Disability and Rehabilitation: Assistive Technology

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Bridging gaps in the design and implementation of

socially assistive technologies for dementia care:
the role of occupational therapy

Wei Qi Koh, Pascale Heins, Aisling Flynn, Aysan Mahmoudi Asl, Lesley Garcia,
Camilla Malinowsky & Anna Brorsson

To cite this article: Wei Qi Koh, Pascale Heins, Aisling Flynn, Aysan Mahmoudi Asl,
Lesley Garcia, Camilla Malinowsky & Anna Brorsson (2022): Bridging gaps in the
design and implementation of socially assistive technologies for dementia care: the
role of occupational therapy, Disability and Rehabilitation: Assistive Technology, DOI:
10.1080/17483107.2022.2111610

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DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY
https://doi.org/10.1080/17483107.2022.2111610

ORIGINAL RESEARCH

Bridging gaps in the design and implementation of socially assistive technologies

for dementia care: the role of occupational therapy
Wei Qi Koha , Pascale Heinsb , Aisling Flynn , Aysan Mahmoudi Aslc , Lesley Garciad , Camilla
Malinowskye and Anna Brorssone
a
School of Nursing and Midwifery, College of Nursing, Medicine and Health Sciences, National University of Ireland Galway, Galway, Ireland;
b
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands; cBiomedical Research Institute of
Salamanca, University of Salamanca, Salamanca, Spain; dDepartment of Mental Health and Clinical Neurosciences, University of Nottingham,
Nottingham, UK; eDepartment of Neurobiology, Care Sciences and Society (NVS), Huddinge, Sweden

ABSTRACT ARTICLE HISTORY

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to Received 25 March 2022
reduced engagement in meaningful occupations, including social participation. In the past few decades, Revised 6 July 2022
socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to Accepted 5 August 2022
support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart
KEYWORDS
home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Occupational therapy;
Despite an increasing body of research and interest in this field, several gaps relating to the design and imple­ emerging technologies;
mentation process of socially assistive technologies continue to undermine their relevance for PLWD in daily socially assistive technology;
life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and social robots; digital
implementation of socially assistive technology is presented. In the design process, occupational therapists are technology; virtual reality;
uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the smart home technology;
occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists dementia; design;
are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate implementation
socially assistive technologies into their routine and daily lives. We recommend that occupational therapists
should continue to be acquainted with such technologies through continuous professional development and
educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists,
technology developers, and researchers to enhance the process of designing and implementing socially assist­
ive technology, so that their relevance for PLWD and their caregivers can be maximised.

� IMPLICATIONS FOR REHABILITATION

� Developers and designers of socially assistive technology should consider the disease trajectory of
different types of dementia, as well as the different needs, abilities, preferences, occupations and rou­
tines of people living with dementia (PLWD) and/or their caregivers.
� Collaborations between technology developers, researchers, and occupational therapists should take
place iteratively throughout the process of designing and implementing socially assistive technology
to maximise their relevance and applicability for people living with dementia and their caregivers.
� To continue enhancing the current role of occupational therapy in socially assistive technology provi­
sion, occupational therapists should keep up to date with socially assistive technology that are being
developed to support the social health of PLWD.

Introduction more apparent through the moderate and advanced stages of

dementia [4]. Such decline may limit their ability to engage in
Dementia is expected to affect 152 million people worldwide by
meaningful occupations, which are defined as the things that
2050 and has been highlighted as a global health priority by the
people need to, want to, and are expected to do in their everyday
World Health Organisation [1]. It is characterised by a decline in lives [5]. PLWD often experience reduced meaningful social
one or more cognitive domains, which include complex attention, engagement, leading to loneliness and social isolation as the dis­
executive functioning, learning, memory, language, perceptual ease progresses [6]. However, being engaged in personally mean­
skills, and social cognition [2]. While there are different types of ingful social activities, such as meeting friends and family, is an
dementia, most are progressive in nature. During the prodromal important determinant of successful adaptation and ageing whilst
stage, people living with dementia (PLWD) may continue to live living with a chronic disease [7,8], including dementia.
independently with or without support [3]. Cognitive and func­ Furthermore, successful engagement in meaningful social activ­
tional decline, as well as behavioural changes, often become ities can result in reduced responsive behaviours such as

