With the increase in the number of publications and reviews on the use of technology by older people and people with dementia in recent years, we aimed to use an umbrella review to examine whether the evidence for our research question is consistent or contradictory. Umbrella reviews focus on research questions or clinical practice for which there is a rich, high-quality evidence base. By reviewing all the existing literature on our research questions, we will be able to provide an overview of the main research findings.

To implement this umbrella review, we used the Preferred Reporting Items for Overviews of Review (PRIOR) statement protocol [26]. We selected and analyzed the studies according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We used the Cochrane PICOS framework (population, intervention, comparison, outcomes, and study design; Table 1). The methods used in all stages of screening, selection and extraction, quality assessment, overlap management, analysis, and synthesis were referenced to ensure that our analysis can be replicated.

We included systematic reviews with or without a meta-analysis focusing on acceptability factors and barriers to the use of technology by people with dementia or carers. The inclusion and exclusion criteria for this umbrella review are presented in Table 1.

Our population includes adults aged 60 years and older with dementia who had been included in studies using technologies. We did not limit the place (eg, home, clinics, academic centers, nursing home, rural populations) of intervention or the type of intervention carried out. We excluded analyses measuring acceptability factors and barriers of studies performed during the COVID-19 pandemic. The reason for this exclusion was to reduce the influence of compulsion or technology being the only way to access the intervention, which could influence the wanted results.

We included all systematic literature reviews that present results on the factors that can limit or enhance the use of technology by older people with dementia and carers. Among these, we focused on factors of acceptability and barriers to use and implementation using technologies. This umbrella review focuses on dementia interventions that are delivered using digital technology. For the purpose of this review, digital technology is defined as technology interventions that use smartphone apps, wearable technology, or mobile text messaging to deliver health care. These digital technologies are developed to support the independence of older people living in the community, alleviating or preventing functional or cognitive impairment, thus limiting the impact of dementia on older people and their caregivers.

The following comparisons were analyzed: technology versus control (no technology), intervention environments, type of technology used, and intervention by carers. Where possible, the intervention of caregivers will be divided into formal and informal caregivers, including factors of acceptability and barriers to the use of technology. The outcomes will be divided into outcomes of people with dementia and outcomes of caregivers. Outcomes of people with dementia include the sociodemographic characteristics of the patients, cost efficiency of using the intervention, changes in health outcomes after using the intervention (eg, Mini-Mental State Examination), patients’ adherence to and engagement with the intervention, adverse events, and barriers to using the intervention (eg, The Unified Theory of Acceptance and Use of Technology Questionnaire, Telehealth Satisfaction Questionnaire). Outcomes of caregivers include the quality and reliability of the interventions (eg, Zarit Burden Interview, Impact of Caregiving Scale, Caregiver Strain Instrument), patients’ follow-up with health care services after using the intervention, caregivers' adherence to and engagement with the intervention, adverse events, and barriers to using the intervention (eg, Telehealth Satisfaction Questionnaire).

Reviews published in peer-reviewed journals were included, without any date limitations.

The search for this umbrella review aimed to identify all systematic reviews of the literature on our research question. ISI Web of Science, Scopus, and PubMed databases were used to search for scientific articles for the development of this umbrella review. In this search, articles were identified using keywords and MeSH words (for PubMed search), individually and/or in combination. The research strategy used in PubMed included the following: (((((Elderly) OR (“Older population”)) OR (“Older people”)) OR (“Geriatrics”[Mesh])) OR (“Aged”[Mesh])) OR (“Aging”[Mesh])(((“Telemedicine”[Mesh]) OR (“Mobile Applications”[Mesh])) OR (“health informatics”)) OR (“healthcare technology”)((((implementation) OR (Barriers)) OR (Acceptance)) OR (Adherence)) OR (Restriction)((((“Dementia”[Mesh]) OR (“Cognition Disorders”[Mesh])) OR (“mental deterioration*”)) OR (“cognitive impairment*”)) OR (“mild cognitive impairment*”)((((((((Elderly) OR (“Older population”)) OR (“Older people”)) OR (“Geriatrics”[Mesh])) OR (“Aged”[Mesh])) OR (“Aging”[Mesh])) AND ((((“Telemedicine”[Mesh]) OR (“Mobile Applications”[Mesh])) OR (“health informatics”)) OR (“healthcare technology”))) AND (((((implementation) OR (Barriers)) OR (Acceptance)) OR (Adherence)) OR (Restriction))) AND (((((“Dementia”[Mesh]) OR (“Cognition Disorders”[Mesh])) OR (“mental deterioration*”)) OR (“cognitive impairment*”)) OR (“mild cognitive impairment*”)).

The research strategy used in Web of Science and Scopus included ((((((((Elderly) OR (“Older population”)) OR (“Older people”)) OR (“Geriatrics”)) OR (“Aged”)) OR (“Aging”)) AND ((((“Telemedicine”) OR (“Mobile Applications”)) OR (“health informatics”)) OR (“healthcare technology”))) AND (((((implementation) OR (Barriers)) OR (Acceptance)) OR (Adherence)) OR (Restriction))) AND (((((“Dementia”) OR (“Cognition Disorders”)) OR (“mental deterioration*”)) OR (“cognitive impairment*”)) OR (“mild cognitive impairment*”)).

