RESUMEN
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.
RESUMEN
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.
RESUMEN
Introduction Background: Loneliness affects up to 42% of long-term care residents and is associated with poor health outcomes. Humanoid robot interventions hold promise for reducing loneliness and decreasing barriers to social interaction in long-term care settings, such as the current COVID-19 safety measures in many countries, limited mobility and poor health. We present a case series examining the effects of a humanoid robot intervention on loneliness and mental health outcomes in long-term care residents. Methods : 8 (n=8) older adults experiencing loneliness in a senior center will undergo an 8-week, twice a week social intervention with the Grace humanoid robot vs. a treatment as usual active control. We will assess change (baseline to week 8) in (1) loneliness (primary outcome), (2) depression severity and (3) stress (secondary outcomes), as well as (4) other exploratory outcomes: anxiety, quality of life and reduction in acute healthcare utilization. We will also assess the feasibility and acceptability of the intervention using qualitative methods. Discussion : The proposed study will assess the effects of a social robot on loneliness and other mental health outcomes, as well as the feasibility of the intervention in older adults living in long-term care settings. Trial Registration NCT05423899 Methods Study Design This is a case series with 8 participants examining an 8-week, 2 sessions per week, 30-min/session humanoid robot interaction intervention in older adults who experience loneliness in a Montreal senior center. Intervention with the Grace Robot The Grace robot was designed by Awakening Health/Hanson Robotics for healthcare settings and to interact with the elderly and those isolated by the COVID-19 pandemic. Grace is a robot with a human-like appearance, which can move, actively listen, engage in conversation, and react appropriately to human emotions. Intervention activities will mostly consist of active listening and general discussions about topics of interest (e.g., hobbies, music). The participant will also have the option of other types of interactions with the robot, including robot-led meditation, robot-led light exercise, listening to music and singing. Because loneliness is a subjective experience and does not have a standardized solution, this is a personalized intervention approach. We anticipate that each older adult participant will have different needs and wishes when interacting with the robot, which will allow for a more natural interaction with the robot. Participants: 8 participants from a Montreal senior center. Please see uploaded table for eligibility criteria. Outcomes All primary, secondary, and exploratory data will be collected at baseline and 8-weeks (primary study endpoint). Primary Outcome: Loneliness as measured by the Revised UCLA 20-item Loneliness Scale at baseline vs. 8-weeks (primary study endpoint), a commonly used validated scale to screen for loneliness. Secondary Outcomes: A: Stress, as measured by the Perceived Stress Scale (PSS), a 14-item scale used to measure the degree to which life events are experienced and appraised as stressful. B: Depression, as measured by the Patient Health Questionnaire (PHQ-9), a 9-item self-report questionnaire used to diagnose depression and assess symptom severity. Exploratory Outcomes: Anxiety and quality of life, as measured by Generalized Anxiety Disorder-7 (GAD-7), EQ-5D-5L, respectively. We will also look for indications of a reduction in acute healthcare utilization (number of hospitalizations and emergency room visits) at 8 weeks post-intervention. Moreover, participant experiences and acceptability with the robot will be measured using qualitative methods. We will also note whether feasibility outcomes have been met, wherein a) >50% of eligible participants will consent, b) recruitment goals are met during the study period (n=8), and c) rate of attrition is <20%. Statistical Analyses: Descriptive statistics will be run with continuous variables summarized using means and standard deviations, and categorical variables summarized using counts and proportions. Primary analyses for all quantitative outcomes will be compared between intervention and control groups, controlling for baseline scores using linear mixed models. For qualitative data, thematic analysis will identify and code central themes, using NVivo software. Results Results available in February 2023. Conclusions The potential benefits of this proposed case series include decreased loneliness, anxiety, depression and other improved mental health outcomes in older adults, as well as decreased healthcare utilization and improved overall quality of life. The results from this cutting-edge study will provide pilot data to inform a larger three-arm, multi-site confirmatory RCT assessing the effects of the Grace robot on mental health outcomes of older adults in LTC homes. This research was funded by The Grace robot (value of $150,000) is provided via an in-kind donation from Awakening Health/Hanson Robotics.
RESUMEN
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.
