2014[39]; 2^nd generation	Surveillance technologies.	Benefits and drawbacks of technology to support caretakers		The formal caregivers were worried about clients’ safety. They need to understand and feel comfortable in using IAT to facilitate the clients’ autonomy.
(22) Nijhof et al 2012[40]; 1^st generation	A special watch which measured sleep/wake rhythm.	The research questions focus on the introduction of the watch, its usage and usability, the interventions that have been taken based on using the watch and the effects of the watch on the sleeping behaviour of the clients.		The IAT was described as big, clumsy and uncomfortable.
(23) Nijhof et al 2013[41]; 3^rd generation	Support touch-screen.	The advantages and disadvantages of the system from the perspective of the client, informal/formal caregiver and the potentials to upscale its use.	Clients and informal caregiver reported good support of daily life activities, the system could help the client to live at home for a longer period of time, despite e.g. limited user friendliness of the lay-out.	Insufficient quality, caregiver know-how and limited involvement of informal caregivers limited usability. Electricity was considered a cost barrier.
(24) Oderud et al 2015[42]; 3^rd generation	GPS Technologies.	Autonomy and independence among clients.	Increased safety for all participants. Clients maintain autonomy and continue their outdoor activities.	Half of the participants had stopped using the IAT after 3 years due to their worsening physical or mental level of functioning
(25) Olsson et al 2013[43]; 3^rd generation	GPS Technologies.	Describe and explore the use and experiences of using a positioning alarm,	Previous use of technology and flexibility of the system facilitates trust in the alarm and in one own ability to use it.
(26) Perilli et al 2013[44]; 1^st generation	A net-book computer with specific software, a global system for mobile communication modem (GSM), a micro-switch, and lists of partners to call with related photos	To make phone calls independently.	All the patients learned to use the system and made phone calls independently to a variety of partners, such as family members, friends, and caregivers.	No information.
(27) Pot et al 2012[45]; 3^rd generation	GPS Technologies.	Feasibility, acceptability, and effectiveness.	The majority of the informal caregivers were able to integrate the use in their daily life. The clients experienced more freedom and were less worried going out alone.
(28) Thorpe et al 2016[46]; 3^rd generation	Smartphone, smartwatch and various applications to offer six support features.	User-centred approach to developing and testing IAT based on off-the-shelf pervasive technologies.	Clients’ motivation, personalized fit and familiarity of the technology.	Clients’ motivation, personalized fit and familiarity of the technology.
(29) Topo et al 2007[47]; 1^st generation	Night and Day calendars (NDC)	How the time-aid was used; and did they find it useful.	Clients’ motivation and a personalized fit of the technology.	Clients’ motivation and a personalized fit of the technology.
(30) Wu et al 2014[48]; Robot; (4th generation)	An indoor mobile platform with two propulsive wheels used as a generic platform and designed to ease the development of advanced robotics solutions. It can recognize and synthesize voices, and navigate in unknown environments. It also remembers appointments, manages shopping lists, plays music, and can be used as a video conference system.	To observe robot-acceptance in older adults.		Participants with neurocognitive disorder (NCD) needed more time to adjust to robot use than their cognitively intact peers. Both groups showed low intention to use the robot, as well as negative attitudes toward this device since they did not perceive it as useful

According to Blackman et al. [7].