Telemedicine for the management of neuropsychiatric symptoms in long-term care facilities: the DETECT study, methods of a cluster randomised controlled trial to assess feasibility

Antoine Piau, Fati Nourhashemi, Adélaïde De Mauléon, Achille Tchalla, Claude Vautier, Bruno Vellas, Maryline Duboue, Nadège Costa, Pierre Rumeau, Benoit Lepage, Maria Soto Martin, Antoine Piau, Fati Nourhashemi, Adélaïde De Mauléon, Achille Tchalla, Claude Vautier, Bruno Vellas, Maryline Duboue, Nadège Costa, Pierre Rumeau, Benoit Lepage, Maria Soto Martin

Abstract

Introduction: Neuropsychiatric symptoms (NPSs) in elderly patients with dementia are frequent in long-term care facilities (LTCFs) and are associated with adverse events. Telemedicine is an emerging way to provide consultation and care to dependent LTCF residents who may not have easy access to specialty services. Several studies have evaluated telemedicine for dementia care but to date, no study has evaluated its impact in the management of NPS in patients with dementia living in LTCF.

Methods and analysis: The Dementia in long-term care facilities: Telemedicine for the management of neuropsychiatric symptoms (DETECT) study is a 24-month multicentre prospective cluster randomised controlled study with two arms: a control arm (usual care) and an intervention arm (telemedicine consultation) for NPSs management. DETECT enrolled 20 LTCFs. The primary outcome is based on the acceptability of the telemedicine among the LTCF staff which will be assessed in the intervention group by quantitative and qualitative indicators. The rate of unscheduled hospitalisations and/or consultations due to disruptive NPSs, psychotropic drug use and health costs will be described in both groups. Approximately, 200 patients are expected to be recruited.

Ethics and dissemination: The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Toulouse University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals.

Trial registration number: NCT02472015.

Keywords: dementia; geriatric medicine; health economics; telemedicine.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Inclusion and follow-up procedures. GP, general practitioner; LTCF, long-term care facility; NPS, neuropsychiatric symptom; TM, telemedicine.

