Provider Perspectives on the Design,Implementation,and Impact of Technology on Person-Centered Dementia Care: Insights From the Alzheimer’s Association Dementia Care Provider Roundtable

Facilitators to Implementation

When choosing technologies, providers described a needs assessment as the first step to successful implementation, stating that oftentimes “organizations think they know what the barriers are, but they really don’t.” After the need has been identified, organizations must purposefully select vendors who will act as “tech partners, not just a vendor, you want someone who’s willing to adjust, and adapt, and be flexible with the constraints you may have.” Once the technology and vendor are chosen, obtaining staff buy-in “from the bottom up” and ensuring that those who will use the technology understand its significance are critical to sustainable use. One participant said “nothing is ever going to be adopted if we’re just saying this is what we’re doing now and not explaining the ‘why’ behind it.” Alongside initial buy-in, providers highlighted the importance of leadership in creating an environment for ongoing feedback from users and recipients, and the need to iteratively refine platforms and initiatives. Several participants described the identification of a “tech champion” as a key component behind sustaining new practices, noting that leadership can facilitate these champions by “celebrating team members who embrace the enhancements and are thinking innovatively.”

Choosing the appropriate technology for the correct setting or individual is important to its implementation (Cho et al., 2023). Similarly, the identification of a tech champion who can successfully advocate for the adoption of new technologies may help facilitate uptake of new initiatives (Miller et al., 2023). Existing literature also highlights the effect of social relationships on successfully implementing technology; technology must be introduced in a non-judgmental space and manner (Miller et al., 2023), and for those living with dementia, the “co-use” of new technologies with supportive care-partners can improve both engagement and enjoyment (Sweeney et al., 2021). However, further research is needed to better understand the impact of the dynamic between providers and vendors on the implementation and person-centeredness of dementia care technologies.

Barriers to Implementation

Discussions surrounding barriers to implementing person-centered dementia technology largely centered around resources and turnover. One participant noted that “constant staff turnover, turnover in residences, move-ins and move-outs change the semantics of the whole neighborhood.” This fluidity results in frequent onboarding and retraining and was described as a barrier towards innovation and consistent use of technologies. Others noted the persistent lack of funding as limiting the purchase of new technologies or upgrading existing infrastructure to accommodate them. To ease this financial burden, providers discussed marketing benefits to potential residents and family members to increase occupancy rates. One participant noted “if I was choosing a community, it would absolutely be [a] priority for me [about] how are you keeping mom or dad engaged…market the heck out of it.” Another described showcasing stylistic technology such as large TV screens when providing tours for prospective residents noting that you “have to be creative because you’re caring for people but you’re also selling your space.” Still, others described a general lack of familiarity and even fear of new technologies among both older adults and those who care for them, with innovations such as AI being extremely foreign to many individuals, limiting their uptake.

Extant literature similarly reports the impact of resource limitations and stigma on technology uptake. Limited financial resources can reduce the accessibility of person-centered technology (Chung et al., 2016; Goodall et al., 2020). And, while older adults may be willing to share personal data with medical professionals and family, concerns remain that the data collected by technology will cause a loss of privacy and be misused (Chung et al., 2016; Wang et al., 2019). To reduce stigma and fears over the misuse of technology, principles of informed consent offer a path forward. Examples include providing accessible and relevant information about the technology to older adults, ensuring comprehension regarding the use and purpose of the technology, providing opportunities for peer mentoring (Chung et al., 2014), and allowing older adults and their families to opt out of the use of the technology.

Positive Impacts

When describing person-centered dementia care, regardless of setting, providers stated that knowledge of the person such as “knowing whether or not they are huggers, whether they like a soft voice, or whether they need a little more volume” was a key aspect to person-centered care. It was widely agreed that digital care platforms can increase effective and timely communication of preferences and needs between staff, care-partners, healthcare providers, and individuals. By providing knowledge “about that person before you even consider providing some kind of care” and allowing the quick transfer of data from one care setting to another, these platforms may facilitate greater individualization and person-centeredness in dementia care. Additionally, providers noted that emerging AI models have the potential to scan care notes, flag individuals with an elevated risk for falls or other safety concerns, and provide individualized preventive plans.

