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Warner A, Palmier-Claus J, Holland C, Tyler E, Rhodes V, Settle G, Lobban F. The Changing Care of Older Adults With Bipolar Disorder: A Narrative Analysis. QUALITATIVE HEALTH RESEARCH 2024:10497323241263043. [PMID: 39076026 DOI: 10.1177/10497323241263043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Older adults with bipolar disorder experience distinct challenges compared to younger age groups with bipolar disorder. They potentially require adaptations to the care they receive. This study aimed to explore experiences of care and changing care needs in older adults with bipolar disorder. People with bipolar disorder (aged ≥60) were recruited through three NHS Trusts in the North West of England, charity organisations, a confidential university participant database, and social media. Participants completed single time-point biographical narrative interviews, which were analysed using narrative analysis. Sixteen participants' accounts led to the creation of four themes: (1) 'Navigating the disruption caused by diagnosis'; (2) 'The removal of services that provided hope'; (3) 'Later life: We are on our own now'; and (4) 'Changing care needs in later life: We still need support'. The care needs of older adults with bipolar disorder appear to change over time, and services often fail to offer adequate, tailored care for this group at present. Current support requires adaptation to be effective and appropriate and to enable this group to age well in later life.
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Affiliation(s)
- Aaron Warner
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jasper Palmier-Claus
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Carol Holland
- Division of Health Research, Centre for Aging Research, Lancaster, UK
| | - Elizabeth Tyler
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Verity Rhodes
- NIHR Applied Research Collaboration North West Coast, UK
| | - Geoff Settle
- NIHR Applied Research Collaboration North West Coast, UK
| | - Fiona Lobban
- Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
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Vasiliadis HM, Spagnolo J, Fleury MJ, Gouin JP, Roberge P, Bartram M, Grenier S, Shen-Tu G, Vena JE, Wang J. Factors associated with mental health service use during the pandemic: Initiation and barriers. Int J Soc Psychiatry 2024; 70:59-69. [PMID: 37646244 PMCID: PMC10860360 DOI: 10.1177/00207640231194489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Scarce are the studies focusing on initiation of new mental health service use (MHSU) and distinguishing individuals who have sought services but have been unsuccessful in accessing these. AIMS Assessing the factors associated with initiating new MHSU as compared to no MHSU due to self-reported no need, no MHSU due to health system and personal barriers and MHSU using resources already in place. METHODS The sample included participants (n = 16,435) in the five established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) who responded to the CanPath COVID-19 health surveys (May-December 2020 and January-June 2021). Multinomial regression analyses were carried out to study MHSU since the pandemic (March 2020) as a function of predisposing, enabling and need factors. Analyses were carried out in the overall sample and restricted to those with moderate and severe symptoms (MSS) of depression and/or anxiety (n = 2,237). RESULTS In individuals with MSS of depression and/or anxiety, 14.4% reported initiating new MHSU, 22.0% had no MHSU due to barriers and personal reasons and 36.7% had no MHSU due to self-reported no need. Age, living alone, lower income, a decrease in income during the pandemic and health professional status were associated with MHSU. Younger adults were more likely to initiate MHSU during the pandemic than older adults who reported not being comfortable to seek mental health care or self-reported no need. Individuals living alone and with lower income were more likely to report not being able to find an appointment for mental health care. CONCLUSIONS Awareness campaigns focusing on older adults that explain the importance of seeking treatment is needed, as well as sensitising health professionals as to the importance of informing and aiding individuals at risk of social isolation and lower socio-economic status as to available mental health resources and facilitating access to care.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, QC, Canada
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, QC, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Verdun, QC, Canada
- McGill University, Montreal QC, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Pasquale Roberge
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy & Administration, Carleton University, Ottawa, ON, Canada
| | - Sébastien Grenier
- Centre de recherche de l’Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
- Département de psychologie, Université de Montréal, Montréal, QC, Canada
| | - Grace Shen-Tu
- Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - Jennifer E. Vena
- Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Wu M, Li C, Hu T, Zhao X, Qiao G, Gao X, Zhu X, Yang F. Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2024; 12:e50787. [PMID: 38231546 PMCID: PMC10831591 DOI: 10.2196/50787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Depression is the most common psychiatric disorder among older adults. Despite the effectiveness of pharmacological and psychological therapies, many patients with late-life depression (LLD) are unable to access timely treatment. Telecare has been shown to be effective in addressing patients' psychosocial issues, while its effectiveness in serving patients with LLD remains unclear. OBJECTIVE This study aimed to evaluate the effectiveness of telecare in reducing depression and anxiety symptoms and improving quality of life (QoL) in patients with LLD. METHODS Databases including the Cochrane Library, Web of Science, PubMed, Embase, and EBSCO were searched for randomized controlled trials (RCTs) evaluating the effectiveness of telecare for LLD from database establishment to December 28, 2022. RESULTS A total of 12 RCTs involving 1663 participants were identified in this study. The meta-analysis showed that (1) telecare significantly reduced depressive symptoms in patients with LLD compared to those in usual care (UC; standardized mean difference [SMD]=-0.46, 95% CI -0.53 to -0.38; P<.001), with the best improvement observed within 3 months of intervention (SMD=-0.72, 95% CI -1.16 to -0.28; P<.001); (2) other scales appeared more effective than the Patient Health Questionnaire-9 for LLD in telecare interventions (SMD=-0.65, 95% CI -0.96 to -0.35; P<.001); (3) telecare was more effective than telephone-based interventions for remote monitoring of LLD (SMD=-1.13, 95% CI -1.51 to -0.76; P<.001); (4) the reduction of depressive symptoms was more pronounced in patients with LLD with chronic conditions (SMD=-0.67, 95% CI -0.89 to -0.44; P<.001); (5) telecare was more effective for LLD in Europe and the Americas than in other regions (SMD=-0.73, 95% CI -0.99 to -0.47; P<.001); (6) telecare significantly reduced anxiety symptoms in patients with LLD (SMD=-0.53, 95% CI -0.73 to -0.33; P=.02); and (7) there was no significant improvement in the psychological components of QoL in patients with LLD compared to those receiving UC (SMD=0.30, 95% CI 0.18-0.43; P=.80). CONCLUSIONS Telecare is a promising modality of care for treatment, which can alleviate depression and anxiety symptoms in patients with LLD. Continued in-depth research into the effectiveness of telecare in treating depression could better identify where older patients would benefit from this intervention.