CONTACT Wei Qi Koh [email protected] School of Nursing and Midwifery, National University of Ireland Galway, Galway H91 TK33, Ireland
This article has been corrected with minor changes. These changes do not impact the academic content of the article.
� 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
2 W. Q. KOH ET AL.

agitation, shadowing, and repetitive questioning [9,10]; provide a likelihood of technology abandonment [36]. For instance, in
feeling of connectedness with self, others, and the environment; Ireland, occupational therapists lead Memory Technology
and promote life satisfaction and quality of life for PLWD [6,8]. Resource Rooms to educate, support and prescribe AT for PLWD
Technology plays a relevant role in supporting individuals to and their care partners. Similar services are available in other
live well with dementia [11]. Over the last few decades, there has countries, such as the UK [37] and Australia [38].
been a growing body of research that focussed on developing The current role of occupational therapy lies mostly in the pro­
and evaluating assistive technology (AT) for PLWD [12–14]. The vision of AT that aims to enhance physical or cognitive health
COVID-19 pandemic has further accelerated the research on and [29]. As such, it is a logical extension for occupational therapists
the use of AT, which has been paramount in enhancing the social to familiarise with and be more involved in AT to enhance social
health of PLWD during periods of social distancing restrictions health, a (relatively) newer field of technology development. This
[15,16]. Assistive technology may be defined as “any item that will position occupational therapists in a better stead to introduce
enables a person with a disability to complete a task that they such technology to PLWD. In similar regard, information about
would otherwise be unable to do" [17,p.525]. AT can range from the knowledge and expertise of occupational therapists should be
everyday technology such as alarm clocks and telephones, to actively disseminated to technology developers and researchers,
information and communication technology [18]. However, we to raise awareness of the role of occupational therapy in the
will focus specifically on socially assistive technology. In this design and implementation of socially assistive technology, and
paper, we define socially assistive technology as AT that is specif­ to advocate for the inclusion of occupational therapists in
ically designed for and/or used to promote social health among these processes.
PLWD by enhancing their capacities to 1) fulfil their potential and The primary objective of this paper is to propose practicable
obligations, 2) manage life with some degree of independence, considerations for bridging pertinent gaps relating to the design
and 3) participate in social activities [7,19]. and implementation of socially assistive technology for PLWD and
Recent evidence shows that different types of socially assistive their caregivers from an occupational therapy lens, and to high­
technology have been used to enhance the social health of PLWD light the necessary collaboration between occupational therapists,
[20–22]. Everyday technology, such as mobile phones, has been technology developers and researchers. Firstly, a brief overview of
increasingly leveraged as digital medium for a myriad of applica­ socially assistive technology will be presented. These examples
tions to benefit the social health of PLWD [20,21,23]. Common include social robots, digital technologies, virtual reality, and
examples include Skype and Zoom, which have been used to smart home technology. Each technology will be described, along
enhance social connections [24,25]. With continued digitalisation, with the current state of evidence on their impacts on social
robotics, virtual reality (VR) and smart home technology also have health. Next, current gaps and limitations to their design and
emerged as novel technologies to support PLWD to engage in dif­ implementation will be highlighted. Finally, practical considera­
