JMIR Publications

ABSTRACT

Background:

Dementia is a growing public health challenge affecting millions of people worldwide. It is a progressive condition that increases the risk of infections, falls, hospital admissions, dependence in activities of daily living, safety issues such as wandering, care home transfers, and death. New ways of supporting people living with dementia (PLWD) at home are urgently needed.

Objective:

The aim of this study is to evaluate a digitally enabled care model that integrates low-burden sensor-based remote monitoring within a nurse-led clinical service.

Methods:

In this mixed-methods study, we will recruit 100 people with confirmed or suspected dementia living at home and deploy the Minder remote monitoring system for at least 12 months. A detailed characterisation of the cohort will be obtained, including cognition, frailty, participant and carer wellbeing, functioning, and quality of life. The feasibility, acceptability, sustainability, and resource requirements of the service will also be assessed. Low-cost sensors provide information about behaviour, environment and physiology from the home. Machine-learning algorithms have been used to develop digital biomarkers of infection, sleep, night-time behaviours, daily activities and routines, and the effects of clinical events and treatment. These will be assessed through clinical reports of sensor-derived data that include anomaly alerts provided to the clinical teams. Algorithms will be assessed for their clinical utility and acceptability. The comparative-effectiveness component will be designed as a target trial emulation using linked electronic health-record data to construct a time-indexed external usual-care control cohort. The primary comparative outcome will be Days Alive and Out of Hospital (DAOH) over 12 months from the activation-index date, with healthcare utilisation, costs, institutionalisation and mortality assessed as secondary outcomes. DAOH and estimated MinderCare effects will also be examined across prespecified strata of baseline inpatient utilisation.

Results:

Recruitment starting in March 2025. We have enrolled 132 PLWD, of whom 103 are currently using MinderCare. 29 participants have withdrawn from the study, mainly due to death or moving into a care home. Interviews have been conducted with 10 participants, and focus groups conducted. The study database will be locked in the first quarter of 2027 to enable analysis. Additional funding has been secured to support the continuation and expansion of MinderCare beyond 2026.

Conclusions:

This study will provide evidence on the feasibility, acceptability, and utility of the MinderCare digitally enabled care model for people with dementia living in their own homes, including the performance of its algorithms. The study will also explore its potential impact on days alive and out of hospital, as well as health and social care utilisation. Clinical Trial: ISRCTN registry 14997677 and NIHR portfolio CPMSID 63023.