Identifying Facilitators and Obstacles in Piloting Dementia Initiatives Within a Living Lab Approach: Systematic Review.

Background: Dementia affects more than 55 million people worldwide, and its progressive cognitive decline creates substantial challenges for intervention testing and real-world implementation. Living Labs (LLs) have become increasingly relevant for piloting interventions in dementia care, offering real-world environments for cocreation and iterative testing. However, operational, ethical, and governance challenges can hinder the effective implementation of dementia-focused initiatives. Objective: This study aimed to identify and synthesize the facilitators and challenges encountered when piloting dementia-related initiatives within an LL approach. Methods: A systematic review was conducted in PubMed, Web of Science, Scopus, and EBSCOhost from database inception to January 31, 2024. Studies were eligible if they reported the piloting, implementation, or evaluation of dementia-related initiatives in an LL context. A narrative synthesis was performed using content analysis for initial coding and thematic analysis for theme development. The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: The 15 included studies were mostly conducted in European countries. Two major themes emerged, namely (1) organizational and operational issues and (2) ethical and legal considerations. Within these, 4 key operational subthemes were identified: engaging people living with dementia (end users), research design and evaluation methods, co-design and testing phases, and LL governance. Ethical and legal considerations covered informed consent procedures and regulatory aspects. Across studies, the most frequently reported facilitators involved familiar environments, stakeholder collaboration, iterative evaluation, and flexible co-design processes. Barriers commonly included fluctuating cognitive symptoms, limited digital literacy, inconsistent stakeholder engagement, time and resource constraints, and fragmented regulatory guidance. Conclusions: Piloting dementia initiatives in LLs requires methodological adaptability, strong governance structures, and ethical procedures tailored to cognitive impairment. These findings provide actionable guidance for researchers, practitioners, industry partners, and policymakers seeking to develop sustainable, user-centered LLs that support innovation in dementia care.