RESUMEN
Introduction Caregiving is a universal experience, with 1 in 4 Canadians (≥15 years old) identifying as caregivers for family or friends, attributing more than 20 hours of care per week. In Canada, caregivers provide approximately 5.7 billion hours of care and hold an economic value of $97.1 billion per year. The COVID-19 pandemic highlighted the critical role that caregivers have on the wellbeing of the aging population. Despite the commonality of informal caregiving, the experience is highly isolating and contributes to high levels of burnout, stress, depression, and anxiety. The undisclosed costs of caregiver burden are not only monetary but may lead to secondary stressors on one's work, family relationships, and general quality of life. The majority of informal caregivers receive no direct education or support to take on this role and are subject to unpredictable and uncontrollable circumstances. Moreover, informal caregivers are oftentimes neglected with little research dedicated to their needs, and sparse social acknowledgement and remittance. For this protocol, a multimedia phone application, known as ProActive Care (PAC), was created to support caregivers. This study aims to prevent caregiver burden and related mental health outcomes for the caregiver using the ProActive Care application with hopes to demonstrate the feasibility of the technology for future uses. Methods This is a study protocol for a mixed methods randomized controlled trial (RCT) of a mobile phone application called ProActive Caring (PAC), compared to a waitlist control group for informal caregivers. Participants (n=60) will be recruited through community organizations and will be included in the study if they are an active informal caregiver for an older adult with a Zarit Burden Inventory score ≤ 21, indicating little or no burnout. Participants will be randomly assigned to either receiving PAC or the waitlist control. Participants assigned to PAC will use the application for a total of 8-weeks and those in the waitlist control group will receive the PAC application after the study has concluded. All participants will be assessed at baseline, 8-weeks, and 10-weeks (i.e., 2-weeks post intervention) for study outcomes. The primary outcome is caregiver burnout, measured by Burnout Scale for Family Cargivers and Preparedness for caregiving scale. Secondary outcomes will include stress (Relative Stress Scale), depression (MADRS), and anxiety (GAD7). Self-efficacy measured by the General self-efficacy scale will be an exploratory outcome. For feasibility and app satisfaction, participants in the intervention group will complete the Modified Mobile Application Rating Scale (M-MARS) and System Usability Scale after study completion. There will be a qualitative component of the study which will be a semi-structured focus group with participants and research coordinators to investigate common caregiving themes, PAC strengths/weaknesses, and caregiver needs. Changes in study outcomes between baseline, 8-weeks, and 10-weeks will be measured using an Analysis of Variance (ANOVA). There will be a within subjects factor of time (Baseline, 8-weeks, 10-weeks) and between subjects factor of condition (PAC intervention vs. Waitlist control). A descriptive phenomenological approach will be used for the qualitative component to code data into themes based on key words and their frequencies. PAC Intervention. The PAC application is a free, downloadable, smartphone application. It is designed to streamline access to local resources and social services information, to ease organization of daily tasks, and promote self-care. Features of PAC include a resource database, a daily log, journal (including prompts), mindfulness activities, and a community board interface aimed at improving negative health impacts of caregiving. Although there are other applications aimed towards caregivers, most provide reactive management tools focusing on the care recipient's needs rather than maintaining the health and wellbeing of the caregiver. Results Not applicable. Conclusions Caregivers' immeasurable contributions to society and to the individuals that require care is crucial to our personal lives and communities as a whole. They provide the ability for people who may be suffering to take comfort in their own homes, while offering nuanced attention and affection for those in need of care. Caregivers are not only essential to the care-recipient, but also to supporting the healthcare and home-care systems through alleviating capacity strain. We expect this PAC application to prevent burnout and burden in caregivers. By utilizing technology to connect individuals and increase one's quality of life, we can take active steps to prevent the burnout of our communities and compassionate caregivers. This research was funded by None.
RESUMEN
Background: Loneliness affects up to 42% of long-term care residents and is associated with poor health outcomes. Humanoid robot interventions hold promise for reducing loneliness and decreasing barriers to social interaction in long-term care settings, such as the current COVID-19 safety measures in many countries, limited mobility, and poor health. We present a protocol describing an assessor-blinded randomized controlled trial comparing the effects of a humanoid robot intervention to treatment as usual, on loneliness and mental health outcomes in long-term care residents. Methods: Seventy-four (n = 74) older adults experiencing loneliness in 3 long-term care homes will be randomized 1:1 to an 8-week, twice a week social intervention with the Grace humanoid robot vs. a treatment as usual active control. We will assess change (baseline to week 8) in (1) loneliness (primary outcome), (2) depression severity, and (3) stress (secondary outcomes), as well as (4) other exploratory outcomes: anxiety, quality of life and reduction in acute healthcare utilization. We will also assess the feasibility and acceptability of the intervention using qualitative methods. Discussion: The proposed study will assess the effects of a social robot on loneliness and other mental health outcomes, as well as the feasibility of the intervention in older adults living in long-term care settings. Trial registration: NCT05423899.
