ABSTRACT
Background : Depressive symptoms in middle-aged and older age bipolar disorder (BD) are associated with decreased quality of life and premature mortality. Yet, currently available pharmacological treatments are limited in efficacy. Mind-body interventions have been shown to improve mood, quality of life, and cognition in other adult populations, and may thus provide a promising therapeutic alternative. Here we conduct the first randomized controlled trial (RCT) examining the efficacy of a group Qigong/Tai Chi intervention (QT-BD) for reducing depressive symptoms in middle-aged and older adults with BD. As a further innovation during the COVID pandemic, we used Zoom to deliver the group intervention and active control. Methods : We conducted a virtually-delivered 12-week pilot RCT with 23 patients with BD aged >= 40 comparing a QT-BD intervention versus an active control (light exercise). We assessed depressive symptoms (primary outcome), verbal fluency (secondary outcome), and functioning/quality of life (exploratory outcomes) at baseline and 12-weeks. Results : No statistically significant differences were observed between groups for all outcomes (all p's>0.05). However, non-significant decreases in depressive symptoms were found in the subgroup of participants with baseline MADRS scores ≥10 in the QT-BD intervention only (p=0.07). Limitations : Our sample size was limited and the virtually-delivered format may have limited the positive benefits of face-to-face interventions. Conclusions : This novel pilot study suggests that QT-BD may be a feasible and efficacious intervention for reducing depressive symptoms in middle- and older-aged BD, particularly when baseline MADRS is ≥10, warranting further investigation in larger-scale trials.
ABSTRACT
Introduction The COVID-19 pandemic has increased the difficulty of accessing important and necessary healthcare services, particularly among older adults. The use of telehealth, which involves the delivery of health services (diagnosis, prevention, treatment) through telephone and telehealth, has increased during the pandemic. Telehealth has been found to be a beneficial and viable alternative to in-person healthcare but accessing and using this alternative is not always accessible to older adults. Given the increased risks to older adults' health and healthcare accessibility brought on by the pandemic, exploring the usage, accessibility, perceptions and benefits of this healthcare alternative in this vulnerable populations are essential. Methods Through a retrospective study, we aim to 1) understand the preferences and accessibility of telehealth among Canadian older adults, 2) address the possible benefits and challenges associated with telehealth access and use among Canadian older adults, and 3) compare the accessibility, preferences and usage of virtual healthcare in Canadian young adults vs older adults. We will analyze data from Canadians aged 55+ in the Canada Health Infoway database. This database contains data from 12 052 Canadians from all provinces and territories, collected from July to August 2021. The data is inclusive of all genders, sexual orientations, races, and ethnicities. Results Results will be available before March 2023. Conclusions This study will be an important step towards understanding the preferences, accessibility, and possible benefits and challenges associated with telehealth in the Canadian older adult population, and in understanding the differences in virtual healthcare accessibility, preferences and usage in young adults vs older adults. Bringing these findings to light can play a key role in addressing barriers and suggesting potential solutions to improve telehealth access and use among Canadian older adults. This research was funded by There is no funding to declare for this study.
ABSTRACT
Introduction Accessibility to virtual healthcare facilitates remote healthcare which could benefit the elderly population. Approximately 60% of Canadians use technological tools for everyday activities, e.g., online shopping and banking. However, compared to everyday activities, online healthcare tools are much less used. Identifying causes for this gap may support use of virtual Telehealth among the elderly population, which may benefit from remote healthcare specifically given restrictions of the recent COVID-19 pandemic. Methods This is a retrospective analysis exploring the use of healthcare technology. The online survey was conducted between December 2019 - February 2020. We stratified the population into 2 age groups: younger than age 55;age 55 and older, weighted by gender, ethnicity, education, community size, and income (https://insights.infoway-inforoute.ca). We performed Chi-squared tests for categorical variables, and Student's t-test for continuous variables. Results There were 12,052 participants in the survey (Table 1), including 1,123 Indigenous people. Divided by age: 7,644 persons were age <55 and 4,408 persons age ≥55. Baseline characteristics were statistically different between the two age-groups: the older age group (age ≥55) was significantly less educated, less ethnically diverse and included more men than women compared to the younger age group (accurate percentages will be presented). Most participants who experienced a virtual healthcare visit – reported positive feedback and benefits (Figures 1, 2). However, among all the survey participants there was preference for in-person healthcare visits when asked about their modality of choice (Figure 3): 92.4% of the older-age-group preferred an in-person visit for an annual exam (compared to 4.4% who preferred via phone and 2.0% who preferred video). Additionally, there was less preference to telehealth among the older age group (Figure 4), and 84.4% of the older-age group did not access online healthcare websites or mobile apps never in the past. The study shows data that was collected before the COVID-19 pandemic. These preferences may have changed and should be further explored. Nevertheless, this analysis shows that the overall preference for healthcare is an in-person modality in all ages. The observed preference of an in-person modality may suggest the importance of the personal connection for patients in healthcare visits. Limitations: there was statistically significant imbalance between demographic variables of the two age groups, indicating potential confounders. In future work we would estimate the difference between the age groups and adjust for these potential confounders. Additionally, the survey was conducted by virtual interviews via computer (provinces) and phone (territories) which suggests a biased population at baseline. Future surveys should mitigate this population bias. Conclusions This analysis shows that even among population with sufficed technological literacy, the preferred healthcare modality was in-person. Additionally, virtual healthcare is perceived differently than virtual shopping or banking. Comparison between individuals with and without past experience of virtual healthcare appointment suggests, that the preference for in-person healthcare modality may change after a personal experience of a virtual healthcare visit. This research was funded by There was no funding for this research project and analysis.