ferent social activities [26,27]. Despite the growing interest in this tions for addressing these gaps will be proposed, based on litera­
field, a recent scoping review has highlighted several factors which ture supplemented with the authors’ clinical and professional
hindered the application and adoption of socially assistive technol­ expertise. The authors comprise a panel of experienced and inter­
ogy in daily life [27]. Pertinent issues relate to their design and nationally diverse occupational therapy clinicians, researchers, and
implementation processes, which can limit their relevance for PLWD educators from the 1) Dementia: Intersectoral Strategy for
and uptake in their daily life. Furthermore, the use of socially assist­ Training and Innovation Network for Current Technology
ive technology for PLWD can be a double-edged sword. While it is (DISTINCT) consortium, which focuses on conducting research on
intended to enhance social connections and productivity, it can also using technology to support the social health of PLWD; 2) the
simultaneously isolate or alienate the intended users [11] if used Science Foundation Ireland (SFI) Centre for Research Training in
improperly, or designed without considering the (current and Digitally Enhanced Reality (D-Real), which focuses on research
changing) functional capacities and needs of PLWD and their care­ involving the use of digital technology; and 3) the Division of
givers. Therefore, it is important to reflect on the gaps in the design Occupational Therapy at Karolinska Institutet, Sweden.
and implementation of socially assistive technologies and suggest
considerations for practice that will enhance their adoption. Socially assistive technologies and their impacts
Social robots
Occupational therapy
Social robots are developed to facilitate and maintain social net­
Occupational therapy is a healthcare profession that is uniquely works between people, reduce social isolation, and provide an
positioned to promote engagement in meaningful occupations, array of services for PLWD, such as cognitive training and affective
and to enhance the social health of PLWD through 1) supporting therapy [39]. Social robots may be categorised as socially assistive,
the maintenance and remediation of their skills and abilities; and telepresence, or pet robots based on their functions [27]. Socially
2) modifying their activities or environment [28]. Occupational assistive robots have several functions alongside their function to
therapy is the leading healthcare profession in the prescription enhance social networks, such as providing medication reminders.
and provision of AT, as evidenced by findings of an international Examples of such robots include Nao and Pepper, which have
survey that involved participants from 52 countries [29]. been used across different dementia care settings [40,41]. Next,
Occupational therapists work with a wide range of population, telepresence robots incorporate a video conferencing platform to
including children [30] and adults with disabilities [31], older facilitate and maintain social interaction. Examples of telepresence
adults [32], and individuals with chronic health conditions such as robots include Giraff and Double, which have been used in coun­
dementia [33]. One of the key roles of occupational therapists tries such as Australia and Finland [42,43]. Finally, pet robots are
entails assessing, prescribing, educating, and training individuals designed to resemble and behave like pets. They are intended as
and their family members to use AT in their daily lives [33–35]. substitutes for live animals to provide physiological and emotional
This has played an important role in equipping users with the benefits for people with dementia [44]. Examples include PARO
relevant skills and confidence to use AT and reducing the (seal), JustoCat (cat), AIBO (dog robot), and Pleo (dinosaur). Several
 DESIGN & IMPLEMENTATION OF SOCIALLY ASSISTIVE TECHNOLOGIES 3