RESUMEN
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).
RESUMEN
Introduction Over 700,000 Canadians are affected by dementia, costing the health care system approximately $10 billion/year. Due to COVID-19, the government has urged individuals over the age of 70 to stay home, putting this population at risk of becoming socially isolated. Those with dementia or mild cognitive impairments (MCIs) and their caregivers are at an even higher risk of becoming stressed, anxious, and agitated while in lockdown. Unsurprisingly, caregiver burden is extremely common, and often precedes institutionalization of the patient, as the demands of the illness begin to exceed that which the caregiver can sustainably provide. Since social distancing measures have shut down activities and support groups for these individuals, there is an urgent need for scalable, cost-effective, non-pharmacological interventions that can be delivered remotely to improve stress and loneliness. There are positive preliminary results examining the effects of yoga on stress suggesting it may be suitable for individuals with dementia and their caregivers. For this reason, we are conducting a randomized clinical trial (RCT) to assess the efficacy of an 8-week virtual chair yoga program. This would be the first virtual chair yoga study to engage both older adults with dementia/MCI and caregivers during COVID-19, which is consistent with the need for decreasing costs and increasing accessibility of novel health interventions during and beyond the pandemic. This study may be one viable solution to address the stress associated with the growing prevalence of dementia and the physical distancing measured associated with the COVID-19 health crisis. Methods A mixed-methods randomized controlled trial was used to assess the efficacy of an 8-week group Chair Yoga program on Zoom for older adults (60+) with dementia/MCI and their caregivers. Participants were assigned to either the treatment or waitlist control group and completed assessments at baseline and week 8. Quantitative assessments were measured at baseline and week 8, and qualitative assessments will be measured post-intervention. The primary and secondary outcomes are changes in stress and loneliness after the 8-week program, respectively. We also explored changes in anxiety, depression, caregiver burnout, fear of COVID-19, mindfulness, and self-compassion. Changes in all continuous variables from pre- to post-program will be evaluated by a Two-Way Mixed Analysis of Variance (ANOVA) with the within-subjects factor of time (baseline and week 8) and between-subjects factor of condition (chair yoga treatment or control). For the qualitative component, a descriptive phenomenological approach will be used to code data into themes based on key words and on frequency/importance of these words. Results We are in the final stages of data collection. Results will be ready by December 2021. Preliminary observations suggest that this program is feasible and acceptable based on positive feedback from older adults and caregivers. Some difficulties encountered were lack of internet access, lack of devices, and scheduling conflicts, which led to individuals not participating in the study. Surprisingly, many older adults were aware and knowledgeable of the Zoom software;we experienced very minor difficulties in using this software for this population. Conclusions We expect this study to validate our hypotheses that the severity of stress, loneliness, caregiver burden, and other self-reported outcomes will significantly decrease in the treatment group compared to the waitlist control group. As such, this intervention may decrease the economic burden on the healthcare system, as it can be delivered to large groups online and is easily scalable and cost-effective. It may also be a benefit to society by potentially decreasing the number of Canadians suffering from chronic stress. Additionally, it will potentially reduce caregiver burden and delay institutionalization of individuals with dementia, the latter of which may be particularly impactful given the rapid spread of COVID-19 through long-term care facilities in Canada. Regardless of the outcome, this study will provide essential pilot data for future large RCTs to improve stress and mental health in both older adults with dementia/MCI and caregivers. This research was funded by Katie Bodenstein received a Canada Graduate Scholarship SSHRC MSc Award and McGill Faculty of Medicine Internal Studentship.
RESUMEN
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).
RESUMEN
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.