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Affiliation(s)
- Man Wu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Chaoyang Li
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Ting Hu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xueyang Zhao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Guiyuan Qiao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xiaolian Gao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
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Ricklan SJ, Sohler N, Ezie CEC, Avalone L, Dinsell V, Lewis C, Fattal O, Balan S, McQuistion H, Pastore F, Sarcevic N, Swift R, Espejo G, Lorenz C. Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic. Community Ment Health J 2024; 60:115-123. [PMID: 38105337 DOI: 10.1007/s10597-023-01210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
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Affiliation(s)
- Sarah J Ricklan
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA.
| | - Nancy Sohler
- CUNY School of Medicine, Harris Hall, 160 Convent Avenue, New York, 10031, NY, USA
| | - C E Chiemeka Ezie
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Lynsey Avalone
- NYC Health and Hospitals, 125 Worth Street, New York, NY, 10013, USA
| | - Victoria Dinsell
- NYU Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Crystal Lewis
- NYU Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Omar Fattal
- NYC Health and Hospitals, 125 Worth Street, Office 423, New York, NY, 10013, USA
| | - Sabish Balan
- Harlem Hospital, 506 Lenox Avenue, New York, NY, 10037, USA
| | - Hunter McQuistion
- NYU Grossman School of Medicine, One Park Ave, 8th Floor, New York, NY, 10016, USA
| | - Frank Pastore
- North Central Bronx Hospital, 3424 Kossuth Avenue, New York, NY, 10467, USA
| | - Nermica Sarcevic
- Jacobi Hospital, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Ronnie Swift
- NY Health and Hospitals/Metropolitan, 1901 First Avenue, New York, NY, 10029, USA
| | - Gemma Espejo
- Montefiore Medical Center, 111 East 210th St, New York, NY, 10467, USA
| | - Carina Lorenz
- NYC Health and Hospitals-Bellevue, 462 1st Avenue, New York, NY, 10016, USA
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Gately ME, Trudeau SA. An Online Learning Experience Simulating Video Telehealth with Older Adults: Student Perceptions. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 9:154-163. [PMID: 38586236 PMCID: PMC10996448 DOI: 10.1007/s41347-023-00363-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024]
Abstract
Older adults are an underserved population with a broad-spectrum of care needs due to multi-morbidity, including increasing rates of mental health conditions. Though a prime target for tele-behavioral health due to access barriers, older adults face a persistent digital divide that necessitates clinician training and education to ensure interprofessional tele-behavioral health is tailored to their needs. This paper presents findings from a simulation learning program designed to teach students about the role of video telehealth with populations with diverse needs. Occupational therapy (OT) students enrolled in a Master's program between 2017 and 2018 conducted a simulated video telehealth session geared for an older adult. Sessions were recorded and annotated by students, who then provided feedback on their experience of the simulation via reflective essays (N = 27). Essays were analyzed using conventional content analysis with themes revealing the benefits of simulation in providing students with an opportunity to experience the often unpredictable nature of video telehealth. Themes also revealed perceived limitations of video and the negative impact of age-related conditions and age itself on older adults' ability to engage in video, reflecting ageist stereotyping and bias as potential barriers to novice practitioners' integration of video telehealth with older adults. Simulation provides students an opportunity to engage in active learning and problem-solving in the moment, fostering students' development of clinical reasoning while promoting reflective practice. Findings reveal the importance of supporting students' recognition of biased attitudes to ensure equitable application of tele-behavioral health care, especially to populations with complex needs.
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Affiliation(s)
- Megan E. Gately
- Geriatric Research Education and Clinical Center, VA; Bedford Health Care System, Bedford, MA, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
| | - Scott A. Trudeau
- Geriatric Research Education and Clinical Center, VA; Bedford Health Care System, Bedford, MA, USA
- Department of Occupational Therapy, Tufts University, Medford, MA, USA
- American Occupational Therapy Association, Bethesda, MD, USA
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6
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Solomonov N. Improving social reward responsivity and social connectedness in psychotherapies for late-life depression: Engage & Connect as an example. Psychiatry Res 2023; 329:115469. [PMID: 37783093 PMCID: PMC10841452 DOI: 10.1016/j.psychres.2023.115469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Abstract
Psychotherapies are effective in reducing late-life depression. Yet, about half of patients remain depressed at treatment end. Advances in neuroscience can inform simplified interventions that target key brain networks impacted by depression. Behavioral activation therapies that increase social connectedness may improve social reward responsivity and alter abnormalities of the Positive Valence System (PVS). Engage & Connect is an example for a scalable and simple neuroscience-informed psychotherapy, aimed to improve PVS functions and social reward responsivity by increasing engagement in rewarding social activities. Interventions that improve social reward responsivity can be promising first-line treatments for late-life depression in the community.
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Affiliation(s)
- Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA.