studies have been conducted to investigate the impact of the Existing knowledge gaps and considerations
aforementioned social robots on PLWD. Synthesised findings sug­ for practice
gest that social robots had positive impacts on the psychosocial To be leaders, we (occupational therapists) can bring our expertise and
domains of older adults - including PLWD - such as reducing lone­ understanding of meaningful human occupation into the discourse,
liness, and enhancing social engagement interaction [44–46]. design, and implementation of technologies [62,p. 281].

Digital technology and virtual reality Designing socially assistive technology

Several phone- and tablet-based interventions continue to be Despite their potential, there are several gaps and challenges to
developed, refined, and/or evaluated for PLWD and their care­ the design of these socially assistive technologies. A recent scop­
givers to promote their social health [20,21]. Some examples ing review outlined several barriers related to the design features
include Photoscope, a digital person-centered artistic photo-activ­ of such technologies for older adults and PLWD such as complex
ity to enhance the social interaction between PLWD in long-term user interfaces and unclear or unpredictable actions [27].
care facilities and their informal caregivers [47], and I-CARE, a tab­ Technology developers play a crucial role in designing technolo­
let-based system to enhance the dyadic relationships between gies for PLWD. However, due to a different disciplinary focus, they
community-dwelling PLWD and their informal caregivers [48]. do not often have experience working with PLWD and use other
Other examples of digital technology interventions that leverage models than social and humanistic models and frameworks to
more established technology platforms include digital gaming guide their design process [33]. This could lead to the omission of
technologies, such as exergames [49] or games using iPads, design features that are integral for supporting PLWD and their
Nintendo Wii, and Nintendo DS [15]. Findings from recent system­ caregivers [63]. For instance, in a pilot study by Barrett and col­
atic reviews suggest that such digital technologies show promise leagues [64], PLWD experienced difficulties using a socially assist­
in enhancing social participation and social support, and reducing ive robot, as the user interface required PLWD to raise their arms
to access the touchscreen from a seated position. This physical
social isolation and loneliness among PLWD [20,21]. They also
movement proved to be physically challenging, as the older
show potential in enhancing social interaction between PLWD
population often experiences frailty [65]. In turn, caregivers had to
and their (informal) caregivers [15,47–49] and support engage­
provide support to overcome such challenges [64]. Given that a
ment in meaningful social activities [48,50].
key driver behind the development of such technologies is to
Virtual reality (VR) is a novel technology involving a
alleviate care provision, it is ironic that caregivers have to provide
“computer-simulated real or imagined environment that enables
additional support to PLWD to account for such design limita­
users to experience the sensation of being present in a different tions. Moreover, the functions of socially assistive technologies do
physical place” [51,p. 558]. VR provides a unique, novel, and safe not always align with the occupational needs of PLWD
virtual world for PLWD to participate in meaningful or reminiscent [26,27,66,67]. For instance, in a study by Orejana et al [68], users
activities including social activities [52] that may be difficult for were provided with a socially assistive robot to support them in
PLWD and their caregivers in daily life, due to physical or logis­ different aspects of daily life, such as providing medication
tical difficulties. VR may be conducted individually or in a group- reminders and providing entertainment. However, some of these
based setting to increase opportunities for social interaction, features were not relevant as the users were still capable of self-
socialisation, and social engagement [53,54]. A qualitative evi­ management. This highlights that personalising and tailoring the
dence synthesis on PLWD’s experiences and perceptions of using functions of socially assistive technologies to the individual abil­
VR revealed that it can provide a means of unlocking the PLWD’s ities, needs, and fluctuating emotions of PWLD, remains a pertin­
connections with formal, informal caregivers and peers [26]. ent technology development gap [69].
Sociability outcomes were reported when using VR with others While strides have been made to include healthcare professio­
and resulted in sustained sociability where the PLWD reflected on nals, such as nurses and medical staff, in the development and
the experience and anticipated subsequent use with peers [26]. research on technology, technology developers appear to be
unaware of the role, expertise, and impact of occupational thera­
pists in assistive technology provision for PLWD [70]. Although
Smart home technology other healthcare disciplines have parallels in terms of their posi­
Smart home technology broadly refers to the connection and tionality and philosophy of care, the occupational therapy profes­
sion can offer a unique, occupation-focussed perspective.
automation of appliances and devices within a home environment
Occupational therapists work closely with PLWD and their care­
via the internet. This connectivity of devices via the internet –
givers to assess and design interventions, including AT prescrip­
known as the Internet of Things [55] - uses sensors to monitor
tion, to support their participation in meaningful (and social)
and effect change to enhance individuals’ experiences of living at
occupations. Assessments are often guided by occupational ther­
home. In the context of dementia, smart home technology has
apy conceptual models, which serve as frame of references to
been designed and used to monitor, support and maximise inde­ gain a holistic understanding about an individual [71]. For
pendent living abilities, and to support social connections [56–58]. instance, the Person-Environment-Occupation (PEO) model [72]
Some examples include Amazon Echo and Alexa which are avail­ guides comprehensive considerations about the person with
able off-the-shelf, the Rosetta [59], and Dem@Care systems [60], dementia (e.g., personal values, physical, cognitive, and social abil­
which are more recently developed (or being developed) for ities), their environment (e.g., their physical, institutional and
PLWD and their caregivers. A recent review showed that while social environments, such the extent of support from caregivers),
only a handful of studies have been conducted to evaluate their their occupations (e.g., daily routines), and how each may evolve
effectiveness on PLWD [61], there is some evidence of positive over the life trajectory. Another example is the Human Activity
impact on performance in activities of daily living, amongst other Assistive Technology (HAAT) model that is often used to guide
health outcomes such as depression and anxiety. assessments of the dynamic interactions considering the person,
4 W. Q. KOH ET AL.

