Empowerment in structures. Practical-ethical considerations of the preconditions for technology-assisted dementia care in Germany based on an expert-interview study.

Background: Intelligent assistive technologies (IAT) have become more common in dementia care. Ethical reflection on technology-assisted dementia care (TADC) has focused so far mainly on individual and interpersonal implications (e.g., self-determination, (in)dependence, safety or privacy issues, caregivers' support and cost-efficiency). From an empowerment-sensitive perspective, however, the societal, political, economic and technological preconditions for TADC should be more deeply analyzed in terms of their accelerating or inhibiting effects on technology development, implementation and usage. Therefore, the aim of this study was to explore these preconditions in the German context and so to contribute to more empowerment-sensitive structures. Methods: Semi-structured interviews were conducted with 20 German-speaking experts from health care, health policy and the fields contributing to IAT (e.g., computer science, engineering). Thematic content analysis was used to analyze the data. Findings: The experts' assessments of the current preconditions for TADC in Germany were starkly ambivalent. In the field of "society", they identified digitalization, a change in mentality towards IAT and demographic change as accelerators, unequally distributed digital literacy, misleading perceptions and a lack of affinity as inhibitors. In the field "politics - regulation - economy", experts identified scarcity of public resources, growing private wealth and regulatory progress as accelerators and unclear financing options, an uncertain market, data protection and ethical challenges as inhibitors. In the field "technology", they identified progress in basic technical research and improved customizability and interconnectivity as accelerators, while deficient digital infrastructure, a lack of user participation, dementia-specific challenges and challenges regarding data collection and security were seen as inhibitors. Conclusions: TADC promises an empowerment of persons with dementia, e.g. by enhancing their self-determination, increasing their independence from social control and by allowing more social participation. Yet its societal, political, economic and technological environments preconfigure the likelihood of successful empowerment as a socio-technical practice within TADC. Accelerators in the fields of society, politics-regulation-economy and technology need to be consolidated and strengthened. Inhibitors need to be mitigated, e.g. by with new educational, political and market economic policies. We make policy recommendations based on these conclusions.