ABSTRACT
Background: A pressing challenge during the COVID-19 pandemic and beyond is to provide accessible and scalable mental health support to isolated older adults in the community. The Telehealth Intervention Program for Older Adults (TIP-OA) is a large-scale, volunteer-based, friendly telephone support program designed to address this unmet need. Methods: A prospective cohort study of 112 TIP-OA participants aged ≥60 years old was conducted in Quebec, Canada (October 2020-June 2021). The intervention consisted of weekly friendly phone calls from trained volunteers. The primary outcome measures included changes in scores of stress, depression, anxiety, and fear surrounding COVID-19, assessed at baseline, 4 and 8-weeks. Additional subgroup analyses were performed with participants with higher baseline scores. Results: The subgroup of participants with higher baseline depression scores (PHQ9 ≥10) had significant improvements in depression scores over the 8-week period measured [mean change score = -2.27 (±4.76), 95%CI (-3.719, -0.827), p = 0.003]. Similarly, participants with higher baseline anxiety scores (GAD7 ≥10) had an improvement over the same period, which, approached significance (p = 0.06). Moreover, despite peaks in the pandemic and related stressors, our study found no significant (p ≥ 0.09) increase in stress, depression, anxiety or fear of COVID-19 scores. Discussion: This scalable, volunteer-based, friendly telephone intervention program was associated with decreased scores of depression and anxiety in older adults who reported higher scores at baseline (PHQ 9 ≥10 and GAD7 ≥10).
ABSTRACT
Introduction Prior to COVID-19, psychiatric disorders affected over 10–15% of older adults (>1,000,000 Canadians aged 60+) with estimated costs of $15 billion/year. The pandemic has increased social isolation and limited resources for this vulnerable population, potentially increasing the risk of stress, anxiety, and depression, thus creating an urgent need for support for isolated older adults. To help prevent the development or worsening of mental illness and improve mental health in older adults, we developed an innovative volunteer-based Telehealth Intervention Program for Older Adults (TIP-OA), where volunteers provide weekly friendly phone calls to older adults (clients). TIP-OA has already served 500+ clients in 10+ languages. Although volunteer-based phoning programs may be affordable, scalable, and accessible, there is limited data about their real-world effectiveness and predictors of response. Seeing as TIP-OA is a novel and ongoing intervention program, we aim to identify predictors of treatment response based on client baseline risk ratings and demographic characteristics to help maximize the program's efficacy and benefits, and to detect vulnerable sub-groups of clients who need additional or alternate support. Methods To identify predictors of treatment response, we conducted a longitudinal study. Participants (n=114) were TIP-OA program users (age ≥ 60) who were screened and assigned a risk rating, were living in Montreal, and consented to take part in research. Clients with no/mild ratings were coded as green (low risk), 2+ moderate ratings as orange (medium risk) and 1+ severe rating as red (high risk). Demographic information and the outcome measure responses were collected via phone at baseline, 4- and 8-weeks after receiving their first call. Our primary objective is to identify whether baseline risk level (green: low risk, orange: medium risk, red: high risk) is associated with improved mental health outcomes at 8-week follow-up for stress (primary outcome), depression, anxiety, and COVID fear (secondary outcomes). Our secondary objective is to identify whether baseline demographic characteristics (age, gender, living environment, ethnicity, neighbourhood, languages spoken) are associated with improvement in primary and secondary outcomes. We will compare outcome scores between groups with different baseline risk levels using two-way ANOVA. Additional analysis of covariance (ANCOVAs) will control for variables that differ between groups at baseline. Additional linear mixed-effect regression models, adjusting for covariates such as age, sex, etc., will analyze the effect of TIP-OA in all outcomes collected at baseline and 8-week follow-up. Results We are currently in the process of analyzing the data, and anticipate results by December 2021. Conclusions We anticipate that TIP-OA will be particularly beneficial for improving stress, depression and anxiety symptoms, and fear of COVID-19 over 8-weeks in participants with higher baseline risk levels. If this study is successful, our potential scientific findings will allow us to further refine the intervention and focus future related interventions to patient populations who could benefit most. High-quality, real-time evidence about the predictors of response to this novel intervention for older adults will be generated, allowing for the