Disabling or Enabling Technology? Ethical and Practical Concerns of Assistive and Surveillance Technologies in Formal Dementia Care Alzheimer Europe Conference, 30th of May 2009 - PowerPoint PPT Presentation

Loading...

PPT – Disabling or Enabling Technology? Ethical and Practical Concerns of Assistive and Surveillance Technologies in Formal Dementia Care Alzheimer Europe Conference, 30th of May 2009 PowerPoint presentation | free to download - id: 4702f3-NGRhZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Disabling or Enabling Technology? Ethical and Practical Concerns of Assistive and Surveillance Technologies in Formal Dementia Care Alzheimer Europe Conference, 30th of May 2009

Description:

Disabling or Enabling Technology? Ethical and Practical Concerns of Assistive and Surveillance Technologies in Formal Dementia Care Alzheimer Europe Conference, 30th ... – PowerPoint PPT presentation

Number of Views:133
Avg rating:3.0/5.0

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Disabling or Enabling Technology? Ethical and Practical Concerns of Assistive and Surveillance Technologies in Formal Dementia Care Alzheimer Europe Conference, 30th of May 2009


1
Disabling or Enabling Technology? Ethical and
Practical Concerns of Assistive and Surveillance
Technologies in Formal Dementia Care Alzheimer
Europe Conference, 30th of May 2009
Alistair Niemeijer, M.A., Department Of
Nursing Home Medicine, VU
University Medical Center, Amsterdam
2
ageing population- dementia on the rise..
3
changing demographic emergence of technological
solutions
  • Demographic Time Bomb (Alisky 2006)
  • Care Vacuum (Agree et al 2005, Astell 2006)
  • Technology to the rescue!
  • Use of technology in relation people with
    dementia provokes conflicting reactions (Cash
    2003)

4
assistive and surveillance technology in dementia
care
  • vast variety of technological interventions in
    dementia care
  • wandering detection (bracelets, chips)
    leefcirkels transl. living circles alarm
    systems, active/passive (movement detection,
    infrared devices) automation of domestic
    environment (automatic lighting, temperature, tv,
    domestic appliances) speaking/listening/video
    connections camera surveillance
  • distinction between assistive and surveillance
    technologies
  • assistive technolgies offer assistance and
    support, enabling certain degree of independence
    over day to day activities
  • surveillance technologies aim to safeguard and
    protect can serve as alternative to (other)
    forms of restraint
  • assistive technology enables surveillance
    technology controls?? (Astel 2006)

5
Wondering about the wanderers
  • this form of (wandering) technology has sparked
    off considerable ethical debate
  • stigmatises, removes personhood, infringes human
    rights of privacy and dignity (Cahil 2003, Astell
    2006)
  • tagging should be reserved for criminals!
    (ONeill 2003)
  • could lead to a more secure environment decrease
    caregiver burden
  • isnt policy of incarceration worse? (Bail 2003,
    Welsh et al 2003)

6
literature review
  • still unclear what ethical and practical
    implications would be in an intramural care
    setting..
  • Main aim of the review
  • ..to explore what is known on effectiveness
    and acceptability of assistive and surveillance
    technologies in the intramural care for people
    with dementia and intellectual disabilities.
  • Insight in these issues serves multiple purposes
  • can technology serve as viable alternative to
    freedom restriction?
  • setting forth the state of the ethical debate
    might contribute to development of clear(er)
    policies

7
method and procedure
  • 6 literature databases were searched
  • Embase.com
  • PsycInfo
  • Cinahl
  • INSPEC
  • ETHXweb
  • Both controlled terms and free text terms were
    used
  • 1st category captured all forms of dementia
  • 2nd category terms related to assistive or
    surveillance technology
  • 3rd category terms related to (potential)
    outcome/influence
  • last category included all articles in
    Dutch/German/French/English
  • Inclusion criteria were set broadly

8
Table 1. Central themes and subthemes on
assistive and surveillance technologies in
the formal care for people with dementia
or intellectual disabilities as covered
in the literature
System/Institution System/Institution Patient Patient
Reliability/efficacy Care relation Care relation Rights of patient
Functional efficacy Duty of care vs autonomy Duty of care vs autonomy Freedom autonomy
Safety/risks Replace care (giver) Replace care (giver) Dignity /stigma
Caregiver burden Person centred care Person centred care Privacy
9
reliability/efficacy
  • functional efficacy
  • few (n6) studies
  • practical problems
  • safety/risks
  • Only 2 RCTs
  • False sense of security
  • caregiver burden
  • Too much emphasis?

System/ Institution System/ Institution Patient Patient
Reliability Efficacy Care relation Care relation Rights of patient
Functional efficacy Duty of care vs autonomy Duty of care vs autonomy Freedom autonomy
Safety/risks Replace care (giver) Replace care (giver) Dignity /stigma
Caregiver burden Person centred care Person centred care Privacy
10
Care relation
  • duty of care vs autonomy
  • carers exhibited lesser tolerance of risk due to
    fear of litigation (Robinson et al 2007b)
  • clear risk policy is needed (Bewley 1998)
  • replace care(giver)
  • use of technology might lead to degrading of
    skills (Cassidy 1994, CounselCare 1993)
  • use of technology is in itself demanding?
    (Lauriks et al 2008, Thompson 1998)
  • person centred care
  • technology should be catered to the individual

System/ Institution System/ Institution Patient Patient
Reliability Efficacy Care relation Care relation Rights of patient
Functional efficacy Duty of care vs autonomy Duty of care vs autonomy Freedom autonomy
Safety/risks Replace care (giver) Replace care (giver) Dignity /stigma
Caregiver burden Person centred care Person centred care Privacy
11
Rights of the patient
  • freedom and autonomy
  • issue of autonomy problematic
  • informed consent wide consultation
  • privacy
  • Big Brother effect (Casas et al 2006)
  • dignity/stigma
  • safer walking technology