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Wilson CM, Arena SK, Boright L, Duplissis N, Hilliker M, Krupa J. Evaluation of a Physical Therapist-Delivered Technology Literacy Algorithm and Protocol for Older Adults: A Pilot Study. Cureus 2023; 15:e47865. [PMID: 38021598 PMCID: PMC10680407 DOI: 10.7759/cureus.47865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Technology literacy is the ability to comfortably understand, use, and navigate digital devices. It is considered a "super social determinant of health", and yet 39% of adults aged 65+ report not using a smartphone, and 25% of seniors still lack internet access. The purpose of this study was to examine the applicability of a physical therapist-delivered clinical assessment tool related to technological literacy and to identify relationships between technology utilization and perceptions related to sociodemographic factors in community-dwelling older adults. Methods A prospective mixed-methods observational-descriptive study where physical therapists (PTs) administered a newly designed technology literacy algorithm to older adults and evaluated the results of the algorithm. A convenience sample of 30 participants aged 65 and older was evaluated for their technology literacy. The exclusion criteria were if the person had a vision deficit, lived in a nursing home or extended care facility, was unable to fluently read and understand the English language, or was not willing to have an in-home visit by a licensed PT. After informed consent was obtained, the participant completed a Past Experience with Technology Questionnaire assessing participant confidence with technology usage and a demographic questionnaire. A PT data collector visited participants' homes and administered a novel technology literacy algorithm. The PTs also provided subjective feedback after patient visits as to their perceptions of the algorithm. Inferential statistics were performed for key variables, including a Kruskal-Wallis test being utilized for variables with three or more levels and a two-sample Wilcoxon test being utilized for variables with two levels. The binary results were evaluated with chi-squared tests. Trends in distribution and measures of central tendency were analyzed for demographic data. Statistical significance was set at P<0.05 with a confidence interval of 95%. Results Participants (n=30) were evenly distributed with regard to age, and 66% of people had a college degree. Most were female, of the white race, and retired. There were statistically significant relationships between older age and decreased comfort level with using the internet (P=0.30) and sending messages (P=0.31), with individuals 80+ years old having a mean confidence of 6.78 out of 10. A statistically significant relationship was also found between higher income and increased confidence in browsing the internet (P = 0.07). Most qualitative data from physical therapist experiences included positive trends such as ease of use, efficiency, and confidence instilled. Constructive feedback included a lack of resources to assist with more advanced technology-related needs and recommendations to refine the algorithm when advanced needs were identified. Conclusion Technology literacy is a vital component of accessing health and medical care and maximizing the quality of that care, especially in the older adult population. The tools created may assist clinicians with identifying and addressing issues related to technology in older adults. This may help a patient navigate health issues that require the use of technology in their home. This study provided evidence that a PT-administered algorithm may be feasible to address technology literacy issues in the homes of older adults.
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Affiliation(s)
- Christopher M Wilson
- Physical Therapy, Oakland University, Rochester, USA
- Physical Medicine and Rehabilitation, Corewell Health, Southfield, USA
| | - Sara K Arena
- Physical Therapy, Oakland University, Rochester, USA
| | - Lori Boright
- Physical Therapy, Oakland University, Rochester, USA
| | | | | | - John Krupa
- Physical Therapy, Oakland University, Rochester, USA
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Neumann A, König HH, Bokermann J, Hajek A. Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review. JMIR Ment Health 2023; 10:e46148. [PMID: 37594785 PMCID: PMC10474517 DOI: 10.2196/46148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/03/2023] [Accepted: 05/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. OBJECTIVE The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. METHODS This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. RESULTS Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). CONCLUSIONS The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. TRIAL REGISTRATION PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5.
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Affiliation(s)
- Ariana Neumann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josephine Bokermann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Brunt TJ, Gale-Grant O. Telepsychiatry: what clinicians need to know about digital mental healthcare. BJPSYCH ADVANCES 2023; 29:230-238. [PMID: 37521104 PMCID: PMC10374879 DOI: 10.1192/bja.2022.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.
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Affiliation(s)
- Thomas J. Brunt
- Psychiatry core trainee at South London and Maudsley NHS Foundation Trust, London, UK, with an interest in telehealth and the use of technology in healthcare
| | - Oliver Gale-Grant
- Conducts research in the MRC Centre for Neurodevelopmental Disorders and Department of Forensic and Neurodevelopmental Science at King's College London, London, UK, focusing on computational modelling of brain development
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10
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Isaacs A, Mitchell EKL, Sutton K, Naughton M, Hine R, Bullock S, Azar D, Maybery D. Clinicians' and Users' Views and Experiences of a Tele-Mental Health Service Implemented Alongside the Public Mental Health System during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105870. [PMID: 37239597 DOI: 10.3390/ijerph20105870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: 'Conditions where use of tele-mental health is appropriate', 'Conditions where tele-mental health may not be useful', 'Advantages of tele-mental health', 'Challenges in using tele-mental health', 'Client outcomes with tele-mental health', and 'Recommendations for future use'. This is one of a few studies where clinicians' and service users' views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | | | - Keith Sutton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Michael Naughton
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Rochelle Hine
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Shane Bullock
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
| | - Denise Azar
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
- Gippsland Primary Health Network, Traralgon, VIC 3844, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, VIC 3820, Australia
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Geng Y, Wang Z, Zhou J, Zhu M, Liu J, James TD. Recent progress in the development of fluorescent probes for imaging pathological oxidative stress. Chem Soc Rev 2023. [PMID: 37190785 DOI: 10.1039/d2cs00172a] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Oxidative stress is closely related to the physiopathology of numerous diseases. Reactive oxygen species (ROS), reactive nitrogen species (RNS), and reactive sulfur species (RSS) are direct participants and important biomarkers of oxidative stress. A comprehensive understanding of their changes can help us evaluate disease pathogenesis and progression and facilitate early diagnosis and drug development. In recent years, fluorescent probes have been developed for real-time monitoring of ROS, RNS and RSS levels in vitro and in vivo. In this review, conventional design strategies of fluorescent probes for ROS, RNS, and RSS detection are discussed from three aspects: fluorophores, linkers, and recognition groups. We introduce representative fluorescent probes for ROS, RNS, and RSS detection in cells, physiological/pathological processes (e.g., Inflammation, Drug Induced Organ Injury and Ischemia/Reperfusion Injury etc.), and specific diseases (e.g., neurodegenerative diseases, epilepsy, depression, diabetes and cancer, etc.). We then highlight the achievements, current challenges, and prospects for fluorescent probes in the pathophysiology of oxidative stress-related diseases.
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Affiliation(s)
- Yujie Geng
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China.
| | - Zhuo Wang
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China.
| | - Jiaying Zhou
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China.
| | - Mingguang Zhu
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China.
| | - Jiang Liu
- State Key Laboratory of Chemical Resource Engineering, College of Chemistry, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China.
| | - Tony D James
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK.
