Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: An Umbrella Review

Abstract The increase of People with Dementia (PwD) living at home underscores the need for innovative eHealth technologies that support both patients and informal caregivers (IC). Sustainable implementation of eHealth technologies within this target group can, however, be difficult. Our study aims at providing an overview of (1) technologies employed in the context of informal dementia care (IDC) and (2) factors influencing the implementation of these technologies. Five databases were searched for (systematic) reviews. 21 reviews were included. A combination of deductive and inductive thematic analysis was performed, using the NASSS Framework to organize the findings. We identified technologies used “by IC”, “by PwD” and “with PwD”. Most represented technologies included: (i) devices for in-home monitoring (ii) technologies for supporting memory, orientation, and day structure, and (iii) communication technologies. Most factors influencing implementation related to the condition of dementia, characteristics of the technology, the expected/perceived value by users, and the characteristics of the IC. Considerably less has been reported on factors related to the implementing organization, the technology supplier, the wider institutional and sociocultural context of policy and regulations, and the adaptation of technology over time. Our study 1) created a comprehensive overview of eHealth technologies employed in the context of IDC and contributes to a better understanding of factors influencing their implementation, and 2) uncovered a knowledge gap regarding success factors for implementation related to the wider context. Although future research is needed, these findings can help researchers improving the development and implementation of eHealth technologies to support IDC.

consumer websites.A total of 1,327 user reviews that met our pre-specified inclusion criteria were included.Descriptive statistics was applied to characterise demographic data, and inductive qualitative content analysis was used to identify themes in the textual data.Most reviews were obtained from consumer sites in the United States, and most reviewers were family members of the users (i.e., older adults and people with dementia).We found that circumstantial reasons, such the inability to own live animals, prompted reviewers to purchase the pet robot.Most reviewers had positive perceptions of the pet robot, and described various activities that users engaged in with it.Impacts of using the pet robot, such as positive emotions, were also described.Finally, experiences about practical aspects of its use, such as durability and hygiene, were discussed.Overall, this study provides useful knowledge that can help researchers, robot developers and clinicians understand the viability of using low-cost pet robots to benefit older adults, including people with dementia.Successful health outcomes in older patients are linked to the quality of the patient-provider relationship.Our study objective was to further understand the role of this relationship specific to pain management through perspectives from older adults and healthcare providers.Semi-structured interviews and focus groups were conducted with 9 older adults and 11 multidisciplinary healthcare providers.Transcripts were analyzed using a thematic analysis.Three main concepts emerged: (1) defining pain management goals -differences in providers and patients' goals for pain and function, with sub-themes of realistic goal setting and a shift in pain treatment to minimize opioids as a first-line medication; (2) communication -perceived gap in providers communicating and coordinating across disciplines and with patients, with sub-themes of improving positive communication and inconsistent messaging among providers; and (3) therapeutic alliance -all parties feel that developing a relationship is built on consistent trust and open dialogue.Although providers and older adults often expressed similar perspectives, there were several areas of misalignment identified within each concept, representing areas of disconnect within the patientprovider pain management relationship.Our findings indicate providers could benefit from education on improving communication around realistic goals and patient-centered outcomes and incorporation of more holistic pain management approaches when working with older adult patients.
Further study should focus on developing educational interventions to address the identified shortcomings.