the activity (i.e., occupations), the context (i.e., environment) and their caregivers to engage meaningfully with the technology. In
the assistive technology (i.e., environment) [73]. consideration of the progressive nature of dementia, it is also
While important, an occupation-focussed perspective is not necessary to factor in regular re-assessments of the needs and abil­
always taken into account when designing socially assistive technol­ ities of PLWD and their caregivers [87]. While these constitute key
ogy for PLWD. As dementia progresses, the types of occupations elements of current occupational therapy practice – given a rapidly
that an individual and their caregivers engage in often change due evolving technological landscape – occupational therapists should
to diminishing abilities [74]. However, there has been insufficient actively acquaint themselves with evolving and emerging socially
consideration about this aspect of dementia during the design pro­ assistive technology to ensure that they are well-informed to advise
cess, which has led to technology abandonment by PLWD and their on suitable and desirable AT for PLWD and their caregivers.
caregivers [75]. By the same note, while a familiar and predictable Thereafter, formal and/or informal caregivers should be
life routine has a profound influence on the function of PLWD [76], coached to support PLWD through problem-solving, identifying,
considerations about how the technology can be designed to align and simplifying steps required to use and embed the socially
with the daily routines of PLWD and their caregivers are often pre­ assistive technology in their daily lives [88,89]. These are import­
cluded from the design process [77]. Rather, they are expected to ant strategies to enhance PLWD’s abilities to participate in activ­
“fit” the AT in their lives [13]. The findings from an ethnographic ities [88]. Such interventions may encompass the use of strengths-
study describing the use of smart home technology with PLWD and based approaches [90], caregiver training, activity gradation and
their caregivers exemplify the abovementioned points [78]. In the modifications [88], and other cognitive strategies such as a com­
study, an individual with dementia had to don a wearable device bination of errorless learning and spaced retrieval [91,92].
which was unfamiliar to her and her routine, which led to infre­ When implementing socially assistive technology in a group-
quent use. Using the technology also required the individual to acti­ based setting, for example in a day-care or residential setting, it is
vate a device, a task that warrants several cognitive functions such also necessary to carefully consider group dynamics [93], such as
as attention and working memory – which decline as part of the the attributes of PLWD who are participating, group size, and the
disease trajectory. In turn, her caregiver had to request an alterna­ similarities or differences in their values or abilities. Correspondingly,
tive wearable device, and “remind” her to use it. These omissions skilled facilitation is necessary to enhance group processes [93,94],
highlight the importance of integrating occupational therapy to ensure that PLWD can engage meaningfully with the socially
expertise to address pertinent gaps in the design of socially assistive assistive technology in the group setting. In one study, group facili­
technologies. Activity analysis is a core occupational therapy skillset tation techniques supported older adults’ engagement with a social
involving thorough analysis of the demands of an activity and iden­ robot [83]. These group facilitation techniques included carefully tai­
tifying the necessary skills for activity engagement [79]. In the con­ loring the social and physical environment to the older adults’ abil­
text of socially assistive technologies, activity analysis may address ities. Occupational therapy clinicians and trained occupational
important design features, such as user interfaces, that cater to the therapy assistants can contribute to this gap by tailoring and facili­
abilities and daily needs of PLWD. tating group-based use of socially assistive technology, or by train­
ing other healthcare professionals to facilitate group-based use of
socially assistive technology.
Implementing socially assistive technology
Implementing a technology refers to putting it to use in practice in
Discussion
daily lives. Even though technology may prove to be effective for
people with dementia in a research study, successful implementa­ We provided an overview of socially assistive technologies that
tion in daily life goes beyond research evidence that demonstrates have been (and are being) developed to benefit the social health
their effectiveness [27]. Similar to the gaps highlighted in the tech­ of PLWD, such as social robots, digital technologies, virtual reality,
nology design process, the mismatch between the socially assistive and smart home technology. Although more controlled studies
technology and the dynamic needs (i.e., existing and changing with larger sample sizes and more rigorous designs are needed,
needs) of PLWD and their caregivers have challenged their uptake. several studies highlight their promise [20,21,26]. We also identi­
Previous studies have highlighted this as an important predictor of fied several gaps in their design and implementation and dis­
AT abandonment [80–82]. Insufficient facilitation, knowledge, and cussed ways in which the unique skills of occupational therapists,
training to support PLWD and their caregivers to integrate AT into and their focus on PLWD and their caregivers’ daily lives and
their daily routines have also challenged implementation efforts occupational engagement, could be used to bridge these gaps.
[12]. For instance, Gibson et al. [18] found that family members Given that engagement with AT by PLWD is potentially a trans­
were unclear about when technology should be introduced to formative, health-promoting occupation in itself, as well as the
PLWD. In another study, Chang and colleagues [83] found that means by which PLWD may influence their own health, it is incum­
users had poor engagement with a social robot in a group setting bent on the profession of occupational therapy to contribute its
without facilitation by a therapist. theoretical and practice expertise to this emerging aspect of health
Deliberate efforts must be made to bridge these gaps to and social care. Occupational therapy “enablement skills” of adapt­
enhance their implementation. Like the role of occupational ther­ ing, advocating, coaching, collaborating, consulting, coordinating,
apy in the provision of other ATs, occupational therapists should designing/building, educating, engaging, and specialising [95] would
be consulted to identify and match the “right” socially assistive all be called upon in various ways at various stages along the
technology to the “right” individuals (i.e., PLWD and/or their care­ design to implementation pathway. At the design phase, collabor­
givers). This will involve discussions to identify activities that are ation and consultation with interdisciplinary teams, including occu­
meaningful to PLWD and/or their caregivers, assessing the func­ pational therapists, can improve the design of adaptive interfaces
tional capacities of PLWD, and assess the ability of the AT to and functionality to meet the (changing) needs of PLWD and their
address their dynamic social needs and wants [9,10,84–86]. These caregivers. This approach could further support the development of
considerations may inform the prescription of socially assistive participatory and co-design methodologies. At the implementation
technology and supporting interventions, to empower PLWD and phase, occupational therapists’ skills in educating and coaching
 DESIGN & IMPLEMENTATION OF SOCIALLY ASSISTIVE TECHNOLOGIES 5

