BACKGROUND: The dementia landscape has evolved, with earlier diagnoses, improved prevention understanding (eg, modifiable factors), and new treatments. Emerging digital technologies (eg, wearables, smart home systems, and mobile apps) offer self‑management opportunities; yet, gaps persist regarding integration into the care needs and preferences of people with dementia. Broader gaps remain concerning intervention design; adaptation; and implementation, including effectiveness, study quality, and accessibility.
OBJECTIVE: This systematic review aims to synthesize and critically appraise existing literature on digital self-management technologies (wearables, smart home systems, and mobile apps) intended to reduce dementia-associated behaviors, enhance self-management, and improve quality of life (QoL). It evaluates intervention characteristics, effectiveness, accessibility, study design, and methodological quality according to international standards.
METHODS: A systematic search across 9 databases (PubMed, Scopus, ACM Digital Library, CINAHL, PsycInfo, Web of Science, IEEE Xplore, Embase, and MEDLINE) identified relevant English‑language studies published between January 1, 2013, and September 30, 2023. Search terms covered dementia, QoL, behavioral and self‑management strategies, and digital technologies. Eligible studies involved adults with dementia using wearable, smart home, or mobile technologies targeting QoL, behavior, and autonomy. Two reviewers independently appraised study design, hardware, and intervention purpose. Outcomes were mapped to the Nursing Outcomes Classification and benchmarked against National Institute for Health and Care Excellence quality standard 184. Accessibility was evaluated by availability, cost, usability, and context. Bias mitigation included a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)‑guided strategy and PROSPERO registration. Methodological quality and bias were assessed using the Mixed Methods Appraisal Tool, the Critical Appraisal Skills Program, and a bespoke characterization framework.
RESULTS: Twenty-four studies evaluated interventions based on wearables, smart home systems, or apps for people with dementia and carers. Outcomes centered on neurocognition (24/24, 100%), self-care (17/24, 71%), and health behavior (13/24, 54%). Identified needs included managing distress (15/24, 62%) and supporting carers (15/24, 62%). Technologies included commercial tools (activity trackers, health-based wearables, and digital prompters) but were often inaccessible due to complex setup requirements and ongoing support needs. Substantial methodological heterogeneity precluded meta-analysis, necessitating narrative synthesis. Study quality was generally good to excellent, but samples were small, reporting incomplete, and outcomes unblinded. Only 1 (17%) of 6 randomized controlled trials reported effect sizes, indicating moderate decline in QoL at 24 months; effectiveness in other studies remains uncertain.
CONCLUSIONS: Research on digital technologies for dementia self‑management shows benefits, particularly with off‑the‑shelf devices and mobile apps supporting person‑centered outcomes. Notable limitations include inadequate participant diversity (eg, atypical dementias and minoritized populations) and insufficient high‑quality research on QoL and behavioral outcomes, such as symptom management and self‑control. Future research must prioritize innovative solutions enhancing accessibility and usability, emphasizing simplified configuration, personalized adaptability, and effective training and support structures.
TRIAL REGISTRATION: PROSPERO CRD42023461841; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023461841.