FACTORS INFLUENCING BRAIN HEALTHY DIETS AMONG OLDER MIDWESTERN AFRICAN AMERICANS
Ashley Shaw, 1 Samantha Fikru, 1 Jannette Berkley-Patton, 2 Chris Goode, 3 Jaime Perales, 4 and Eric Vidoni, 4 1.University of Kansas Medical Center, Kansas City, Kansas, United States, 2. University of Kansas City,Missouri,United States,3. Ruby Jean's Juicery,Kansas City,Missouri,United States,4. University of Kansas Medical Center,Fairway,Kansas,United States Emerging evidence suggests that up to half of Alzheimer's disease (AD) cases are a result of modifiable risk factors related to poor diet such as blood pressure and diabetes, disproportionately affecting African Americans.Adherence to brain healthy diets remains low among African Americans.Therefore, it is important to understand needs, preferences, and barriers to inform intervention designs aimed to reduce AD risk among African Americans.Using a qualitative community-based research approach, we conducted six semi-structured focus group discussions (n= 30) to explore older African American experiences with brain healthy diets, preferences, and barriers to eating healthy.Secondly, we assessed the feasibility and acceptability of collecting biomarkers of health status and dietary behaviors among African Americans.A thematic analysis was conducted to identify emerging themes and biomarkers of health status were analyzed using descriptive statistics.We identified four themes: "Knowledge and Beliefs about Brain Healthy Diets," "Eating Practices," "Ways to Improve Dietary Practices," and "Preferences for Enhancing Awareness about Brain Healthy Diets."Themes indicated that older African Americans are receptive to healthy dietary consumption but perceived lack of education, cost, access, and perception of losing one's culture as barriers to adherence.A total of 87.5% of participants completed biomarker assessments and 82% tested positive for 1 or more cardiovascular risk factor.Our study identified ways to enhance brain healthy dietary practices to reduce dementia risk.Also, our study demonstrated feasibility and acceptability in collecting AD related biomarkers in the African American community.The increase of People with Dementia (PwD) living at home underscores the need for innovative eHealth technologies that support both patients and informal caregivers (IC).Sustainable implementation of eHealth technologies within this target group can, however, be difficult.Our study aims at providing an overview of (1) technologies employed in the context of informal dementia care (IDC) and (2) factors influencing the implementation of these technologies.Five databases were searched for (systematic) reviews.21 reviews were included.A combination of deductive and inductive thematic analysis was performed, using the NASSS Framework to organize the findings.We identified technologies used "by IC", "by PwD" and "with PwD".Most represented technologies included: (i) devices for in-home monitoring (ii) technologies for supporting memory, orientation, and day structure, and (iii) communication technologies.Most factors influencing implementation related to the condition of dementia, characteristics of the technology, the expected/perceived value by users, and the characteristics of the IC.Considerably less has been reported on factors related to the implementing organization, the technology supplier, the wider institutional and sociocultural context of policy and regulations, and the adaptation of technology over time.
on related to the condition of dementia, characteristics of the technology, the expected/perceived value by

sers, and the characteristics of the IC.Considerably less has been reported on fa
tors related to the implementing organization, the technology supplier, the wider institutional and sociocultural context of policy and regulations, and the adaptation of technology over time.


FACTORS INFLUENCING IMPLEMENTATION OF EHEALTH TECHNOLOGIES TO SUPPORT INFORMAL

Our study 1) created a comprehensive overview of eHealth technologies employed in the context of IDC and contributes to a better understanding of factors influencing their implementation, and 2) uncovered a knowledge gap regarding success factors for implementation related to the wider context.Although future research is needed, these findings can help researchers improving the development and implementation of eHealth technologies to support IDC.


FACTORS RELATED TO THE CARE MANAGEMENT PRACTICE FOR OLD PUBLIC ASSISTANCE RECIPIENTS IN OSAKA CITY OF JAPAN

Takako Ayabe, 1 Yoshihito Takemoto, 2 Shinichi OKADA, 3 Johannes Kiener, 4 and Masakazu SHIRASAWA, 5 1.BAIKA Women's university,ibaraki,Osaka,Japan,2. Okayama Prefectural University,Soja,Okayama,Japan,3. Osaka City University,Osaka,Osaka,Japan,4. Saitama University,Saitama,Saitama,Japan,5. International University of Health and Welfare,Minato City,Tokyo,Japan The research was conducted between January 22 and February 25, 2021.The data was collected by selfadministered questionnaires mailed to the participants at 800 care management centers and comprehensive community support centers in Osaka City.The centers were randomly selected.The response rate was 19.1%.The independent variables were: obtaining the qualification of a Senior Care Manager (SCM), who was a qualified person that acquired advanced knowledge and skills in care management by advanced training; experience years in Social Work (SW); experience years in care management; experiences in training programs for team approach; and experiences in training programs for supporting Old Public Assistance Recipients (OPAR).The dependent variables were the categorized contents in the Care Management Practice for old public assistance recipients.They were: Care planning and Implementation (CI); Assessment; Financial Support and Evaluation (FSE); Contract and Explanations in care management; Coordinating Informal support and Formal services in Care planning; and Arrangements in Financial supports for Formal service costs.The Structural Equation Modeling was performed for the examinations of the relationships.As a result, the goodness of the fit indices was acceptable, and we retained the models.In correlational analyses, CI and Assessment were significantly correlated with SCM (p<.05).FSE was significantly correlated with SW (p<.001) and OPAR (p<.05).In conclusion, the results implied that advanced qualification of a Senior Care Manager and a specified training program for supporting old public assistance recipients were effective in providing appropriate care management services.