RESUMEN
BACKGROUND: The worldwide prevalence of anxiety in older adults is estimated at between 6 and 10%. In Canada, adults 65 and older experience anxiety at a rate of 6.4%, affecting more than 300,000 people. Anxiety in older adults has been linked to difficulties retaining new information and engaging in instrumental daily activities of living. Due to COVID-19 restrictions, novel methods of delivering therapy programs remotely are needed; however, data is limited. There is some evidence that older adults prefer non-pharmacological approaches for anxiety that can be delivered in the community. Emotion-focused mindfulness therapy (EFMT) is a mindfulness-based intervention that emphasizes meditation and observing thoughts and emotions as they arise. This emphasis has been demonstrated to reduce symptoms of anxiety in general populations. This study aims to evaluate the feasibility of EFMT with older adults. METHODS: This pilot feasibility randomized controlled trial will use a wait list control trial design. Due to COVID-19 restrictions, we will use telehealth delivery via Zoom rather than in-person delivery. The first 48 people to meet the eligibility criteria will be randomly allocated to either receive EFMT immediately, or in approximately 8 weeks time from enrollment (1:1 allocation ratio). Data will be collected at baseline, 8 weeks following baseline, and 16 weeks following baseline. The primary outcomes will determine the feasibility of the intervention based on recruitment, enrolment, retention, and adherence to all components of the intervention. The secondary outcome will be changes to anxiety over time. DISCUSSION: The results of this trial will determine the feasibility and potential effectiveness of video-delivered EFMT for late-life anxiety compared to no treatment. If the results are promising, a larger randomized controlled trial may be conducted. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04415528 . Registered on June 4, 2020 PROTOCOL VERSION: Protocol version 2, January 2, 2021.
RESUMEN
(1) Introduction: Undergraduate (UG) nursing students are vulnerable to stress throughout their education, known to result in burnout, with high attrition rates of up to 33%. There is a growing body of evidence to suggest that mindfulness-based interventions are effective for the management of anxiety, depression and wellbeing, thereby reducing stress in healthcare provider populations. The aim of this narrative review was to synthesize and provide a critical overview of the current evidence in relation to mindfulness-based interventions for UG nursing students in a university setting. (2) Methods: A review of the literature was conducted in March 2020 and updated in May 2021, utilising the databases CINAHL, Medline and PsycINFO. (3) Results: Fifteen studies were included in the review, with three common themes identified: (i) the positive impact of mindfulness on holistic wellbeing, (ii) mindfulness-based techniques as a positive coping mechanism within academic and clinical practice, and (iii) approaches to the delivery of mindfulness-based interventions. (4) Conclusions: Mindfulness-based interventions are effective strategies for the management of stress, development of self-awareness and enhanced academic and clinical performance in undergraduate nursing students. No ideal approach to delivery or duration of these interventions was evident from the literature. Best practice in relation to delivery of mindfulness-based interventions for nursing students is recommended for future studies.
RESUMEN
BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642.
RESUMEN
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.
RESUMEN
BACKGROUND: Telemedicine is a timely solution for the restrictions that COVID-19 social distancing places upon conventional modalities of healthcare provision. Geriatric populations affected by dementia require greater access to healthcare services, particularly in rural areas. As such, the aim of this systematic review is to examine the impact of telemedicine on health outcomes in elderly individuals with dementia living in rural areas. METHODS: A systematic review was completed using Ovid Medline, Web of Science and ACM Digital Libraries. The keywords for the selection of articles were: (telemedicine OR Telehealth) AND (Rural) AND (Age* OR Eld*) AND (Dementia) and (Telemedicine) AND (Rural Health OR Rural Population OR Hospitals, Rural OR Rural Health Services) AND (Aged OR Aging) AND (Dementia OR Multi-Infarct Dementia OR Vascular Dementia OR Frontotemporal Dementia). Among the 94 articles identified, 79 (84.0 %) were screened, 58 (61.7 %) were assessed and 12 (12.8 %) were included. RESULTS: The studies had diverse populations. Two were conducted in Australia, five in Canada, one in Korea, and four in the United States of America. The studies used a variety of cognitive tests and reported mixed results regarding the differences in patient performance when assessed in-person as compared to telemedicine consultation. Overall, both patients and physicians reported satisfaction with telemedicine; however, there were mixed results regarding the reliability of cognitive tests and the infrastructure required. Convenience, satisfaction, comfort and recommending telemedicine were reported to be high in the telemedicine group and physicians reported they would use telemedicine again. CONCLUSION: The testing conditions and the accessibility of telemedicine yield inconclusive results as to whether telemedicine can improve the management of dementia in geriatric individuals.