The Protective Impact of Telemedicine on Persons With Dementia and Their Caregivers During the COVID-19 Pandemic

Abstract

Objectives: Social distancing under the COVID-19 pandemic has restricted access to community services for older adults with neurocognitive disorder (NCD) and their caregivers. Telehealth is a viable alternative to face-to-face service delivery. Telephone calls alone, however, may be insufficient. Here, we evaluated whether supplementary telehealth via video-conferencing platforms could bring additional benefits to care-recipient with NCD and their spousal caregivers at home.

Participants: Sixty older adults NCD-and-caregiver dyads were recruited through an activity center.

Design, intervention: The impact of additional services delivered to both care-recipient and caregiver through video conference (n = 30) was compared with telehealth targeted at caregivers by telephone only (n = 30), over 4 weeks in a pretest-post-test design. Interviews and questionnaires were conducted at baseline and study's end.

Measurements, results: Supplementary telemedicine had averted the deterioration in the Montreal Cognitive Assessment evident in the telephone-only group (ηp2 = 0.50). It also reversed the falling trend in quality of life observed in the telephone only group (QoL-AD, ηp2 = 0.23). Varying degrees of improvements in physical and mental health (Short-Form 36 v2), perceived burden (Zarit Burden Interview Scale) and self-efficacy (Revised Caregiving Self-Efficacy Scale) were observed among caregivers in the video-conferencing group, which were absent in the telephone-only group (ηp2 = 0.23-0.51).

Conclusion: Telemedicine by video conference was associated with improved resilience and wellbeing to both people with NCD and their caregivers at home. The benefits were visible already after 4 weeks and unmatched by telephone alone. Video conference as the modus operandi of telehmedicine beyond the context of pandemic-related social distancing should be considered.

Keywords: COVID-19 pandemic; Caregiver; dementia; telehealth.

Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1

Comparison of all primary measures obtained in the care-recipients with NCD [A–C] and in their caregivers [D–G]at baseline and at study's end 4-week later, denoted as "Pre" and "Post", respectively, in the abscissa of each individual plot. * denotes group difference at p <0.05 based on one-way ANOVA of pretest or post-test scores. # denotes group difference at p <0.05 based on ANCOVA of post-test scores with pretest scores as covariate. § denotes a significant time effect based on one-way repeated measures ANOVA restricted to either group. All values refer to group means ± standard error (SE, estimated from the error variance in the 2 × 2 ANOVA).

FIGURE 2

Scatter plot of pre–post changes observed in the care-recipients with NCD and their spousal caregivers based on relevant outcome measures that yielded statistical evidence for a group effect across time. Pre–post changes were normalized with respect to the mean and standard deviation of all subjects (N = 60), and then averaged to provide the summative indices for improvement (i.e., positive changes) in care-recipients and their caregivers, as represented by the abscissa and ordinate axes, respectively. Three regression lines, indicated by the arrows, are fitted to all or a subset of the data. The black regression line through the origin is fitted to all 60 dyads [ANOVA of the linear regression was highly significant at F(1,58) = 65.25, p <0.001; R2 = 0.53, b = 0.66 ± 0.08]. The red regression line is fitted to the dyads in the intervention group (N = 30) [ANOVA of this linear regression was significant at F(1,28) = 9.21, p = 0.005; R2 = 0.25, b = 0.49 ± 0.16], whereas the blue regression line is fitted to dyads in the control group (N = 30), of which no significant association in pre–post changes between partners of the dyads was found [ANOVA of this linear regression was far from statistical significance F(1,28) = 0.15, p = 0.70; R2 = 0.005, b = 0.04 ± 0.09]. The light blue and pink backgrounds show the location of quadrants I and III in the Cartesian plane, where most of the intervention and control groups lay, respectively.