System/ Institution System/ Institution Patient Patient
Reliability Efficacy Care relation Care relation Rights of patient
Functional efficacy Duty of care vs autonomy Duty of care vs autonomy Freedom autonomy
Safety/risks Replace care (giver) Replace care (giver) Dignity /stigma
Caregiver burden Person centred care Person centred care Privacy
12
Discussion
  • Hardly any RCT research
  • No ethical consensus has yet been reached,
    underlining the need for clear(er) policies
  • But for a few key articles, majority of articles
    lack in depth analysis
  • Difference UK and US
  • mechanical acceptance (Eltis 2005)

13
Discussion
  • Lack of patient perspective
  • Empirical ethical research is lacking
  • Limitations of this review
  • Appropriate terminology?
  • Search strategy

14
Conclusions
  • Study offers overview and elucidation of ethical
    debate and points to omissions
  • The thematic overview this study provides can
    contribute to the much described call for
    developing clearer policies
  • More research is needed, in particular taking
    into account the client perspective
  • Review is part of larger research project

15
Staff Partners
  • Alistair Niemeijer M.A., Department of Nursing
    Home Medicine/ Institute for Research in
    Extramural Medicine, VU University Medical
    Centre, Amsterdam 
  • In collaboration with
  • C.M.P.M Hertogh, MD, PhD, Project Supervisor

    Department of Nursing Home Medicine/ Institute
    for Research in Extramural Medicine, VU
    University Medical Centre, Amsterdam
  • B.J.M. Frederiks, PhD, Department of Public and
    Occupational Health/Institute for Research in
    Extramural Medicine, VU University Medical
    Centre, Amsterdam
  • Prof. J. Legemaate, PhD, Department of Public and
    Occupational Health/Institute for Research in
    Extramural Medicine, VU University Medical
    Centre, Amsterdam
  • Prof. J.A. Eefsting, MD, PhD, Department of
    Nursing Home Medicine, Institute for Research in
    Extramural Medicine, VU University Medical
    Centre, Amsterdam 
  • This research project is funded by the following
    organisations RVVZ, Nuts Ohra, ActiZ,
    Vereniging Gehandicaptenzorg Nederland, Het
    Zonnehuis, Stichting Regionale Zorgverlening
    Zeeland

16
Thank you!
  • Thank you for your attention!
  • For more information please contact me at
    a.niemeijer_at_vumc.nl

17
Example searchstrategy (PsycINFO)
  • Database(s)
  • PsycINFO
  • Thesaurusterminologie Mental Retardation and
    Dementia met NTs includes all intended terms
  • PATIENT
  • P
  • DE("mental retardation" or "anencephaly" or
    "borderline mental retardation" or "crying cat
    syndrome" or "downs syndrome" or "home reared
    mentally retarded" or "institutionalized mentally
    retarded" or "mild mental retardation" or
    "moderate mental retardation" or "profound mental
    retardation" or "psychosocial mental retardation"
    or "severe mental retardation" or "tay sachs
    disease" or "dementia" or "aids dementia complex"
    or "dementia with lewy bodies" or "presenile
    dementia" or "alzheimers disease" or "creutzfeldt
    jakob syndrome" or "picks disease" or "senile
    dementia" or "senile psychosis" or "vascular
    dementia") OR kwdement OR kwalzheimer disease
    OR kwalzheimers disease OR ((ticogniti OR
    tiintellectual) AND (tiimpair OR
    tidysfunction OR tidisabilit OR tidisabled
    OR tidisorder)) OR ((abcogniti OR
    abintellectual) AND (abimpair OR
    abdysfunction OR abdisabilit OR abdisabled
    OR abdisorder))
  • INTERVENTION
  • I
  • Kwdomotic OR kwrobotic OR DErobotics OR
    decomputer applications OR DEcomputer
    peripheral devices OR kwict service OR kwict
    services OR deinformation technology OR
    deassistive technology OR deapparatus OR
    detelemedicine OR kwelectronic OR kweas
    system OR kweas systems OR kwnon
    pharmacological OR kwsensor OR kwsensors OR
    kwsurveillance device OR kwsurveillance system
    OR kwsurveillance technology OR kwassistive
    technology OR kwgps OR de"automated information
    processing" or DE"automated information coding"
    or DE"automated information retrieval" or
    DE"computer searching" or DE"automated
    information storage" OR DE"information
    technology"
  • AIM/GOAL
  • O
  • KwWandering OR tisafety OR de"accident
    prevention" OR kwsecurity OR kwpatient coding
    OR demonitoring OR kwwalking OR de"motor
    performance" OR kwcoercion OR kwconfinement OR
    kwconstriction OR kwconstraint OR
    kwcurtailment OR ticontrol OR kwfreedom OR
    kwimmobili?ation OR kwlimitation OR
    kwrestraint OR tirestrict OR kwautonomy OR
    tiindependen OR kwliberty OR kwprivacy OR
    kwself determination OR kwself reliance OR
    kwself rule OR kwself sufficient OR kwself
    sufficiency OR kwambulatory OR kwmobility OR
    kwdomestic OR kwhome OR detracking OR
    kwtracking OR kwtagging OR defear OR
    deanxiety OR DE"computer anxiety" or
    de"performance anxiety" or de"social anxiety"
    OR DEneeds or de"health service needs" or
    de"psychological needs" OR de"well being" OR
    DE"risk management" OR DE"quality of life" OR
    DE"home environment"
  • Total search in scheme P AND I AND O gt 246 hits
    (20080121)

ab cognitive
ti dysfunction
DE dementia
robotics
sensor
assistive technology
safety
security
restrain
restrict
About PowerShow.com