FAMILY CAREGIVING IN THE SOMALI-AMERICAN COMMUNITY DURING COVID-19

Rajean Moone, 1 Kamal Suleiman, 2 and Elizabeth Lightfoot, 3 1.University of Minnesota,Woodbury,Minnesota,United States,2. University of Pennsylvania,Woodbury,Minnesota,United States,3. Arizona State University,Woodbury,Minnesota,United States This poster describes a study of Somali American family caregiving during the COVID-19 pandemic, specifically investing the unique caregiving challenges faced by Somali caregivers.The findings from this study, which was part of a larger study related to family caregiving, were drawn from in-depth interviews of ten Somali family caregivers in Minnesota.All interviews were conducted in Somali during the summer of 2020 and translated and transcribed by a certified translator and research assistant.The major themes that emerged from this study related to Visitation, Hospital Accompaniment, and Self Sacrifice.As Somali culture is centered around extended family connections, isolation places particular strain.Second, family members typically serve as advocates, translators and guides during hospital visits.The restrictions on hospital accompaniment due to COVID-19 caused increased stress and poorer care of family caregivers and their loved ones.Third, in the Somali community, family placement is a last resort.Caregivers reported great sacrifices in time, comfort and opportunities to care for family members during COVID-19.Most of the caregivers described their coping with these sacrifices in terms of radical acceptance and God consciousness.These findings have important implications for providing supports for Somali family caregivers.


FEASIBILITY OF AN INNOVATIVE REHABILITATION PROGRAM ADAPTED FOR THE POST-ACUTE NURSING HOME SETTING

Addie Middleton, 1 Jane Driver, 2 Marcus Ruopp, 2 Lindsay Lefers, 2 Jessica Rawlins, 2 Rebekah Harris, 3 and Jonathan Bean, 3 1.VA Boston,Boston,Massachusetts,United States,2. VA Boston Healthcare System,Brockton,Massachusetts,United States,3. VA Boston Healthcare System,VA Boston Healthcare System,Massachusetts,United States Live Long Walk Strong is a rehabilitation program that produces large clinically meaningful improvements in mobility when implemented as an outpatient program for older adults.We adapted Live Long Walk Strong for the post-acute nursing home setting within the Veterans Health Administration as a clinical demonstration project.The adapted version includes novel elements and bridges the inpatient stay and three months post-discharge.The inpatient phase focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, leg strength and pow

FACTORS INFLUENCING IMPLEMENTATION OF EHEALTH TECHNOLOGIES TO SUPPORT INFORMAL
Our study 1) created a comprehensive overview of eHealth technologies employed in the context of IDC and contributes to a better understanding of factors influencing their implementation, and 2) uncovered a knowledge gap regarding success factors for implementation related to the wider context.Although future research is needed, these findings can help researchers improving the development and implementation of eHealth technologies to support IDC.