Data from the included studies were analyzed by 2 independent reviewers (MVP and RM) and extracted into Microsoft Excel according to the acceptability and barriers of new technologies, reported by people with dementia or their caregivers. Discrepancies will be resolved through discussion with a third author (NP).

Results analysis will aim to present the technology used and the factors of acceptability and barriers to its use to support people with mild cognitive impairment or dementia and their carers. It will describe in detail each of the studies analyzed, presenting the study population, site of the intervention, time of the intervention, technology used and its category, evaluation instruments, and site. It will also describe the intervention that was carried out, reasons for acceptability and barriers, impact of the intervention, and limitations or future research with people with dementia and their carers. If possible, we will use the Consolidated Framework for Implementation Research (CFIR) to organize and analyze the factors of acceptance, barriers, and impact of support technologies for people with mild cognitive impairment or dementia and their caregivers. The CFIR tool provides a comprehensive theoretical framework that will help categorize and interpret the results, promoting a deeper understanding of the factors that influence the acceptance of and challenges with implementing technologies for people with mild cognitive impairment and dementia as well as their caregivers.

The methodological quality of all the included studies was assessed using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) checklist [27]. The tool helps categorize the quality of reviews according to 7 critical areas and 9 noncritical areas. The assessment will be grouped into low, moderate, and high critical quality categories.

No patients nor members of the public were involved in the development of this comprehensive review. However, the scope and methods of this review were based on the literature and discussed with experts.

The proposed comprehensive review was based exclusively on published data from secondary sources and therefore did not involve any interactions with human beings.

The results of the umbrella review will be presented at international conferences in the fields of, for example, gerontology and geriatrics, health informatics, primary care, public health, and social sciences and will be published in a journal aimed at a wide audience. When the results are published, we will make the data generated by our research openly and publicly available. The team also intends to use social networks and the institutional websites of its research centers to disseminate its findings through websites, social media, and newsletters.

As far as we know, this will be the first umbrella review addressing acceptance factors and barriers to the implementation of digital interventions in older people with dementia and their caregivers. Providing information on the facilitators and barriers to the implementation of digital interventions in people with dementia and their caregivers is extremely relevant from a clinical perspective [6,7,9,13,17,19,22,25]. This debate, present in the literature, encompasses several key issues: the effectiveness of digital interventions, the acceptability and usability of these technologies by older adults with dementia, and the various barriers to successful implementation, such as technological complexity and lack of digital literacy [12-14]. Additionally, there is concern about the potential for digital technologies to increase the burden on caregivers, who must learn and manage new technologies while providing care [12-14]. Discussions also focus on how digital technologies can improve QoL and health outcomes for people with dementia and their caregivers, including assessing clinical effectiveness and the impact on daily living and well-being [13,25]. Furthermore, the economic feasibility and broader social implications of implementing digital technologies in dementia care have been debated, including considerations of cost-effectiveness and potential health care cost reductions [6,7,25]. By systematically reviewing and synthesizing the available literature, this review seeks to provide a clearer understanding of these issues, thereby contributing to the theoretical debate and offering insights for future research and policy development.

Our umbrella review can significantly contribute in several ways, as noted in the following paragraphs.

It can identify barriers and facilitators. By synthesizing the results of various systematic reviews and meta-analyses, this review identifies common barriers and facilitators for implementing digital technologies in dementia care. This includes technical, financial, social, and psychological aspects that influence the accessibility and effectiveness of these interventions [12-14].

It can provide information for policies and practices. Insights obtained from this review can inform the formulation of policies and clinical practices, helping to shape guidelines that encourage the adoption of effective and sustainable technologies in dementia care [6,7,25].

Guidance for future research will be obtained. By highlighting gaps in the existing literature, this review can point to areas that need further investigation. This includes the need for studies exploring new technologies as well as studies examining diverse populations and different care contexts [12-14].

The review will also highlight research gaps in the field, pointing to associations and issues that have not been adequately explored. For example, there may be a lack of studies evaluating the impact of emerging technologies or considering the cultural and socioeconomic variability among different groups of patients and caregivers. Additionally, there may be a need for investigations into the long-term effects of using digital technologies in dementia care [12-14].

Overall, this umbrella review will contribute to the current debate on the value of a technological approach in dementia care. By providing a holistic view of the facilitators and barriers, this review can promote a more informed discussion on how to better integrate technology into geriatric care, potentially leading to better support for the autonomy and QoL of patients and their caregivers.

In summary, this review offers a unique opportunity to consolidate and critically evaluate the existing evidence on the acceptance and barriers to digital interventions in dementia care. Its findings can influence both clinical practice and future research, contributing to a better understanding and implementation of these technologies in a context that continues to grow in importance due to the aging global population.

To the best of our knowledge, this is the first general review that specifically addresses issues related to acceptability factors and barriers to the use of digital technology in people with dementia and caregivers. However, we expect to find difficulties: We expect to find systematic reviews with different protocols and different populations with different objectives. That will make the possibility of reaching final conclusions more difficult and, in certain cases, unobtainable.