- School of Chemistry and Chemical Engineering, Henan Normal University, Xinxiang 453007, China
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12
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Marbin D, Gutwinski S, Lech S, Fürstenau D, Kokwaro L, Krüger H, Schindel D, Schreiter S. Use of digital technologies by users of psychiatric inpatient services in Berlin, Germany: a cross-sectional patient survey. BMJ Open 2023; 13:e067311. [PMID: 36944459 PMCID: PMC10032388 DOI: 10.1136/bmjopen-2022-067311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
UNLABELLED Few studies and almost exclusively from the USA have recently investigated mobile phone and computer use among users of psychiatric services, which is of high relevance regarding the increasing development of digital health applications and services. OBJECTIVE, DESIGN AND SETTING In a cross-sectional patient survey, we examined (a) rates and purposes of mobile phone, computer, internet and social media use, and (b) the role of social and clinical predictors on rates of utilisation among psychiatric inpatients in Berlin, Germany. PARTICIPANTS AND RESULTS Descriptive analyses showed that among 496 participants, 84.9% owned a mobile phone and 59.3% a smartphone. Among 493 participants, 68.4% used a computer regularly. Multivariate logistic regression models revealed being homeless, diagnosis of a psychotic illness, being of older age and a lower level of education to be significant predictors for not owning a mobile phone, not using a computer regularly or having a social media account, respectively. CONCLUSIONS Users of psychiatric services may have access to mobile phones and computers, although rates are lower than in the general population. However, key barriers that need to be addressed regarding the development of and engagement with digital health interventions are factors of social exclusion like marginalised housing as well as clinical aspects like psychotic illness.
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Affiliation(s)
- Derin Marbin
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Psychiatrische Universitätsklinik der Charité im St Hedwig-Krankenhaus, Berlin, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Psychiatrische Universitätsklinik der Charité im St Hedwig-Krankenhaus, Berlin, Germany
| | - Sonia Lech
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Linda Kokwaro
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Helena Krüger
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Schindel
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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13
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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14
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Khowaja A, Syed N, Michener K, Mechelse K, Koning H. Managers' and Administrators' Perspectives on Digital Technology Use in Regional Long-Term Care Homes During the COVID-19 Pandemic. Gerontol Geriatr Med 2023; 9:23337214221146665. [PMID: 36644686 PMCID: PMC9837260 DOI: 10.1177/23337214221146665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
In this paper, we explore managers' and administrators' perspectives on digital technology use for residents during province-wide lockdowns (June-August 2021) during the COVID-19 pandemic in seven regional long-term care homes (LTC) in Niagara, Canada. Fifteen semi-structured interviews were conducted with participants representing operational, financial, and recreational departments where we discussed their needs and factors influencing the use of digital technology during the phases of increased restrictions on visitors and social isolation. Our findings indicate extensive use of cellular devices including smartphones, however additional iPads were needed to meet the ever-rising demand for virtual connections. Almost all participants revealed supportive leadership, redeployed staff, and community donations as main facilitators for technology use. Barriers related to managing varying elderly cognitive capacities and technical issues affected technology use. Based on our findings, we conclude that financial commitment and community support are integral for future-proofing LTC homes with technological innovations.
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Affiliation(s)
- Asif Khowaja
- Brock University, St. Catharines, ON, Canada,Asif Khowaja, Faculty of Applied Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, Canada.
| | - Nawal Syed
- Brock University, St. Catharines, ON, Canada
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15
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Saragih ID, Tonapa SI, Porta CM, Lee BO. Effects of telehealth intervention for people with dementia and their carers: A systematic review and meta-analysis of randomized controlled studies. J Nurs Scholarsh 2022; 54:704-719. [PMID: 35769007 DOI: 10.1111/jnu.12797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Interventions delivered using telehealth modalities are becoming standard practice with patient populations around the world, partly because of innovation necessitated by the COVID-19 pandemic and partly due to improved infrastructure and comfort of providers, patients, and families, through technology. Though increasingly utilized, the effectiveness of telehealth interventions with families with dementia remains unclear. This gives rise to the need for investigation to develop telehealth interventions that are evidence based and not merely convenient tools. This current study is designed to systematically examine the impact and effectiveness of telehealth-delivered psychoeducational and behavioral interventions among persons with dementia and their caregivers. DESIGN The design combines systematic review and meta-analysis. METHODS A total of eight databases were electronically accessed and searched as of November 16, 2021. Experimental studies identifying the results of telehealth interventions for persons with dementia and associated caregivers published in English have been reviewed in this study. Standardized mean differences (SMD) offering 95% confidence intervals (CI) were developed to pool the effect size using a random effects model (in this case, Stata 16.0). The Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB-2) was used to analyze the study's methodological soundness. FINDINGS Nineteen cases met the eligibility criteria (including 1379 persons with dementia and 1339 caregivers). Overall, telehealth interventions demonstrated effects in the expected directions on depression (SMD -0.63; 95% degree of confidence intervals (CI) -0.88 to -0.38, p < 0.001); and caregivers' perceived competency (SMD 0.27; 95% CI -0.05 to 0.50, p = 0.02). There were, however, no statistically significant effects observed on cognitive function or multiple aspects of quality of life for subjects. CONCLUSIONS Telehealth interventions appear to effect a reduction in depression among persons diagnosed with dementia while improving the perceived competency of caregivers. CLINICAL RELEVANCE The study's results could be used as evidence of the effectiveness of using telehealth for persons with dementia and their caregivers, including contextualizing where they are used (i.e., long-term care facilities, private homes, etc.), understanding the mechanisms in play (including intervention delivery and systems), and isolating and identifying mediating influences.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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16
