Acceptability and Feasibility of a Multicomponent Telehealth Care Management Program in Older Adults With Advanced Dementia in a Residential Memory Care Unit

Abstract

The aim of the current study was to examine the acceptability and feasibility of a multicomponent care management program in older adults with advanced dementia in a long-term memory care unit. Eighteen older adults with moderate to severe dementia were asked to wear an activity monitor (Fitbit Charge 2 HR) and participate in a once monthly telehealth intervention via iPads over a 6-month period. Activity monitor data were used to assess compliance. Acceptability was assessed through qualitative interviews conducted with the caregiving staff on the memory unit. The care management program was acceptable to residents and their caregivers. Results indicated that the care management program is feasible in older adults with advanced dementia although activity monitor adherence was better during the day than at night. Telehealth session compliance was excellent throughout the study. A long-term multicomponent dementia care program is acceptable and feasible in individuals with advanced dementia. Future studies should aim to evaluate whether data received from activity monitors can be used in a dementia care intervention program.

Telemedicine and Telehealth in Nursing Homes: An Integrative Review

“…The scheduling of telemedicine was varied. In 2 studies, persons living with dementia received weekly 37 or monthly 36 counseling. Other programs scheduled geriatrician consults individually as needed.…”

“… Determine if incorporating the use of point-of-care (POC) testing within the SNF would allow for quicker medical intervention. Prospective nonrandomized trial Convenience sample – patients screened on admission Intervention group: n = 49 Historical comparison group: n = 92 Patient satisfaction questionnaire Self-care knowledge questionnaire Number or type of video conferences Number of on-site visits by SNF provider Number of patient transports Number of provider office visits Length of stay from hospital and NH EHR Video sessions Chest patch (HR, RR, body position, single-lead ECG) BP cuff, weight scale, pulse-oximeter Cloud-based clinician dashboard Bluetooth stethoscope i-STAT labs (BNP, Chem 8+/BMP) Tablet with video camera Parametric ( t tests) Nonparametric (χ 2 ) Multiple regression analysis using generalized linear model fitting 17.39% of case group rehospitalized within 30 days post discharge in comparison with 23.9% of control group Telemedicine group had 6.51% absolute risk reduction and 27.24% relative risk reduction 70% of patients felt telehealth intervention was “good”; 30% rated as “excellent” Time to intervention for medication adjustment significantly reduced (clinically significant but not statistically significant due to sample size): From 1080 to 6 min for ACE-I 5760 to 5 min for beta blocker 3641 to 5 min for diuretics Time to ED reduced from 84 to 15 min New diagnoses of atrial fibrillation and pneumonia through video session assessment, ECG, and stethoscope De Vito et al, 2020 36 Examine acceptability and feasibility of wearable devices and monthly telemedicine sessions in dementia care Mixed methods n = 18 residents n = 6 caregivers Bristol ADL NPI-Q QoL-AD QUALIDEM Activity monitor Outcomes tracked: Falls, hospitalizations, medication changes, behavioral episodes Caregiver interviews Fitbit activity monitor Video sessions Descriptive statistics 88% daytime adherence to wearing activity monitor across 6 mo; poor adherence at night. >90% adherence to monthly telemedicine intervention; 92% of medical wellness goals, 89% of behavioral goals, and 82% of cognitive goals were met.…”

“… The HF and SNF providers used a Bluetooth stethoscope to remotely auscultate heart and lung sounds. POC lab testing used to measure BNP, BMP Data viewable on dashboard for SNF and HF clinic clinicians 21-mo study period (March 2014–December 2015) Heart failure Patients (N = 141) HF office clinicians (unknown roles) NH providers NH nursing staff HHC staff 81 — Suburban United States De Luca et al, 2016 37 Access to neurology and psychology specialists Telehealth impact on psychological measures, quality of life, and neurobehavioral symptoms Improving vital signs and clinical management BP, pulse-oximeter, ECG via Bluetooth devices Recorded sounds from Bluetooth stethoscope Dashboard for providers Videoconferencing solution for telemedicine visits Study period undefined, T0 = before telecare protocol T1 = after telecare protocol Dementia Depression Residents (N = 59) Neurologist Psychologist NH nursing staff 80 — — Italy De Vito et al, 2020 36 Activity monitors and monthly wellness telemedicine visits with PLWD Activity monitor to track steps, HR, and sleep data Monthly telemedicine visits with neuropsychologists and PLWD and their caregiver: setting wellness goals, care recommendations Monthly questionnaires 6-mo study period Dementia Residents (n = 18) NH caregiver (n = 6) Neuropsychologists (n = 1) 84 — — United States Yu et al, 2014 38 Using telehealth and sensors to record incontinence episodes Using technology insights to develop clinical care plans ...…”

The acceptability and effectiveness of eHealth interventions to support assessment and decision-making for people with dementia living in care homes: A systematic review

“…Care staff liked the ability to identify patterns of behavior (De Vito et al, 2020) and interventions that provided them with tangible evidence that confirmed their beliefs about a resident's symptoms and concerns to discuss with external professionals (Wang et al, 2021). In one study, a digital platform collated location data alongside qualitative contextual data input by staff to display resident routines over time which were shared with external professionals (Wang et al, 2021).…”

Improving Older People’s Lives Through Digital Technology and Practices

“…With this in mind, the third paper in this special issue from Ummels et al (2020) discusses how a pocket activity tracker can be adapted to work with older people and therefore be used to give insight into the amount of physical activity older people undertake and increase awareness and motivation to increase their physically activity. The fourth paper of this special issue is by De Vito et al (2020) who explore and monitor activity by conducting a telehealth intervention once a month. This intervention pertains to the care of older people living with advanced dementia, showing acceptance and feasibility of such technology over 6 months, as part of the care.…”