For persons with dementia, providers discussed the potential of technologies designed to increase resident engagement to reduce the use of antipsychotics and other pharmacological interventions. One provider hypothesized “by increasing engagement we’ll see decreases in behavioral expressions … result[ing] potentially in a decreased use of psychotropic medications.” Others noted that technological monitoring can increase autonomy and independence for long-term care residents with dementia, giving staff tools to unobtrusively ensure the continued safety and well-being of residents while allowing residents “to be able to move about freely…[providing] a perceived sense of independency, autonomy, and choice.”

Other technologies were described as “taking the things that are repetitive and boring” off staff workloads and increasing staff’s capacity for engagement through the streamlining of non-resident facing tasks, such as cleaning. While increasing staff efficiency was perceived as a positive, providers noted that technology should not be designed to replace human interaction but instead enhance programming already in place; “we want tech that enhances our programming but doesn’t take away us doing it, we want it to work with us and help us and not just do it for us.” This goal could be achieved by pairing digital experiences “with a programmatic element like … an event and creating a better, larger, more integrative experience and stimulating a resident living with dementia’s ability to share their experiences and have a more joyful experience.”

Literature surrounding the role of technology in person-centered communication and engagement is well established, with technology providing older adults the means to engage with both others and their own past self in new and innovative ways, such as through digital storytelling programs (Goodall et al., 2020) or virtual reality visitations to childhood haunts (Miller et al., 2023). Within long-term care, technologies can facilitate resident engagement by providing a structure for staff to organize resident programming (Neal et al., 2020). While the evidence surrounding the effectiveness of technology on reducing behavioral expressions of persons with dementia varies (Chan et al., 2021), a recent meta-analysis of non-pharmacologic information and communication technology-based interventions found statistically significant effects of these technologies on both depression and agitation (Cho et al., 2023). Additionally, the use of video platforms containing messages recorded by family members has the potential to reduce resistance to care and improve the mood of individuals living with dementia (Goodall et al., 2020).

Many practice recommendations for person-centered dementia care such as getting to know the individual, building authentic relationships, and providing meaningful opportunities for engagement, require substantive time spent with the person (Fazio et al., 2018). For home care organizations, digital planning and registration systems can reduce workload related to manual scheduling and recording of time spent on care delivery, negating the need for hand-written forms and subsequent data entry, and in long-term care settings the digitalization of administrative processes and resident records can facilitate documentation processes (Thoma-Lürken et al., 2015). While organizations report anecdotal labor-saving effects related to these technologies (Thoma- Lürken et al., 2015), there is a need for further research on both their cost-effectiveness and the impact of increasing efficiencies on relationship building and person-centered dementia care.

Negative Impacts

Although technology was discussed as having potential to increase the person-centeredness of dementia care, there was a consensus that organizations and individuals must use caution that they do not lead to depersonalization and poorer quality of care. Examples included care planning software, which, while useful, may result in a one size fits all approach producing non-person-centered “overly prescriptive” interventions. Other interventions, such as robotic pets for persons living with dementia “may calm one person…and at the same time become very agitating for the person sitting next to them.” Participants also discussed concerns that technology may replace human interactions among dementia care, stating, “it can be problematic if staff members start thinking of [technologies] as a way to be the sitter instead of having direct care provided by a human.”

Current literature reflects the need for person-centered decision making when implementing technologies. For instance, while the use of robotic pets for those living with dementia may have positive impacts for some, there remain concerns that certain individuals may find the use of these pets demeaning, and that they may increase agitation for those experiencing more advanced stages of the disease (Chan et al., 2021; Neal et al., 2020). Others have highlighted concerns that technology may hinder person-centeredness by removing the opportunity for human-human contact (Leonardsen et al., 2023), or reduce social engagement by replacing meaningful personal interactions with browsing the web or playing digital games (Kiselica et al., 2024). Another concern is that many technologies focus on providing functional assistance or maintaining safety with little emphasis on supporting self-esteem, agency, or the personhood of the individual (Koo & Vizer, 2019). A potential solution to some of these issues is designing technologies that align with theoretical approaches to person-centeredness, creating interventions focused on increased engagement and cultivating a greater sense of self-identity (Goodall et al., 2020).