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Kim Y, Hong S, Choi M. Effects of Serious Games on Depression in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37753. [PMID: 36066964 PMCID: PMC9490522 DOI: 10.2196/37753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is a severe psychological concern that negatively affects health in older adults. Serious games applied in various fields are considered appropriate interventions, especially in mental health care. However, there is a lack of evidence regarding the effects of serious games on depression in older adults. OBJECTIVE This study aimed to investigate the characteristics and effectiveness of serious games for depression in older adults. METHODS A systematic review and meta-analysis of randomized controlled trials were conducted. In total, 5 electronic databases (PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library) were searched to identify relevant studies published until July 6, 2021. A total of 2 reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the JBI Critical Appraisal Checklist. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) by using a random effects model. RESULTS A total of 17 studies with 1280 older adults were included in the systematic review, and 15 studies were included in the meta-analysis. Serious game interventions were classified into 3 types: physical activity (PA), cognitive function, and both PA and cognitive function. The meta-analysis demonstrated that serious games reduced depression in older adults (SMD -0.54, 95% CI -0.79 to -0.29; P<.001). Serious games had a more significant effect size in community or home settings (SMD -0.61, 95% CI -0.95 to -0.26; P<.001) than in hospital settings (SMD -0.46, 95% CI -0.85 to -0.08; P=.02); however, the difference between groups was not significant. Among the types of games, games for PA (SMD -0.60, 95% CI -0.95 to -0.25; P<.001) and games for both (SMD -0.73, 95% CI -1.29 to -0.17; P=.01) had a significant effect on reducing depression in older adults. However, no significant correlations were observed between the duration or number of serious games and depression. CONCLUSIONS Serious games were beneficial in reducing depression in older adults. Regardless of the study setting, serious games appeared to reduce depression. Particularly, serious games including PA had a significant impact on reducing depression. Furthermore, high-quality randomized controlled trials are needed to establish substantial evidence for the effectiveness of serious games on depression in older adults. TRIAL REGISTRATION PROSPERO CRD42021242573; https://tinyurl.com/26xf7ym5.
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Affiliation(s)
- Yesol Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Soomin Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea.,Yonsei Evidence Based Nursing Centre of Korea, A JBI Affiliated Group, Seoul, Republic of Korea
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17
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Abdallah L, Stolee P, Lopez KJ, Whate A, Boger J, Tong C. "Virtual care yes, but it has to be in addendum": A Qualitative Study of COVID-19's Impact on Older Adults' Perceptions of Virtual Care. JMIR Aging 2022; 5:e38546. [PMID: 36054599 PMCID: PMC9586256 DOI: 10.2196/38546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is “here to stay.” As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. Objective This research aims to understand older adults’ perspectives and experiences of virtual care during the pandemic. Methods As part of a larger study on older adults’ technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. Results Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post–COVID-19.
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Affiliation(s)
- Lama Abdallah
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | - Paul Stolee
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | | | - Alexandra Whate
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | - Jennifer Boger
- University of Waterloo, 200 University Ave. West, Waterloo, CA
| | - Catherine Tong
- University of Waterloo, 200 University Ave. West, Waterloo, CA
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18
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Budhwani S, Fujioka J, Thomas-Jacques T, De Vera K, Challa P, De Silva R, Fuller K, Shahid S, Hogeveen S, Chandra S, Bhatia RS, Seto E, Shaw J. Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews. J Am Med Inform Assoc 2022; 29:990-999. [PMID: 35187571 PMCID: PMC9006706 DOI: 10.1093/jamia/ocac022] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We sought to understand and synthesize review-level evidence on the challenges associated with accessibility of virtual care among underserved population groups and to identify strategies that can improve access to, uptake of, and engagement with virtual care for these populations. MATERIALS AND METHODS A scoping review of reviews was conducted (protocol available at doi: 10.2196/22847). A total of 14 028 records were retrieved from MEDLINE, EMBASE, CINAHL, Scopus, and Epistemonikos databases. Data were abstracted, and challenges and strategies were identified and summarized for each underserved population group and across population groups. RESULTS A total of 37 reviews were included. Commonly occurring challenges and strategies were grouped into 6 key thematic areas based on similarities across communities: (1) the person's orientation toward health-related needs, (2) the person's orientation toward health-related technology, (3) the person's digital literacy, (4) technology design, (5) health system structure and organization, and (6) social and structural determinants of access to technology-enabled care. We suggest 4 important directions for policy development: (1) investment in digital health literacy education and training, (2) inclusive digital health technology design, (3) incentivizing inclusive digital health care, and (4) investment in affordable and accessible infrastructure. DISCUSSION AND CONCLUSION Challenges associated with accessibility of virtual care among underserved population groups can occur at the individual, technological, health system, and social/structural determinant levels. Although the policy approaches suggested by our review are likely to be difficult to achieve in a given policy context, they are essential to a more equitable future for virtual care.
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Affiliation(s)
- Suman Budhwani
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Tyla Thomas-Jacques
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ryan De Silva
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Simone Shahid
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Sophie Hogeveen
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Shivani Chandra
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ontario Health, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Global eHealth Innovation, University Health Network, Techna Institute, Toronto, Ontario, Canada
| | - James Shaw
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
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19
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Eis S, Solà-Morales O, Duarte-Díaz A, Vidal-Alaball J, Perestelo-Pérez L, Robles N, Carrion C. Mobile Applications in Mood Disorders and Mental Health: Systematic Search in Apple App Store and Google Play Store and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042186. [PMID: 35206373 PMCID: PMC8871536 DOI: 10.3390/ijerph19042186] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The main objective of this work was to explore and characterize the current landscape of mobile applications available to treat mood disorders such as depression, bipolar disorder, and dysthymia. METHODS We developed a tool that makes both the Apple App Store and the Google Play Store searchable using keywords and that facilitates the extraction of basic app information of the search results. All app results were filtered using various inclusion and exclusion criteria. We characterized all resultant applications according to their technical details. Furthermore, we searched for scientific publications on each app's website and PubMed, to understand whether any of the apps were supported by any type of scientific evidence on their acceptability, validation, use, effectiveness, etc. Results: Thirty apps were identified that fit the inclusion and exclusion criteria. The literature search yielded 27 publications related to the apps. However, these did not exclusively concern mood disorders. 6 were randomized studies and the rest included a protocol, pilot-, feasibility, case-, or qualitative studies, among others. The majority of studies were conducted on relatively small scales and 9 of the 27 studies did not explicitly study the effects of mobile application use on mental wellbeing. CONCLUSION While there exists a wealth of mobile applications aimed at the treatment of mental health disorders, including mood disorders, this study showed that only a handful of these are backed by robust scientific evidence. This result uncovers a need for further clinically oriented and systematic validation and testing of such apps.
