The possibilities and limitations of technology in promoting social participation and enriching dyadic relationships in dementia caregiving

Abstract

With no existing cure for dementia today, increasing attention is being directed at living as well as possible with the disease. This ethos is central to the concept of social health, where social participation and maintenance of relationships are central aspects. Dementia affects not only the individual with the disease but also those who care for them, with the quality of the caregiving relationship influencing the well-being of both dyad members. Positive experiences in caregiving through enrichment and social participation are important supporters of relationship sustenance. There is unexploited potential in technology to promote social health in dementia caregiving dyads, and an existing knowledge gap in how facilitated social interaction might support relationship sustenance. This lack of knowledge has been highlighted by the impacts of preventive measures in response to the SARS-CoV-19 pandemic.

This cumulative dissertation aims to explore the potential of technological solutions to support dyadic caregiving relationships through enrichment and social participation in the context of dementia. Based on a systematic literature review, a pilot case study, a cross-sectional study, a feasibility trial and a scoping review, this body of work shows that 1) social technology can promote positive social interaction in caregiving dyads through a multitude of mechanisms; 2) little training is provided in nursing homes for caregivers to ensure social participation among residents with dementia using technology, with ad hoc solutions implemented to help residents connect with their loved ones virtually; 3) the severity of the COVID-19 induced social isolation of community-dwelling caregiving dyads was related to pre-outbreak social connections and the use of social technology to maintain these; 4) a tablet-based activation system is a feasible tool to facilitate positive social interactions in community-dwelling caregiving dyads; and 5) psychosocial intervention components may contribute to enrichment of dyadic caregiving relationships. Barriers and facilitators to incorporating social technology in dementia caregiving were also identified. Limitations derive from limitations of the data, including small sample sizes, restricted participant characteristics available, and little existing literature on novel technologies to support social health in a dementia context. Furthermore, the empirical findings must be interpreted in the context of unprecedented circumstances, especially as this dissertation focuses on social participation and relationship sustenance during times of severe social isolation and fear of infection.

To facilitate the availability and accessibility of social technology to support participation in meaningful activities and enrichment of dementia caregiving relationships, the aforementioned limitations must be overcome as far as possible. This can be achieved by conducting large-scale randomised controlled trials using social technologies in dementia caregiving dyads, both in institutional and community settings. Barriers and facilitators identified in this body of work must be taken into consideration when designing such trials. Moreover, social health must be recognised on equal terms as the physical and mental health domains if technology to promote social health is to be implemented successfully.