Telegerontology: A Novel Approach to Rural Dementia Care
e-Health ePoster Library. Wallack E. Jun 6, 2017; 167112; EP08.04
Elizabeth Wallack
Elizabeth Wallack
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Abstract
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Purpose/Objectives: Telegerontology is a type of home Gerontology support that takes advantage of Information and Communications Technologies to facilitate remote medical care. The goal of this project is to test Telegerontology as a way to assist people with dementia and their caregivers to stay safe and age in place in rural and remote regions of eastern Newfoundland. We intend to enhance the caregiver/patient/physician triad using the remotely delivered expertise of a dementia care team and specialized remote assessment tools, thereby improving care for people with dementia in rural and remote areas.

Methodology/Approach: Participants (n=19) were recruited through primary care physicians in four geographical regions within the Eastern Health Authority of Newfoundland. Primary care physicians identified potential participants from their practices and participated in interviews prior to the intervention phase of the study. Blocks of patients, grouped by primary care physician practice were randomized into intervention and control groups. All participants receive an initial home visit, an iPad with study-designed remote assessment apps, a case report with recommendations sent to family physician (implementation at the discretion of Dr.), occupational therapy recommendations, and post, 6 month and 12 month follow up. The intervention group received weekly Skype™ or telephone calls from a representative of the dementia care team.

Finding/Results: Ten participants were assigned to the intervention group and 9 were assigned to the control group. The average age in the intervention group was 76 (SD±8.0), who had on average 8 comorbid conditions (SD±4) and who were prescribed an average of 8 (SD±5) medications. The control group (n=9) had a mean age of 77 (SD±7), with 9 (SD±4) comorbid conditions and were prescribed on average 8 (SD±4) medications. Caregivers in both groups reported similar levels of stress (Caregiver Hassle Scale) at baseline with 19.89 (SD±14.98) in the intervention and 19.44 (SD±19.99) in the control group. There were no significant differences found between the groups with respect to level of disability (Barthel Index) t(17)=2.076, p=0.053 or stage of dementia (Reisberg Scale) t(17)=0.992, p=0.580. At this time there have been an equal number of falls in the treatment and control groups (1:1); and fewer reported emergency room visits (2:4), hospital stays (1:2), primary care physician visits (18:22) and admissions to long term care (1:3) in the intervention group versus the control. Primary care physicians (n=11) noted the importance of anticipatory care, system navigation and caregiver validation in successfully managing dementia patients at home. With respect rural practice a lack of resources (dementia specific supports), unclear circles of care, and lack of communication between physicians and families were seen as barriers to effect service delivery. Twelve month follow up is complete for the first group (n=9). At this time we are completing 6 month follow up on group 2 (n=10). 12 month assessment will be complete in April 2017. Full results will follow.

Conclusion/Implications/Recommendations: Preliminary findings provide evidence of the benefits of Telegerontology for the remote management of people with dementia living at home.

140 Character Summary: The utility of Telegerontology was assessed as a way to assist people with dementia and their caregivers to stay safe and age in place in rural/remote Newfoundland.
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