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Affiliation(s)
- Sophie Eis
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
| | - Oriol Solà-Morales
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
- Correspondence:
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | | | - Noemí Robles
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
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20
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Chu CH, Nyrup R, Leslie K, Shi J, Bianchi A, Lyn A, McNicholl M, Khan S, Rahimi S, Grenier A. Digital Ageism: Challenges and Opportunities in Artificial Intelligence for Older Adults. THE GERONTOLOGIST 2022; 62:947-955. [PMID: 35048111 PMCID: PMC9372891 DOI: 10.1093/geront/gnab167] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
Artificial intelligence (AI) and machine learning are changing our world through their impact on sectors including health care, education, employment, finance, and law. AI systems are developed using data that reflect the implicit and explicit biases of society, and there are significant concerns about how the predictive models in AI systems amplify inequity, privilege, and power in society. The widespread applications of AI have led to mainstream discourse about how AI systems are perpetuating racism, sexism, and classism; yet, concerns about ageism have been largely absent in the AI bias literature. Given the globally aging population and proliferation of AI, there is a need to critically examine the presence of age-related bias in AI systems. This forum article discusses ageism in AI systems and introduces a conceptual model that outlines intersecting pathways of technology development that can produce and reinforce digital ageism in AI systems. We also describe the broader ethical and legal implications and considerations for future directions in digital ageism research to advance knowledge in the field and deepen our understanding of how ageism in AI is fostered by broader cycles of injustice.
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Affiliation(s)
- Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Rune Nyrup
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK
| | - Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Jiamin Shi
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andria Bianchi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Alexandra Lyn
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Molly McNicholl
- University of Cambridge, Cambridge, UK.,London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Shehroz Khan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Samira Rahimi
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Mila-Quebec AI Institute, Montréal, Quebec, Canada
| | - Amanda Grenier
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Baycrest Hospital, Toronto, Ontario, Canada
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21
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Zaman SB, Khan RK, Evans RG, Thrift AG, Maddison R, Islam SMS. Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review. JMIR Aging 2022; 5:e25251. [PMID: 34994695 PMCID: PMC8783284 DOI: 10.2196/25251] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/10/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Raihan Kabir Khan
- Department of Health Sciences, James Madison University, Harrisonburg, VA, United States
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Melbourne, Australia.,Department of Physiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
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22
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Beaudreau SA, Otero MC, Walker JA, Gould CE, Sisco S, White P, Pella K, Wiley E, Voorhees K, Wetherell JL. Problem Solving Training for Veterans with Complex Comorbidities: Treatment Delivery Adaptations during COVID-19. Clin Gerontol 2022; 45:145-158. [PMID: 34405768 DOI: 10.1080/07317115.2021.1963382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To summarize adaptations due to COVID-19 for VA Problem Solving Training (PST) for clinicians serving medically complex patients and to compare patient mental health outcomes in the year before (2019) and during COVID-19 (2020). METHODS Clinicians attended a multi-day workshop and up to 6 months of small-group consultation for two training cases. In 2019 and 2020, 122 Veteran patients completed baseline and posttreatment measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7 item), and negative problem-solving beliefs (Negative Problem Orientation Questionnaire). Qualitative data were collected on clinician's pandemic-related treatment implementation challenges. RESULTS Program adaptations during COVID-19 addressed challenges due to delivering treatment by telephone, video, or in person; Veteran patient recruitment barriers; and privacy issues for telephone and video. Veterans in both pre-pandemic and COVID-19 cohorts had significant improvements in depression, anxiety, and negative problem-solving beliefs, with no significant differences in the amount of improvement between the two cohorts. CONCLUSIONS Flexibilities afforded to clinicians delivering the PST training program during the pandemic addressed key obstacles and barriers to recruitment, and implementation did not diminish the effectiveness of the intervention. CLINICAL IMPLICATIONS Findings support continued implementation of the PST training program with added flexibility to treatment delivery beyond the pandemic.
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Affiliation(s)
- Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Marcela C Otero
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica A Walker
- Office of Mental Health and Suicide Prevention, VACO, Washington, DC, USA
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Shannon Sisco
- Mental Health Care Line, Michael E. DeBakey VAMC, Houston, Texas, USA
| | | | - Kaycie Pella
- Home Based Primary Care, Jack C. Montgomery VA Medical Center, Muskogee, Oklahoma, USA
| | - Elizabeth Wiley
- Mental Health Service, VA North Texas Health Care System, Dallas, Texas, USA
| | - Kathryn Voorhees
- Geriatrics and Extended Care, Robley Rex VAMC, Louisville, Kentucky, USA
| | - Julie Loebach Wetherell
- Mental Health Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
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23
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Kunonga TP, Spiers GF, Beyer FR, Hanratty B, Boulton E, Hall A, Bower P, Todd C, Craig D. Effects of Digital Technologies on Older People's Access to Health and Social Care: Umbrella Review. J Med Internet Res 2021; 23:e25887. [PMID: 34821564 PMCID: PMC8663708 DOI: 10.2196/25887] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/23/2021] [Accepted: 10/15/2021] [Indexed: 01/22/2023] Open
Abstract
Background The 2020 COVID-19 pandemic prompted the rapid implementation of new and existing digital technologies to facilitate access to health and care services during physical distancing. Older people may be disadvantaged in that regard if they are unable to use or have access to smartphones, tablets, computers, or other technologies. Objective In this study, we synthesized evidence on the impact of digital technologies on older adults’ access to health and social services. Methods We conducted an umbrella review of systematic reviews published from January 2000 to October 2019 using comprehensive searches of 6 databases. We looked for reviews in a population of adults aged ≥65 years in any setting, reporting outcomes related to the impact of technologies on access to health and social care services. Results A total of 7 systematic reviews met the inclusion criteria, providing data from 77 randomized controlled trials and 50 observational studies. All of them synthesized findings from low-quality primary studies, 2 of which used robust review methods. Most of the reviews focused on digital technologies to facilitate remote delivery of care, including consultations and therapy. No studies examined technologies used for first contact access to care, such as online appointment scheduling. Overall, we found no reviews of technology to facilitate first contact access to health and social care such as online appointment booking systems for older populations. Conclusions The impact of digital technologies on equitable access to services for older people is unclear. Research is urgently needed in order to understand the positive and negative consequences of digital technologies on health care access and to identify the groups most vulnerable to exclusion.
