Video‐Enhanced Care Management for Medically Complex Older Adults with Cognitive Impairment

Abstract

This pilot study assessed feasibility of videoenhanced care management for complex older veterans with suspected mild cognitive impairment (CI) and their care partners, compared with telephone delivery. DESIGN: Pilot randomized controlled trial. SETTING: Durham Veterans Affairs Health Care System. PARTICIPANTS: Participants were enrolled as dyads, consisting of veterans aged 65 years or older with complex medical conditions (Care Assessment Need score ≥90) and suspected mild CI (education-adjusted Modified Telephone Interview for Cognitive Status score 20-31) and their care partners. INTERVENTION: The 12-week care management intervention consisted of monthly calls from a study nurse covering medication management, cardiovascular disease risk reduction, physical activity, and sleep behaviors, delivered via video compared with telephone.MEASUREMENTS: Dyads completed baseline and follow-up assessments to assess feasibility, acceptability, and usability. RESULTS: Forty veterans (mean (standard deviation (SD)) age = 72.4 (6.1) years; 100% male; 37.5% Black) and their care partners (mean (SD) age = 64.7 (10.8) years) were enrolled and randomized to telephone or video-enhanced care management. About a third of veteran participants indicated familiarity with relevant technology (regular tablet use and/or experience with videoconferencing); 53.6% of internet users were comfortable or very comfortable using the internet. Overall, 43 (71.7%) care management calls were completed in the video arm and 52 (86.7%) were completed in the telephone arm. Usability of the video telehealth platform was rated higher for participants already familiar with technology used to deliver the intervention (mean (SD) System Usability Scale scores: 65.0 (17.0) vs 55.6 (19.6)). Veterans, care partners, and study nurses reported greater engagement, communication, and interaction in the video arm. CONCLUSION: Video-delivered care management calls were feasible and preferred over telephone for some complex older adults with mild CI and their care partners. Future research should focus on understanding how to assess and incorporate patient and family preferences related to uptake and maintenance of video telehealth interventions.

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses

“…In the US, the pandemic aggravated a baseline situation where there was high staff turnover in nursing homes, with greater than 50% of nurses leaving their job within a year [ 25 ]. The devalued working conditions of nursing home staff meant that many workers held second jobs and double- or triple-duty caregiving roles [ 26 ]. In a London-based study, there was a significantly higher COVID-19 positivity among staff who worked at multiple facilities compared to staff working in a single facility [ 27 ].…”

Barriers to telehealth access among homebound older adults

“…Moreover, video-based telehealth has been shown to be feasible, and in some cases preferable, to the provision of healthcare services by telephone in older adults with mild cognitive impairment. 20 Our aims were to understand existing videobased telehealth usage and capability among MSVD's patients and to determine which patients might be most likely to benefit from receiving a new video-based telehealth device. Querying MSVD providers, who often have long-term relationships with patients and unique insight into their resources, allowed for rapid collection of patient information to accelerate appropriate device dissemination.…”

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study

“…These incidental findings provide some clues to our expected results. For example, studies often highlight how the visual component of videoconferencing makes relationship building easier compared with telephonic consultation [21,[75][76][77]. Other studies suggest that adjustments to the background, camera positioning, and volume, along with the increased use of verbal confirmations during the interaction, are useful [21,29,75,78].…”

“…For example, studies often highlight how the visual component of videoconferencing makes relationship building easier compared with telephonic consultation [21,[75][76][77]. Other studies suggest that adjustments to the background, camera positioning, and volume, along with the increased use of verbal confirmations during the interaction, are useful [21,29,75,78]. Helping patients navigate technology with a positive attitude, including the use of in-person support to provide the caring touch and hands-on technical assistance, has been reported to enhance rapport [29,54,79,80].…”