References

    1. Rolland Y, Abellan van Kan G, Hermabessiere S, et al. . Descriptive study of nursing home residents from the REHPA network. J Nutr Health Aging 2009;13:679–83. 10.1007/s12603-009-0197-4
    1. de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, et al. . A multicentric individually-tailored controlled trial of education and professional support to nursing home staff: research protocol and baseline data of the IQUARE study. J Nutr Health Aging 2013;17:173–8. 10.1007/s12603-013-0008-9
    1. Matthews FE, Dening T. Prevalence of dementia in institutional care. Lancet 2002;360:225–6. 10.1016/S0140-6736(02)09461-8
    1. Helmer C, Pérès K, Letenneur L, et al. . Dementia in subjects aged 75 years or over within the PAQUID cohort: prevalence and burden by severity. Dement Geriatr Cogn Disord 2006;22:87–94. 10.1159/000093459
    1. Seitz D, Purandare N, Conn D. Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. Int Psychogeriatr 2010;22:1025–39. 10.1017/S1041610210000608
    1. Selbæk G, Engedal K, Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc 2013;14:161–9. 10.1016/j.jamda.2012.09.027
    1. Brodaty H, Draper B, Low LF. Nursing home staff attitudes towards residents with dementia: strain and satisfaction with work. J Adv Nurs 2003;44:583–90. 10.1046/j.0309-2402.2003.02848.x
    1. Bullock R, Hammond G. Realistic expectations: the management of severe Alzheimer disease. Alzheimer Dis Assoc Disord 2003;17(Suppl 3):S80–5. 10.1097/00002093-200307003-00004
    1. Zwijsen SA, Kabboord A, Eefsting JA, et al. . Nurses in distress? An explorative study into the relation between distress and individual neuropsychiatric symptoms of people with dementia in nursing homes. Int J Geriatr Psychiatry 2014;29:384–91. 10.1002/gps.4014
    1. Whall AL, Kim H, Colling KB, et al. . Measurement of aggressive behaviors in dementia: comparison of the physical aggression subscales of the Cohen-Mansfield agitation inventory and the ryden aggression scale. Res Gerontol Nurs 2013;6:171–7. 10.3928/19404921-20130321-01
    1. Lachs MS, Rosen T, Teresi JA, et al. . Verbal and physical aggression directed at nursing home staff by residents. J Gen Intern Med 2013;28:660–7. 10.1007/s11606-012-2284-1
    1. Cohen-Mansfield J, Werner P, Watson V, et al. . Agitation among elderly persons at adult day-care centers: the experiences of relatives and staff members. Int Psychogeriatr 1995;7:447–58. 10.1017/S1041610295002195
    1. Schmidt SG, Dichter MN, Palm R, et al. . Distress experienced by nurses in response to the challenging behaviour of residents - evidence from German nursing homes. J Clin Nurs 2012;21:3134–42. 10.1111/jocn.12066
    1. Zuidema SU, de Jonghe JF, Verhey FR, et al. . Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. Int Psychogeriatr 2011;23:1632–9. 10.1017/S1041610211001438
    1. Pitfield C, Shahriyarmolki K, Livingston G. A systematic review of stress in staff caring for people with dementia living in 24-hour care settings. Int Psychogeriatr 2011;23:4–9. 10.1017/S1041610210000542
    1. Banaszak-Holl J, Hines MA. Factors associated with nursing home staff turnover. Gerontologist 1996;36:512–7. 10.1093/geront/36.4.512
    1. Normann HK, Asplund K, Norberg A. Attitudes of registered nurses towards patients with severe dementia. J Clin Nurs 1999;8:353–9. 10.1046/j.1365-2702.1999.00261.x
    1. de Rooij AH, Luijkx KG, Declercq AG, et al. . Professional caregivers’ mental health problems and burnout in small-scale and traditional long term care settings for elderly people with dementia in the Netherlands and Belgium. J Am Med Dir Assoc 2012;13:486.e7–486.e11. 10.1016/j.jamda.2012.01.001
    1. Gitlin LN, Kales HC, Lyketsos CG. Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012;308:2020–9. 10.1001/jama.2012.36918
    1. Livingston G, Kelly L, Lewis-Holmes E, et al. . A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess 2014;18:1–226. 10.3310/hta18390
    1. Soto ME, Andrieu S, Villars H, et al. . Improving care of older adults with dementia: description of 6299 hospitalizations over 11 years in a special acute care unit. J Am Med Dir Assoc 2012;13:486.e1–486.e6. 10.1016/j.jamda.2011.12.058
    1. Wang HE, Shah MN, Allman RM, et al. . Emergency department visits by nursing home residents in the United States. J Am Geriatr Soc 2011;59:1864–72. 10.1111/j.1532-5415.2011.03587.x