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Affiliation(s)
- Tafadzwa Patience Kunonga
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Frances Spiers
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona R Beyer
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elisabeth Boulton
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Alex Hall
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Chris Todd
- National Institute for Health Research Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Dawn Craig
- National Institute for Health Research Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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24
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Vera San Juan N, Shah P, Schlief M, Appleton R, Nyikavaranda P, Birken M, Foye U, Lloyd-Evans B, Morant N, Needle JJ, Simpson A, Lyons N, Rains LS, Dedat Z, Johnson S. Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis. PLoS One 2021; 16:e0257270. [PMID: 34529705 PMCID: PMC8445423 DOI: 10.1371/journal.pone.0257270] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.
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Affiliation(s)
- Norha Vera San Juan
- Department of Health Service and Population Research, NIHR Mental Health Policy Research Unit, King’s College London, London, United Kingdom
| | - Prisha Shah
- NIHR Mental Health Policy Research Unit COVID-19 Co-Production Group, London, United Kingdom
| | - Merle Schlief
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Rebecca Appleton
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit COVID-19 Co-Production Group, London, United Kingdom
| | - Mary Birken
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Una Foye
- Department of Health Service and Population Research, NIHR Mental Health Policy Research Unit, King’s College London, London, United Kingdom
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Justin J. Needle
- Division of Health Services Research and Management, City University of London, London, United Kingdom
| | - Alan Simpson
- Department of Health Service and Population Research, NIHR Mental Health Policy Research Unit, King’s College London, London, United Kingdom
| | - Natasha Lyons
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Zainab Dedat
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
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25
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Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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26
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Der-Martirosian C, Heyworth L, Chu K, Mudoh Y, Dobalian A. Patient Characteristics of VA Telehealth Users During Hurricane Harvey. J Prim Care Community Health 2021; 11:2150132720931715. [PMID: 32507009 PMCID: PMC7278288 DOI: 10.1177/2150132720931715] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: Research on patient characteristics of telehealth users is relatively new. More studies are needed to understand the characteristics of telehealth users during disasters. This study attempts to bridge this gap and examines patient characteristics of telehealth users compared with nontelehealth users at the Houston VA Medical Center (VAMC) immediately before and after Hurricane Harvey (2017). Methods: Since use of telehealth services reached its peak and gradually declined within 2 weeks after the landfall, the data analyses focused on 14 days before/14 days after Harvey. Two sets of analyses were conducted using chi-square, t test, and one-way analysis of variance: (1) Patient characteristics of telehealth users were compared with nontelehealth users. (2) Patient characteristics were compared between 3 subgroups of telehealth users. Results: Compared with nontelehealth users, telehealth users were older (mean age: 60.8 vs 58.5 years, P < .001) and had a higher mean Nosos health risk score (1.9 vs 1.4, P < .001). They also had a higher mean number of outpatient visits (28.0 vs 19.8, P < .001), higher emergency room use (37% vs 29%, P < .001), and higher rates of hospitalizations (21% vs 13%, P < .001) during the 12 months before Harvey. When compared to less frequent telehealth users, the most frequent telehealth users were the oldest and most medically complex patients. Conclusions: As the largest integrated health care system in the United States, the VA has many advantages favoring successful implementation of telehealth services during disasters. However, more research is needed to better understand how VA telehealth could meet the varying needs of veterans to lower risk of harm during differing types of disasters.
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Affiliation(s)
- Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | | | - Karen Chu
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Yvonne Mudoh
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), U.S. Department of Veterans Affairs, North Hills, CA, USA.,University of Memphis School of Public Health, Memphis, TN, USA
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27
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Bincy K, Logaraj M, Ramraj B. Depression and its associated factors among the older adults in rural, Tamilnadu, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.100677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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28
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Hernandez-Tejada MA, Skojec T, Frook G, Steedley M, Davidson TM. Addressing the psychological impact of elder mistreatment: Community-based training partnerships and telehealth-delivered interventions. J Elder Abuse Negl 2021; 33:96-106. [PMID: 33480307 DOI: 10.1080/08946566.2021.1876578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This manuscript describes a two-pronged approach to addressing elder abuse in community-residing older adults. Part 1 of the program involves briefly training community healthcare providers to screen for elder abuse and refer for services; Part 2 is an intervention program that addresses mental health impacts of elder abuse in a non-stigmatizing, non-threatening manner, and leverages telehealth for greater reach.
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Affiliation(s)
| | - Theresa Skojec
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Gabrielle Frook
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Mara Steedley
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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29
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Di Carlo F, Sociali A, Picutti E, Pettorruso M, Vellante F, Verrastro V, Martinotti G, di Giannantonio M. Telepsychiatry and other cutting-edge technologies in COVID-19 pandemic: Bridging the distance in mental health assistance. Int J Clin Pract 2021; 75:10.1111/ijcp.13716. [PMID: 32946641 PMCID: PMC7536971 DOI: 10.1111/ijcp.13716] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS In this paper, we discuss the potential role of telepsychiatry (TP) and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS Telemental health services may be particularly feasible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION Telepsychiatry is a promising and growing way to deliver mental health services but is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.
