In the United States today, there are more than 5.5 million people living with Alzheimer's and other dementia, and the number is continually growing. As the baby boomer generation ages, the incidence of Alzheimer's disease (AD) will increase, not only affecting the lives of those living with the disease, but also the lives of caregivers and the healthcare system as a whole. Telehealth has great potential to improve the standard of care for patients living with Alzheimer's disease.
Helping the Patient with Alzheimer's Stay at Home with Telehealth
How can we use the positive strides in innovative treatments and technologies to help Alzheimer’s patients and their caregivers and providers? One of the answers lies in telehealth, and an accompanying transformation of the traditional model of care.
The traditional model of care for patients with Alzheimer's relies on long term residential care with a focus on the relationship between the patient and the primary care provider. Getting the patient to the clinician's office can be extremely complicated, presenting challenges for the caregiver and the patient. This is especially true in rural areas where medical care may be far from where the patient/caregiver live, but also poses logistical challenges in urban and suburban areas as well.
For the Alzheimer’s patient, especially in the early stages of the disease, telehealth can provide an answer to this difficult problem. With the use of telehealth, the patient can be seen by a specialist who may be hundreds of miles away without the need to travel the distance to the clinician’s office.
In addition, telehealth helps the patient stay at home, prioritizing “aging in place,” something 89% of Americans over age 50 prefer. Telehealth has proven to be a helpful vehicle for facilitating aging in place by providing patient treatment and monitoring in the home. Telehealth allows for the patient to remain in the home while receiving care, ensuring continuity of the care environment and avoiding a change that may trigger unfavorable patient behaviors or reactions, such as anxiety, confusion and agitation.
Telehealth also has been proven to improve patient safety within the home, with researchers citing medication reminders, wandering-prevention tracking, and caregiver education support as uses of telehealth technologies that result in enhanced patient safety. One study found that certain tracking programs reduced the risk of nighttime falls by nearly 49%, while another found that the use of video monitoring was shown to increase the likelihood of medication compliance among dementia-afflicted patients living alone.
Other examples of existing telehealth/electronic applications include electronic applications providing reminders (medication management prompting devices), social contract (cell phones, online chat groups) and safety (alarm systems, monitoring system, wayfinding and action triggered lighting).
Improving the Life of the Caregiver
The benefits of telehealth have proven to be important for not only the patient, but also for the patient’s caregiver. Caregivers of a patient with Alzheimer's experience high levels of stress and role captivity that can lead to negative physical, psychological, social, and spiritual outcomes. Caregivers can feel isolated and can often experience guilt about their frustration, exhaustion, and their own feelings of fear and confusion.
Many existing telehealth programs have focused on supporting the caregiver specifically, to reduce the negative outcomes so many caregivers experience. Examples include web-based training and educational programs to support caregivers, i.e. interactive curricula that improve knowledge about and competence for caregiving and the accompanying challenges.
Another type of in-home caregiver support links caregivers with expert guidance for managing challenging care situations using video monitoring. Through this program, caregivers are trained to capture behaviors that are a problem via computer recording, which is then wirelessly uploaded for a team of experts to review and provide feedback. A pilot study of the program demonstrated improved behavior management and caregiver communication and was reported as easy to use. This program has helped caregivers learn how to best care for their loved one with Alzheimer’s.
Aiding the Clinician in Improving Outcomes
Diseases of cognitive impairment, including memory loss and neurodegenerative diseases, are placing an increased and enormous demand on the US healthcare system. In 2014, the medical cost of caring for patients with dementia was around $214 billion, and it is expected to rise to $1.2 trillion by 2050. Additionally, patients suffering with Alzheimer's and related diseases have more than triple the number of hospitalizations and nursing home admissions compared with older adults with other conditions.
Research has established the reliability and the validity for neurocognitive testing and neurological examinations via video telemedicine. Video conferencing can link primary care professionals to specialists for assessments, enhancing the administration of standardized assessments and examinations without the need for many in-person provider appointments and meetings.
With telehealth, it is much easier to be seen by a specialist, thereby enabling a doctor’s visit that may otherwise not occur because of limited mobility of the AD patient. This remote connection enables a doctor’s visit that may not occur otherwise, helping the clinician monitor patients more closely (and quickly) to provide education and additional assistance when the patient needs it. Telehealth provides the clinician with a clearer understanding of the patient’s circumstances, as it allows the clinician to clearly understand the challenges the patient faces at home and offer treatments based on these observations.
A Promising Future with Telehealth for Patients with Alzheimer's
Telemedicine and e-health services are increasingly available for people affected by Alzheimer’s and the subject is continually being explored through pilot programs and research studies. Telehealth can support aging in place while reducing the pressure and challenges for caregivers and improving quality of life for the Alzheimer’s patient.
For changes to be seen and improvements to occur, the patient, the caregiver, and the clinician must realize the potential benefits of telehealth and harness the power of technology. When that happens, we can expect to see improved patient outcomes, greater peace of mind for the caregivers, and a decreased burden on provider capacity and the health care system.
References:
Bossen, A., Kim, H., Steinhoff, A., Strieker, M., & Williams, K. (2015). Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technology and TeleHealth,49.
Murphy, A. M., & Schwartz, J. L. (2018). Innovative Treatment Models for Alzheimer's Disease and Dementia Care. Journal of Health Care Finance,44(3).