ABSTRACT
Background: Cognitive rehabilitation group therapies, such as Motivationally Enhanced Compensatory Cognitive Training for Mild Cognitive Impairment (ME-CCT-MCI), are associated with improvements in cognitive functioning, cognitive complaints, and subjective daily functioning domains. While traditionally delivered via in-person, the COVID-19 pandemic resulted in a transition to video visit delivery by many providers and health organizations, including the VA. However, many older adults are unable to participate in video telehealth due to low technological literacy or lack of internet access. Expanding dissemination approaches to include telephone- based delivery may improve access to cognitive rehabilitation services for many older adults. This study assessed the feasibility, acceptability, and preliminary efficacy of an 8-week, telephone-based ME-CCT-MCI group for older adult veterans without technical literacy during the COVID-19 pandemic. Methods: A convenience sample of eleven older adult veterans (Mage=77.72, SD=4.12) with subjective memory complaints and stated inability to use the VA's Video Connect system for video visits was recruited from geriatric clinics within a Veterans Affairs Medical Center. Two rounds of 8-week ME-CCT-MCI groups were conducted, with each group meeting by telephone for one hour a week. Participants completed a battery of measures before and after participation and change over time was evaluated using paired samples t-tests. Measures included the Montreal Cognitive Assessment - Blind, Multifactorial Memory Questionnaire, Geriatric Depression Scale, Geriatric Anxiety Scale, Short Form Health Survey (SF-12) and a group satisfaction questionnaire. Results: Feasibility was demonstrated through good rates of session attendance (M = 6.72 out of 8 sessions), and acceptability was demonstrated through excellent self-reported measures of group satisfaction (M = 9.18/10). Participants demonstrated significant improvements in cognitive functioning (p = .03), subjective memory satisfaction (p = .01) and subjective memory abilities (p < .01) between pre-test and post-test measures. No differences were found for subjective memory strategies, depression, anxiety, or perceived health. Conclusions: Findings offer preliminary support for the feasibility, acceptability, and efficacy of telephone-based ME-CCT-MCI for technologically unready older veterans.
ABSTRACT
Background Comprehensive geriatric assessment (CGA) and geriatric syndromes are taught as part of the geriatric rotation for fourth-year medical students. Students then rotate at a geriatric clinic and apply their knowledge under attendings' supervision. With a limitation of on-site rotation due to the COVID-19 pandemic, teaching and services were conducted via a virtual platform. The synchronously coordinated onsite clinic visit and virtual classrooms were arranged. Methods Patients who would come for an in-person visit were asked whether they are interested to participate in the virtual teaching activity. Sessions were conducted via a secure online virtual meeting in HIPAA-compliant matters according to school policy. Medical students attended lectures on geriatric syndromes and CGA before the clinic. Students were guided on health professionalism for telehealth. Attending supervised and summarized the care plan with patients. Students received feedback on their performance and shared their experiences on the visit. An online anonymous evaluation was sent for purposes of class development. Results Sixteen virtual clinic sessions for 84 students were conducted throughout 2 months. Each session had 4 -6 students. The overall satisfaction was 4.89/5. Positive comments included the opportunity to apply CGA with patients and readiness to practice in a telemedicine manner. Half of the class rated this session as the equivalent to the regular clinic while the other half would like an onsite clinic class. Each visit took longer and requires technical and management support from administrative staff. Patients also reported high satisfaction, 4.6/5, and most took pride in being able to involve in training the future healthcare providers. Conclusions Telemedicine and virtual classrooms have been game-changer for both medical educators and students. Older adults who are disproportionately affected by COVID-19 are the least familiar with the technology. They are comfortable with coming in for a regular visit, nevertheless, they see the importance of having medical students as part of their care team. Our study has highlighted an opportunity to leverage telemedicine arrangements to provide a safe care-providing environment for patients and a suitable learning environment for medical students.
ABSTRACT
OBJECTIVES: To describe the clinical characteristics, 30-day mortality, and associated factors of patients living in nursing homes (NH) with COVID-19, from March 20 to June 1, 2020. DESIGN: This is a retrospective study. A geriatric hospital-based team acted as a consultant and coordinated the care of older people living in NHs from the hospital. SETTING AND PARTICIPANTS: A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs. METHODS: A logistic regression was performed to analyze the factors associated with mortality. In addition, Kaplan-Meier curves were applied according to mortality and its associated factors using the log-rank Mantel-Cox test. RESULTS: The diagnosis of COVID-19 was mainly made by clinical compatibility (N = 430). Median age was 87 years, 64.6% were women and 45.9% were transferred to be cared for at the hospital. A total of 282 patients died (44.7%) within the 30 days of first attention by the team. A severe form of COVID-19 occurred in 473 patients, and the most frequent symptoms were dyspnea (n = 332) and altered level of consciousness (n = 301). According to multiple logistic regression, male sex (P = .019), the Clinical Frailty Score (CFS) ≥6 (P = .004), dementia (P = .012), dyspnea (P < .001), and having a severe form of COVID-19 (P = .001), were associated with mortality, whereas age and care setting were not. CONCLUSIONS AND IMPLICATIONS: Mortality of the residents living in NHs with COVID-19 was almost 45%. The altered level of consciousness as an atypical presentation of COVID-19 should be considered in this population. A severe form of the disease, present in more than three-quarters of patients, was associated with mortality, apart from the male sex, CFS ≥6, dementia, and dyspnea, whereas age and care setting were not. These findings may also help to recognize patients in which the Advance Care Planning process is especially urgent to assist in the decisions about their care.