translation of these findings to the application and further development of TIP-OA or related interventions on a larger scale. Another benefit is that our findings can contribute to a next step in this line of research: as older adults are becoming more familiar/comfortable with technology, there is possibility for future high-impact research examining other telehealth and digital health interventions for older adults. This research was funded by TIP-OA received funding support from the Canadian Institutes of Health Research (CIHR#201909PJ8-432903), the Lady Davis Institute, and charitable donations to the Jewish General Hospital Division of Geriatric Psychiatry. The initial training of TIP-OA volunteers through the Touch-Volunteer in Partnership program was funded in part by the What connects us-Ce qui nous lie Dementia Community Investment Public Health Agency of Canada (PI: Park Co-PIs: Belchior, Valente #1920-HQ-000092). Development and adaptation of the Touch-Volunteer in Partnership manual for telehealth was funded in part by The Canadian Institute of Health Research (PI: Park, Primary Knowledge Users: Rouleau, Stewart, PHSI #293636 & PI: Park, Looper, Stewart, SPOR #397525) and the Jewish General Hospital Foundation (PI: Looper).
ABSTRACT
Introduction: Older adults with dementia have been significantly at more risk for not receiving the care needed and for developing further mental health problems during COVID-19. Although the rise in telemedicine adoption in the healthcare system has made it possible for patients to connect with their healthcare providers virtually, little is known about its use and effects among older adults with dementia and their mental health. Objective: This systematic review aimed to explore the use, accessibility, and feasibility of telemedicine in older adults with dementia, as well as examine the potential mental health impacts of these technologies, through reviewing evidence from studies conducted during COVID-19. Methods: PubMed, Scopus, and Web of Science databases were searched with the following keywords: (COVID* OR SARS-CoV-2 OR Coronavirus) AND ("mental health" OR Depression OR Stress) AND (Dementia OR Multi-Infarct Dementia OR Vascular Dementia OR Frontotemporal Dementia) AND (elder OR Aging OR Aging OR Aged) AND (Telemedicine OR "Remote Consultation" OR telehealth OR technology). Results: A total of 7 articles from Asia, Europe, and the United States were included in this review. Throughout the studies cognitive and mental health assessments (e.g., MoCA, FAST, etc.) were performed. Despite the barriers, telemedicine was noted as a feasible approach to assist individuals with dementia in connecting with their service providers and family while reducing complications related to travel (e.g., difficulty moving, traffic, distance). Conclusions: Due to the COVID-19 pandemic, finding alternative ways to provide services to older adults with dementia through technology may continue to become more necessary as time goes on.
ABSTRACT
Introduction: Social-distancing due to COVID-19 has led to social isolation, stress, and mental health issues in older adults, while overwhelming healthcare systems worldwide. Telehealth involving phone calls by trained volunteers is understudied and may be a low-cost, scalable, and valuable preventive tool for mental health. In this context, from patient participatory volunteer initiatives, we have adapted and developed an innovative volunteer-based telehealth intervention program for older adults (TIP-OA). Methods and analysis: To evaluate TIP-OA, we are conducting a mixed-methods longitudinal observational study. Participants: TIP-OA clients are older adults (age ≥ 60) recruited in Montreal, Quebec. Intervention: TIP-OA volunteers make weekly friendly phone calls to seniors to check in, form connections, provide information about COVID-19, and connect clients to community resources as needed. Measurements: Perceived stress, fear surrounding COVID-19, depression, and anxiety will be assessed at baseline, and at 4- and 8-weeks. Semi-structured interviews and focus groups will be conducted to assess the experiences of clients, volunteers, and stakeholders. Results: As of October 15th, 2020, 150 volunteers have been trained to provide TIP-OA to 305 older clients. We will consecutively select 200 clients receiving TIP-OA for quantitative data collection, plus 16 volunteers and 8 clinicians for focus groups, and 15 volunteers, 10 stakeholders, and 25 clients for semi-structured interviews. Discussion: During COVID-19, healthcare professionals' decreased availability and increased needs related to geriatric mental health are expected. If successful and scalable, volunteer-based TIP-OA may help prevent and improve mental health concerns, improve community participation, and decrease healthcare utilization. Clinical Trial Registration: ClinicalTrials.gov NCT04523610; https://clinicaltrials.gov/ct2/show/NCT04523610?term=NCT04523610&draw=2&rank=1.