Table 1. Recommendations to enhance the design and implementation of socially assistive technologies.
A) Designing socially assistive technology
Gaps Considerations for bridging the gaps
1. Not considering (and anticipating) the current and evolving needs, � Technology developers and occupational therapists (researchers,
preferences, abilities, and occupational preferences of PLWD and their educators, and/or clinicians) could reach out to each other to collaborate
caregivers in the (iterative) process of designing technology. The outreach may be
done through clinical services or national representative organisations for
Dementia is progressive; this means that the abilities of PLWD to engage the occupational therapy profession.
in their day-to-day routines can change over time. Correspondingly, their
needs and ability of PLWD and their caregivers to interact with and use � Technology developers and researchers could consider the disease
the technology can also evolve rapidly. trajectory of different dementias, and understand the implications on the
functional abilities and needs of PLWD and their caregivers.
2. Not aligning the function of socially assistive technology with the
occupational needs of PLWD and their caregivers � Technology developers and researchers could consult with occupational
therapists who have knowledge of holistic and occupation-based models
to enhance the comprehensiveness of considerations for technology
Each individual and their caregiver may have different needs and
preferences. Therefore, a tailored approach to technology development design in relation to PLWD and their occupations. Examples include the
is needed. Person-Environment-Occupation (PEO) model and the Human Activity
Assistive Technology (HAAT) model.
3. Not aligning socially assistive technology with the daily (and familiar)
� Occupational therapists could engage in professional development and
routines of PLWD and their caregivers
further education to keep up to date with emerging technology and
advocate for active occupational therapy involvement.
Familiar routines are important for PLWD (and their caregivers), as
such considerations about how technology can be designed to align � Educators could consider educating about socially assistive technology
with the routine of PLWD and their caregivers have to be within the occupational therapy educational and professional
made explicit. development curriculum.
B) Implementing socially assistive technology
Gaps Considerations for bridging the gaps
1. Not facilitating PLWD and their caregivers to choose the “right” � Technology developers and researchers could consider establishing a
socially assistive technology relationship with national assistive technology clinics and services to
inform clinicians about emerging technologies, to support the uptake of
Different socially assistive technology may suit different PLWD and their these technologies by PLWD and their caregivers.
caregivers, depending on their unique preferences and needs. For
example, a socially assistive technology with medication reminder � Occupational therapists could consider:
functions may not as relevant or appropriate for PLWD in residential (i) collaborating with technology developers and researchers to design
facilities, or for caregivers who are keen to support PLWD in medications comprehensive assessments to match and to tailor the socially assistive
without technology. technology to PLWD and their caregivers, and (ii) developing a clear
intervention plan to train and equip them with the skills and confidence
2. Not facilitating and training to support PLWD and their caregivers to to use the technology in their daily lives.
integrate socially assistive technology into their daily routines
� Occupational therapists and service providers (e.g., assistive technology
Routines are important for PLWD. There is an insufficient focus on how clinics and providers) could factor in regular re-assessments of the
the technology can be integrated into the daily lives of PLWD and changing needs and diminishing abilities of PLWD and their caregivers to
their caregivers. determine the suitability of the socially assistive technology over time.
3. Not facilitating the use of socially assistive technology in dementia � Service providers (e.g., healthcare providers, dementia care facilities) could
care facilities work with occupational therapists to design and facilitate the use of
In dementia care facilities, the use of technology may occur in a socially assistive technology in shared/group-based settings. An example
group setting. includes group-facilitation techniques.

