Telemedicine could help rural patients with dementia

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By Carolyn Crist

NEW YORK (Reuters Health) - Older adults with dementia require ongoing access to healthcare services, and telemedicine could be a good option to bridge that gap during the pandemic, particularly in rural areas, according to a new systematic review.

Both patients and doctors say that telemedicine works, the authors report in Maturitas, though there are still questions about the reliability of virtual cognitive tests and access to the appropriate technology.

"Telemedicine is an asset in supporting aging in the community, not only in rural populations but also in urban settings, especially during COVID-19," said lead author Dr. Harmehr Sekhon of McGill University in Montreal, Canada.

The pandemic has further isolated older adults, Dr. Sekhon said, and the loneliness and lack of a regular schedule has affected their health and well-being. Vulnerable groups, including those in geographically isolated areas, need consistent formal and informal care to age healthily in their communities, she added.

"The impact of COVID-19 on older adults' mental health is a growing concern, and telemedicine will play an important role," she told Reuters Health by email.

Dr. Sekhon and colleagues conducted a systematic review of articles related to telemedicine, dementia and rural populations, yielding 12 studies from Australia, Canada, South Korea and the U.S. The studies analyzed cognitive tests given over virtual appointments and patient and doctor satisfaction with telemedicine. Two of the articles had a control group, which included patients who attended in-person consultations to compare with the telemedicine consultations.

Overall, both the patients and doctors seemed to be happy with telemedicine as an appointment option and gave high scores for convenience and comfort. Most doctors and patients said they'd use telemedicine again, and nearly all of the patients said they'd recommend telemedicine to others. At the same time, the studies showed mixed results for patient performance on virtual cognitive tests as compared with in-person appointments.

In particular, one study found significant differences in cognitive test scores for in-person versus telemedicine consultations, but two studies didn't find any major differences. Another study found a difference between scores on two different types of cognitive tests.

Telemedicine may not be a good fit for patients with more severe cognitive decline, hearing loss, communication impairments or confusion, the authors write. In some cases, telemedicine coordinators were able to help patients to prepare their setup and deal with these concerns before an appointment.

Similarly, some patients may have technical difficulties, and those who live in remote areas may have trouble with Internet access and video or audio quality. Some of the concerns can be addressed through technology troubleshooting with patients, the authors suggest.

In some cases, neurological and physical exams should be done in person, they added, and having a rural doctor nearby is helpful. Ultimately, virtual options should be tailored to fit patients' needs.

"The incorporation of telemedicine should be an iterative process where feedback from patients, caregivers and healthcare members is continuously considered," Dr. Sekhon said.

Another major concern is that a lack of continuity of care could leave vulnerable patients without doctors or health staff who could conduct in-person appointments or make sure cognitive tests are reliable over telemedicine, the study authors write. Other vulnerable groups, such as immigrants and indigenous older adults, may face difficulties if they are not fluent or comfortable with the doctor's native language.

"Telemedicine has the advantage of providing medical resources in rural areas, but few studies have been conducted to investigate its efficacy in dementia care," said Dr. Jae-Won Jang of Kangwon National University Hospital in Chuncheon, South Korea. Dr. Jang, who wasn't involved in the review, has researched telemedicine among patients with dementia.

"Telemedicine may be a useful alternative to face-to-face clinical visits," he told Reuters Health by email. "Particularly for management of dementia in patients who have less severe initial cognitive decline."

SOURCE: https://bit.ly/30FbdMx Maturitas, online September 23, 2020.

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