Virtual CARE for Caregivers of PWD: Adapting to the New Normal

Caregivers of persons with dementia (PWD) often experience increases in depression, anxiety, and burden as the disease progresses. In fact, as the PWD’s neuropsychiatric symptoms increase and independence in ADLS decrease, caregivers psychological and physical health outcomes worsen. The literature suggests that caregiver interventions that teach specific skills are more beneficial than psychoeducational interventions, particularly regarding the amelioration of the psychological impacts of informal caregiving. However, because of caregiving demands, caregiver’s own physical limitations, and competing obligations, it can be difficult to attend caregiver support or education programs outside the home. With the emergence of the COVID-19 pandemic, arranging such interventions became more complex, Therefore, we report on preliminary qualitative outcomes of a study investigating the feasibility and acceptability of converting an in-person, group dementia caregiver education intervention, CARE, to a telehealth platform. We report the findings of two objectives: 1) lessons learned when attempting to convert an in-person group intervention to telehealth and 2) experience and perceived benefit of attending a virtual group from the perspective of the participants of our first two groups. Briefly, our findings demonstrate the strong need for technological support. Participants report positive experience regarding the convenience of attending the group from their home, the benefits of the assigned exercises, and the support they found from other group members. The COVID-19 pandemic has forced many to embrace the virtual option as they adapt to a new normal. There are undoubtedly hurdles to overcome, but there are also advantages to be leveraged.

Program Evaluation of My Life, My Story: Virtual Storytelling in the COVID-19 Age.

OBJECTIVES: COVID-19 negatively affected older adults' well-being and quality of life, particularly individuals with dementia. My Life, My Story (MLMS) was developed at Veterans Health Administration as an opportunity for Veterans to interact and share life stories using guided interviews. This paper describes a program evaluation of MLMS delivered to Veterans with cognitive concerns and their caregivers using telehealth technology during COVID-19. METHODS: Fourteen Veteran-caregiver dyads completed MLMS interviews with occupational therapy trainees using telehealth technology. Most (10 of 14) participating Veterans had mild-to-moderate dementia. Trainees ascertained Veteran and caregiver demographics such as age and recent cognitive evaluation scores via chart review. Trainees also gathered Veteran-caregiver technology and interview experience through post-interview program evaluation questionnaires. RESULTS: Dyads reported generally positive interview and technological experience, despite technological glitches occurring in most (approximately 70%) interviews. Caregivers assisted with videoconferencing setup and participated in ten interviews. CONCLUSIONS: Veterans with cognitive concerns successfully participated in virtual MLMS interviews during COVID-19. Caregivers enhanced Veteran engagement and often provided technological support. CLINICAL IMPLICATIONS: Telehealth technology enabled participation in My Life, My Story by individuals with cognitive concerns and their caregivers. Post pandemic, clinicians may consider integrating telehealth technology with patients facing access challenges.

Factors Influencing Barriers and Facilitators to In-home Video Telehealth for Dementia Management.

OBJECTIVES: Quality dementia care, which recognizes caregivers as vital care partners, is a scarce resource. Innovative solutions like video telehealth may increase the reach of extant clinicians; however, little is known about perceived barriers and facilitators to in-home video telehealth for dementia management from the perspectives of caregivers. METHODS: Twenty-four caregivers of community-dwelling Veterans with dementia participated in semi-structured interviews. Questions gathered perceived facilitators and barriers to in-home video telehealth for dementia management through experience with related technology. Transcripts were analyzed using directed content analysis which was guided by factors previously identified as influencing older adults' adoption of technology. RESULTS: Caregiver experience with related technology was mostly facilitative to video telehealth, which was thought best suited for follow-up care. Increased access and decreased patient-caregiver stress were potential benefits. Barriers included perceived limitations of video and the belief that persons with dementia would have limited ability to manage technological aspects and to engage in video telehealth on their own. CONCLUSIONS: This study improves our understanding of the factors that caregivers perceive as barriers and facilitators to in-home video telehealth for dementia management. CLINICAL IMPLICATIONS: Strategies to optimize video telehealth include capitalizing on caregivers' social network and providing targeted training.

National Geriatric Network Rapidly Addresses Trainee Telehealth Needs in Response to COVID-19.

BACKGROUND/OBJECTIVES: Coronavirus disease 2019 (COVID-19) has pushed many geriatric healthcare providers to attempt video visits for the first time. Although the Veterans Health Administration (VA) is a pioneer in telemedicine, rapid shifts to nearly exclusive use of telehealth for healthcare delivery and changes regarding trainee engagement in telehealth served as the impetus for rapidly assessing telehealth training needs. DESIGN: National needs assessment (online survey) of associated health trainees and medical fellows affiliated with Geriatric Research Education and Clinical Centers (GRECCs). SETTING: National GRECC network -- 20 VA centers of excellence focused on supporting Veterans as they age. Each GRECC is affiliated with a school of medicine at a major university. PARTICIPANTS: Trainees (n = 89) representing 12 disciplines. RESULTS: Two-thirds of participants had received some telehealth training. However, most had never done a video-to-home visit, and, regardless of telehealth experience, they reported low confidence. Based on open-ended questions exploring training needs, educational resources were rapidly developed and disseminated. INTERVENTION: Within 1 week of the assessment, a nuts-and-bolts guide regarding remote access, technology requirements, video-conferencing platforms, and managing emergencies was sent to the national network of GRECC associate directors for education for dissemination among discipline-specific training directors at their sites. This resource was subsequently submitted to the national VA COVID Strong Practices SharePoint site. An interdisciplinary team of geriatric specialists with extensive video-to-home experience also organized a national webinar that peaked at just over 700 participants. GRECC Connect, a network of geriatric specialty teams funded to improve care access for rural older veterans using telehealth and associated health training programs at each GRECC facilitated rapid development and dissemination of both resources. CONCLUSION: We quickly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID-19. Although the webinar and nuts-and-bolts resources were developed within the VA context, they have demonstrated high demand and broader applicability. Results should continue to inform curriculum development efforts to address telehealth training gaps within and outside the VA.