users, designing and coordinating programmes, consulting with Subsequently, strategies at the education and post-qualification level
health systems, and advocating at the policy level could improve should be developed to sustain this movement. Including contex­
the adoption, engagement, and spread of socially assistive technolo­ tualised learning in education curricula for healthcare professionals,
gies in the everyday life of PLWD and their caregivers [96]. such as the use of simulation [97], could be one strategy to ensure
Examples of such initiatives may include the development of tar­ readiness for using socially assistive technologies in practice.
geted educational and training materials that are tailored to PLWD We also echo calls from the Human-Computer Interaction (HCI)
and their caregivers, care providers, and health systems. research community to embrace interdisciplinarity for the benefit
Despite the rapid technological advancements in socially assistive of end-users. Occupational therapists, like HCI researchers and
technology intended to enhance the social health of PLWD and their other healthcare professionals, share an obligation to aim for the
caregivers, such technologies have ironically not become a part of highest ethical standards in research and practice. These collab­
mainstream dementia care. They have not been widely adopted by orative actions we propose here could have far-reaching implica­
healthcare professionals, including occupational therapists. Despite tions in terms of improving digital equity and occupational
having a well-established role in traditional AT provision, occupa­ justice; PLWD should have the rights and opportunities to lever­
tional therapists seem to be less informed of socially assistive tech­ age on socially assistive technology to support their engagement
nologies that continue to be developed, and their potential to in meaningful occupations [98]. Therefore, we encourage both
influence the social health of PWLD [33,69]. Therefore, alongside occupational therapy and HCI practitioners to reach out to each
efforts that should be made to involve occupational therapists in the other to avoid this blind spot and to work together collabora­
design and implementation of socially assistive technology, efforts tively in this mutual endeavour. Occupational therapists specialis­
should also be made to move socially assistive technology into clin­ ing in roles as dementia researchers themselves could be most
ical practice and the education curriculum for the next generation of effective in bridging the gap between the two communities of
healthcare professionals, including occupational therapy clinicians. HCI researchers and behavioural scientists with an occupational
6 W. Q. KOH ET AL.

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The authors thank Dr. Claudia von Zweck and Mr. Ritchard 0[11] IJsselsteijn W, Tummers-Heemels A, Brankaert R. Warm
Ledgerd for their feedback to improve this paper. technology: a novel perspective on design for and with
people living with dementia. In: Brankaert R, Kenning G,
editors. HCI and design in the context of dementia. Cham:
Disclosure statement Springer; 2020. p. 33–47.
No potential conflict of interest was reported by the author(s). 0[12] Boger J, Quraishi M, Turcotte N, et al. The identification of
assistive technologies being used to support the daily
occupations of community-dwelling older adults with
Funding
dementia: a cross-sectional pilot study. Disabil Rehabil
This work was supported by the Marie Curie Innovative Training Assist Technol. 2014;9(1):17–30.
Network (ITN) action, H2020-MSCA-ITN-2018, under grant agree­ 0[13] Gibson G, Dickinson C, Brittain K, et al. Personalisation,
ment number 813196, and the Science Foundation Ireland Centre customisation and bricolage: how people with dementia
for Research Training in Digitally-Enhanced Reality (D-REAL) under and their families make assistive technology work for
grant number 18/CRT/6224. them. Ageing Soc. 2019;39(11):2502–2519.
0[14] Pappad�a A, Chattat R, Chirico I, et al. Assistive technolo­
gies in dementia care: an updated analysis of the litera­
ORCID ture. Front Psychol. 2021;12:644587.
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Aysan Mahmoudi Asl http://orcid.org/0000-0002-2231-6650 and the use of technology in caregiving dyads living with
Lesley Garcia http://orcid.org/0000-0003-1343-8397 dementia during COVID-19 restrictions. Front Public
Camilla Malinowsky http://orcid.org/0000-0002-6938-5282 Health. 2022;10:697496.
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