A large clinical trial is testing whether a package of motion sensors, bed-exit alarms, gas detectors, and automatic lights can keep people with dementia living at home longer instead of moving into a care home. Dementia eventually makes independent living risky—people may forget to turn off the stove, wander outside at night, or fall unnoticed. Assistive technology and telecare (ATT) devices can monitor these dangers, but the NHS lacks clear evidence on whether providing a full suite of these tools actually delays institutionalisation or is worth the cost. The ATTILA trial directly compares a comprehensive ATT package against a minimal intervention (smoke detectors only) in people with dementia at high risk of being placed in a care home. If the trial shows that ATT extends time at home and is cost-effective, the NHS could adopt standardised home-safety assessments and device menus for dementia patients. This would shift care away from reactive crisis admissions toward proactive risk management in the community. If it does not, the NHS can avoid spending on devices that offer no real benefit. Either way, the trial provides the hard evidence commissioners need to decide.
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Design: A randomised controlled multi-centre clinical trial. We will compare the effects of an assessment followed by access to a suite of assistive technology and telecare (ATT) services with assessment and a control intervention; limited to the fitting and checking of smoke detectors; on the time that people with dementia who are at high risk of institutionalisation can be maintained in independent living. Target population: Participants will be patients with all dementia diagnoses and will include individuals with young-onset dementias. Health Technologies being assessed: Commercially available ATT devices that we and others have successfully piloted to promote independent home-living for people with dementia. All participants will undergo a full assessment of home safety and risk and the potential for ATT intervention to monitor and manage risk. Following assessment, participants randomised to receive ATT would be provided with elements from a dementia-specific menu to include: 1. Monitored sensors; including smoke detectors, gas detectors, temperature extremes sensors, carbon monoxide detectors, property exit sensors, bed exit sensors, movement detection and pager systems. 2. System to augment assessment; using Just Checking. 3. Non-monitored (stand-alone) systems; including automatic lights (motion activated or dawn to dusk, battery or mains), motion/door contact to activate previously recorded message, gas isolation switch, carer alerting devices (including stand-alone pager activated by door contacts or passive infra-red (PIR), PIR/door contacts linked to small electrical devices). 4. Peripheral systems; including a keysafe for emergency access. 5. Associated environmental adaptation; including non-toxic fire retardent spray for furniture and clothing. Participants randomised to the control arm will be supplied with battery operated smoke detectors if assessment of home safety and risk has identified that this is indicated. Measurement of cost and outcomes: The co-primary trial outcomes will be (i) Time in days from randomisation to institutionalisation and (ii) Cost-effectiveness.
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