ABSTRACT
BACKGROUND: For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes. OBJECTIVE: To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19. DESIGN: Qualitative, observational study using grounded theory. PARTICIPANTS: Informal caregivers aged 18 + who cared for an older adult who received tele-dementia services at two major VA healthcare systems participated in 30-60-min semi-structured telephone interviews. INTERVENTIONS: Interviews were designed using Fortney's Access to Care model. MAIN MEASURES: Thirty caregivers (mean age = 67, SD = 12, 87% women) were interviewed. KEY RESULTS: Five major themes were (1) Tele-dementia care avoids routine disruption and pre-visit stress; (2) Transportation barriers to in-person visits include not only travel logistics but navigating the sequelae of dementia and comorbid medical conditions. These include cognitive, behavioral, physical, and emotional challenges such as balance issues, incontinence, and agitation in traffic; (3) Tele-dementia care saves time and money and improves access to specialists; (4) Tele-dementia facilitated communication between caregiver and provider without hindering communication between PLWD and provider; and (5) Caregivers described ideal future dementia care as a combination of virtual and in-person modalities with in-home help, financial and medical support, and dementia-sensitive caregiver access. Caregivers interviewed saved 2.6 h ± 1.5 h (range: 0.5 to 6 h) of travel time. Multiple caregivers described disruption of routines as difficult in PLWD and appreciated the limited preparation and immediate return to routine post telemedicine visit as positives. CONCLUSIONS: Caregivers found tele-dementia care convenient, comfortable, stress reducing, timesaving, and highly satisfactory. Caregivers would prefer a combination of in-person and telemedicine visits, with an opportunity to communicate with providers privately. This intervention prioritizes care for older Veterans with dementia who have high care needs and are at higher risk for hospitalization than their same age counterparts without dementia.
ABSTRACT
INTRODUCTION: Current clinical practice guidelines aim to decrease the use of unnecessary indwelling urinary catheters to prevent catheter associated urinary tract infections. Patients with benign prostatic hyperplasia often experience increased post-void residual urine volume and subsequent bladder catheterization to prevent complications such as urinary tract infections or hydronephrosis. However, the management of urinary retention in patients with benign prostatic hyperplasia varies and clinical guidelines are lacking. In this study we gather information on post-void residual urine volume, the use of catheters and associated complications in a sample of older veterans with benign prostatic hyperplasia. METHODS: A retrospective chart review was performed using 660 patients screened for documented post-void residual urine volume greater than 100 cc, age greater than 65 years and the absence of cancer. A final chart review of 136 male veterans was performed for this analysis. RESULTS: A total of 59 (43.4%) indwelling urinary catheters were placed. Catheters were placed in subjects with modest post-void residual urine volumes in the 100 to 150 cc range and in those with a post-void residual urine volume greater than 500 cc. Overall complication rates were low. Among those patients who had a catheter placed 51% reported hematuria, 36% reported pain and only 1 had documented urosepsis. Hydronephrosis occurred in 4 cases, each with a post-void residual urine volume of 301 to 400 cc, and 3 of these individuals had an indwelling urinary catheter placed. In those patients emergency room visits and hospitalizations were more frequently associated with placement of an indwelling urinary catheter. CONCLUSIONS: Larger studies are needed for the development of clinical guidelines on the treatment of patients with benign prostatic hyperplasia and urinary retention.
