Personalisation, customisation and bricolage: how people with dementia and their families make assistive technology work for them

Abstract

Assistive Technologies (AT) are being 'mainstreamed' within dementia care, where they are promoted as enabling people with dementia to age in place alongside delivering greater efficiencies in care. AT provision focuses upon standardised solutions, with little known about how AT's are used by people with dementia and their carers within everyday practice. This paper explores how people with dementia and carers use technologies in order to manage care. Findings are reported from qualitative semi structured interviews with 13 people with dementia and 26 family carers. Readily available household technologies were used in conjunction with and instead of AT to address diverse needs, replicating AT functions when doing so. Successful technology use was characterised by 'bricolage' or the non-conventional use of tools or methods to address local needs. Carers drove AT use by engaging creatively with both assistive and everyday technologies, however carers were not routinely supported in their creative engagements with technology by statutory health or social care services, making bricolage a potentially frustrating and wasteful process. Bricolage provides a useful framework to understand how technologies are used in the everyday practice of dementia care, and how technology use can be supported within care. Rather than implementing standardised AT solutions, AT services and AT design in future should focus on how technologies can support more personalised, adaptive forms of care.

Carers’ experience of using assistive technology for dementia care at home: a qualitative study

“…Other studies on AT have reported on carers modifying existing AT devices for newer purposes22 26 or using AT devices for comorbidities52 not associated with dementia, this was not possible for all carers and care situations among the participants in this study. The dynamic nature of progress of an illness such as dementia, the context and environment in which AT is being used and the motivation for using AT, necessitates viewing AT use for supporting carers and persons with dementia from a dynamic biopsychosocial model for health 53.…”

“…With technological advances, in the Internet of Things (extension of internet connectivity into physical devices and everyday objects)24 and artificial intelligence, AT will become more personalised to individual needs and user requirements 25. However, despite several recommendations carers are still not placed at the centre of design, prescription and use of AT for someone with dementia 19 26. A recent systematic review19 found that there was no consistency in describing or classifying AT for use in dementia and that carers often struggle due to a lack of support for using AT, AT not meeting the needs of individual carers and design flaws in the AT.…”

Placing assistive technology and telecare in everyday practices of people with dementia and their caregivers: Findings from an embedded ethnography of a national dementia trial

“…The findings suggest, however, that how many policy makers and ATT manufacturers imagine community care through ATT service provision may not reflect actual practices in technology-enabled dementia care. As previous research has also suggested, people with dementia and caregivers may, contingently rather than systematically, make ATT work for them (Greenhalgh et al, 2013;Gibson et al, 2018) ACCOMMODATE, however, highlights not only the role of caregivers to fit these technologies into care practices but also how their use of ATT can change the spaces and placement of care and everyday life. It shows how people's practices with ATT shift dependencies in care arrangements (Mort et al, independently in the community" without support from caregivers to help adapt technologies to "fit"…”

“…There is relatively little research to examine how people with dementia and their caregivers actually use these technologies in their everyday lives and how such experiences may affect their wellbeing and ability to sustain their community-based care arrangements. The little research that existed is limited in scale, often focused on cross-sectional interview methodologies (Gibson et al 2015;Gibson et al, 2018;Newton et al, 2016), with limited attention to how people with dementia and their caregivers use technology over time as their care and support needs change. A Collaborative COMMunity-based ethnography Of people with Dementia and their caregivers using Assistive technology and Telecare in England (ACCOMMODATE) aimed to address this empirical research gap from a sub-sample of caregivers and people with dementia participating in a national randomized controlled trial evaluating the efficacy of ATT.…”

Surveillance Technology in Dementia Care: Implicit Assumptions and Unresolved Tensions

“…For example, McCabe and Innes [12] described their GPS device for safer walking as AT. Another example is from Gibson and colleagues [31] and how carers and people with dementia made AT such as GPS devices work for them through personalisation, customisation and bricolage. The act of bricolage is combing household technologies with AT (e.g.…”