FACTORS RELATED TO THE CARE MANAGEMENT PRACTICE FOR OLD PUBLIC ASSISTANCE RECIPIENTS IN OSAKA CITY OF JAPAN
Takako Ayabe, 1 Yoshihito Takemoto, 2 Shinichi OKADA, 3 Johannes Kiener, 4 and Masakazu SHIRASAWA, 5 1.BAIKA Women's university,ibaraki,Osaka,Japan,2. Okayama Prefectural University,Soja,Okayama,Japan,3. Osaka City University,Osaka,Osaka,Japan,4. Saitama University,Saitama,Saitama,Japan,5. International University of Health and Welfare,Minato City,Tokyo,Japan The research was conducted between January 22 and February 25, 2021.The data was collected by selfadministered questionnaires mailed to the participants at 800 care management centers and comprehensive community support centers in Osaka City.The centers were randomly selected.The response rate was 19.1%.The independent variables were: obtaining the qualification of a Senior Care Manager (SCM), who was a qualified person that acquired advanced knowledge and skills in care management by advanced training; experience years in Social Work (SW); experience years in care management; experiences in training programs for team approach; and experiences in training programs for supporting Old Public Assistance Recipients (OPAR).The dependent variables were the categorized contents in the Care Management Practice for old public assistance recipients.They were: Care planning and Implementation (CI); Assessment; Financial Support and Evaluation (FSE); Contract and Explanations in care management; Coordinating Informal support and Formal services in Care planning; and Arrangements in Financial supports for Formal service costs.The Structural Equation Modeling was performed for the examinations of the relationships.As a result, the goodness of the fit indices was acceptable, and we retained the models.In correlational analyses, CI and Assessment were significantly correlated with SCM (p<.05).FSE was significantly correlated with SW (p<.001) and OPAR (p<.05).In conclusion, the results implied that advanced qualification of a Senior Care Manager and a specified training program for supporting old public assistance recipients were effective in providing appropriate care management services.

FAMILY CAREGIVING IN THE SOMALI-AMERICAN COMMUNITY DURING COVID-19
Rajean Moone, 1 Kamal Suleiman, 2 and Elizabeth Lightfoot, 3 1.University of Minnesota,Woodbury,Minnesota,United States,2. University of Pennsylvania,Woodbury,Minnesota,United States,3. Arizona State University,Woodbury,Minnesota,United States This poster describes a study of Somali American family caregiving during the COVID-19 pandemic, specifically investing the unique caregiving challenges faced by Somali caregivers.The findings from this study, which was part of a larger study related to family caregiving, were drawn from in-depth interviews of ten Somali family caregivers in Minnesota.All interviews were conducted in Somali during the summer of 2020 and translated and transcribed by a certified translator and research assistant.The major themes that emerged from this study related to Visitation, Hospital Accompaniment, and Self Sacrifice.As Somali culture is centered around extended family connections, isolation places particular strain.Second, family members typically serve as advocates, translators and guides during hospital visits.The restrictions on hospital accompaniment due to COVID-19 caused increased stress and poorer care of family caregivers and their loved ones.Third, in the Somali community, family placement is a last resort.Caregivers reported great sacrifices in time, comfort and opportunities to care for family members during COVID-19.Most of the caregivers described their coping with these sacrifices in terms of radical acceptance and God consciousness.These findings have important implications for providing supports for Somali family caregivers.

FEASIBILITY OF AN INNOVATIVE REHABILITATION PROGRAM ADAPTED FOR THE POST-ACUTE NURSING HOME SETTING
Addie Middleton, 1 Jane Driver, 2 Marcus Ruopp, 2 Lindsay Lefers, 2 Jessica Rawlins, 2 Rebekah Harris, 3 and Jonathan Bean, 3 1.VA Boston,Boston,Massachusetts,United States,2. VA Boston Healthcare System,Brockton,Massachusetts,United States,3. VA Boston Healthcare System,VA Boston Healthcare System,Massachusetts,United States Live Long Walk Strong is a rehabilitation program that produces large clinically meaningful improvements in mobility when implemented as an outpatient program for older adults.We adapted Live Long Walk Strong for the post-acute nursing home setting within the Veterans Health Administration as a clinical demonstration project.The adapted version includes novel elements and bridges the inpatient stay and three months post-discharge.The inpatient phase focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, leg strength and power, and trunk muscle endurance.The care transition and virtual (telehealth) post-discharge phase