    1. Becker MA, Boaz TL, DeMuth A, et al. . Predictors of emergency commitment for nursing home residents: the role of resident and facility characteristics. Int J Geriatr Psychiatry 2012;27:1028–35. 10.1002/gps.2817
    1. Fong TG, Jones RN, Marcantonio ER, et al. . Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med 2012;156:848–56. 10.7326/0003-4819-156-12-201206190-00005
    1. Sampson EL, Gould V, Lee D, et al. . Differences in care received by patients with and without dementia who died during acute hospital admission: a retrospective case note study. Age Ageing 2006;35:187–9. 10.1093/ageing/afj025
    1. Hurd MD, Martorell P, Delavande A, et al. . Monetary costs of dementia in the United States. N Engl J Med 2013;368:1326–34. 10.1056/NEJMsa1204629
    1. Barlow J, Singh D, Bayer S, et al. . A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions. J Telemed Telecare 2007;13:172–9. 10.1258/135763307780908058
    1. van den Berg N, Schumann M, Kraft K, et al. . Telemedicine and telecare for older patients–a systematic review. Maturitas 2012;73:94–114. 10.1016/j.maturitas.2012.06.010
    1. Ramos-Ríos R, Mateos R, Lojo D, et al. . Telepsychogeriatrics: a new horizon in the care of mental health problems in the elderly. Int Psychogeriatr 2012;24:1708–24. 10.1017/S1041610212000981
    1. Martin-Khan M, Flicker L, Wootton R, et al. . The diagnostic accuracy of telegeriatrics for the diagnosis of dementia via video conferencing. J Am Med Dir Assoc 2012;13:487.e19–487.e24. 10.1016/j.jamda.2012.03.004
    1. Edirippulige S, Martin-Khan M, Beattie E, et al. . A systematic review of telemedicine services for residents in long term care facilities. J Telemed Telecare 2013;19:127–32. 10.1177/1357633X13483256
    1. Lyketsos CG, Roques C, Hovanec L, et al. . Telemedicine use and the reduction of psychiatric admissions from a long-term care facility. J Geriatr Psychiatry Neurol 2001;14:76–9. 10.1177/089198870101400206
    1. Barton C, Morris R, Rothlind J, et al. . Video-telemedicine in a memory disorders clinic: evaluation and management of rural elders with cognitive impairment. Telemed J E Health 2011;17:789–93. 10.1089/tmj.2011.0083
    1. Azad N, Amos S, Milne K, et al. . Telemedicine in a rural memory disorder clinic-remote management of patients with dementia. Can Geriatr J 2012;15:96–100. 10.5770/cgj.15.28
    1. Katz S, Ford AB, Moskowitz RW, et al. . Studies of illness in the aged. The index of adl: a standardized measure of biological and psychosocial function. JAMA 1963;185:914–9.
    1. de Medeiros K, Robert P, Gauthier S, et al. . The neuropsychiatric inventory-clinician rating scale (npi-c): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010;22:984–94. 10.1017/S1041610210000876
    1. Logsdon R, Gibbons LE, McCurry SM, et al. . Quality of life in Alzheimer’s disease: patient and caregiver reports. J Ment Health Aging 1999;5:21–32.
    1. Luttenberger K, Graessel E. Recording care time in nursing homes: development and validation of the "RUD-FOCA" (Resource Utilization in Dementia-Formal Care). Int Psychogeriatr 2010;22:1291–300. 10.1017/S1041610210000487
    1. Costa N, Ferlicoq L, Derumeaux-Burel H, et al. . Comparison of informal care time and costs in different age-related dementias: a review. Biomed Res Int 2013;2013:1–15. 10.1155/2013/852368
    1. Briggs A, Gray A. The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy 1998;3:233–45. 10.1177/135581969800300410
    1. Spector A, Orrell M, Goyder J. A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res Rev 2013;12:354–64. 10.1016/j.arr.2012.06.005
    1. Morgan DG, Stewart NJ, D’Arcy C, et al. . Work stress and physical assault of nursing aides in rural nursing homes with and without dementia special care units. J Psychiatr Ment Health Nurs 2005;12:347–58. 10.1111/j.1365-2850.2005.00846.x
    1. Burgio LD, Stevens A, Burgio KL, et al. . Teaching and maintaining behavior management skills in the nursing home. Gerontologist 2002;42:487–96. 10.1093/geront/42.4.487
    1. Elliott KE, Scott JL, Stirling C, et al. . Building capacity and resilience in the dementia care workforce: a systematic review of interventions targeting worker and organizational outcomes. Int Psychogeriatr 2012;24:882–94. 10.1017/S1041610211002651
    1. Richter T, Meyer G, Möhler R, et al. . Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev 2012;12:CD008634 10.1002/14651858.CD008634.pub2

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