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Affiliation(s)
- Francesco Di Carlo
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Antonella Sociali
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Elena Picutti
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Valeria Verrastro
- Department of Medical and Surgical SciencesUniversity “Magna Graecia” of CatanzaroCatanzaroItaly
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
- Department of Clinical, Pharmaceutical and Biological SciencesUniversity of HertfordshireHertsUK
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
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30
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Tegeler C, Beyer AK, Hoppmann F, Ludwig V, Kessler EM. Current state of research on psychotherapy for home-living vulnerable older adults with depression. Z Gerontol Geriatr 2020; 53:721-727. [PMID: 33185718 PMCID: PMC7661801 DOI: 10.1007/s00391-020-01805-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/10/2020] [Indexed: 01/24/2023]
Abstract
Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the "young-old", there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.
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Affiliation(s)
- Christina Tegeler
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany.
| | - Ann-Kristin Beyer
- Institute for Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Fee Hoppmann
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany
| | - Valentina Ludwig
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany
| | - Eva-Marie Kessler
- Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197, Berlin, Germany.
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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Cajamarca G, Herskovic V, Rossel PO. Enabling Older Adults' Health Self-Management through Self-Report and Visualization-A Systematic Literature Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4348. [PMID: 32759801 PMCID: PMC7436010 DOI: 10.3390/s20154348] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 12/15/2022]
Abstract
Aging is associated with a progressive decline in health, resulting in increased medical care and costs. Mobile technology may facilitate health self-management, thus increasing the quality of care and reducing costs. Although the development of technology offers opportunities in monitoring the health of older adults, it is not clear whether these technologies allow older adults to manage their health data themselves. This paper presents a review of the literature on mobile health technologies for older adults, focusing on whether these technologies enable the visualization of monitored data and the self-reporting of additional information by the older adults. The systematic search considered studies published between 2009 and 2019 in five online databases. We screened 609 articles and identified 95 that met our inclusion and exclusion criteria. Smartphones and tablets are the most frequently reported technology for older adults to enter additional data to the one that is monitored automatically. The recorded information is displayed on the monitoring device and screens of external devices such as computers. Future designs of mobile health technology should allow older users to enter additional information and visualize data; this could enable them to understand their own data as well as improve their experience with technology.
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Affiliation(s)
- Gabriela Cajamarca
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Valeria Herskovic
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Pedro O. Rossel
- Department of Computer Science, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile;
- Centro de Investigación en Biodiversidad y Ambientes Sustentables (CIBAS), Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
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Pabst A, Löbner M, Stein J, Luppa M, Kersting A, König HH, Riedel-Heller SG. Internet-Based Cognitive Behavior Therapy Only for the Young? A Secondary Analysis of a Randomized Controlled Trial of Depression Treatment. Front Psychiatry 2020; 11:735. [PMID: 32848915 PMCID: PMC7396625 DOI: 10.3389/fpsyt.2020.00735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Late-life depression is a major public health concern, driving the development of complementary treatment options. This study investigates the effectiveness and acceptability of internet-based Cognitive Behavioral Therapy (iCBT) in older individuals (60+ years) compared to younger age groups. MATERIALS AND METHODS Secondary analysis of a cluster-randomized controlled trial with 647 (18-82 years; mean 43.9) mild to moderately severe depressed primary care patients receiving either iCBT + treatment as usual (TAU) or TAU alone. Severity of depression was measured by the Beck Depression Inventory (BDI-II) at baseline, 6 weeks and 6 months. Intention-to-treat analysis in three age groups (18-39 years, n = 264; 40-59 years, n = 300; 60+ years, n = 83) was performed, using mixed-effects regression models to quantify treatment effect. RESULTS No age differences in the effectiveness of iCBT were found. Patients in the intervention group consistently showed a greater reduction in depression severity than controls in all three age groups and at both follow-ups. Effect sizes ranged from d = 0.30 (40-59 years, 6 weeks) to d = 1.91 (60+ years, 6 months). Uptake of the intervention was banded around 70% with no differences between age groups (χ² = 0.18, p = .915). The mean number of completed modules increased with age (χ² = 18.99, p = .040). DISCUSSION iCBT is equally effective in both younger and older individuals, thus providing a valuable complementary element of routine late-life depression care. CLINICAL TRIAL REGISTRATION DRKS-ID: DRKS00005075 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005075.
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Affiliation(s)
- Alexander Pabst
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G. Riedel-Heller
- Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Abstract
PURPOSE OF REVIEW As a global pandemic, COVID-19 has profoundly disrupted the lives of individuals, families, communities, and nations. This report summarizes the expected impact of COVID-19 on behavioral health, as well as strategies to address mental health needs during the COVID-19 pandemic and its aftermath. The state of Michigan in the USA is used to illustrate the complexity of the mental health issues and the critical gaps in the behavioral health infrastructure as they pertain to COVID-19. Scoping review was conducted to identify potential mental health needs and issues during the COVID-19 pandemic and its aftermath. RECENT FINDINGS The ramifications of COVID-19 on mental health are extensive, with the potential to negatively impact diverse populations including healthcare providers, children and adolescents, older adults, the LGBTQ community, and individuals with pre-existing mental illness. Suicide rates, alone, are expected to rise for Michiganders due to the economic downturn, isolation and quarantine, increased substance use, insomnia, and increased access to guns associated with the COVID-19 pandemic. This report promotes awareness of a behavioral health crisis due to COVID-19. Increasing access to behavioral health care should minimize COVID-19's negative influence on mental health in Michigan. We propose a three-prong approach to access: awareness, affordability, and technology. Addressing workforce development and fixing gaps in critical behavioral health infrastructure will also be essential. These actions need to be implemented immediately to prepare for the expected "surge" of behavioral health needs in the ensuing months.
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Varsi C, Solberg Nes L, Kristjansdottir OB, Kelders SM, Stenberg U, Zangi HA, Børøsund E, Weiss KE, Stubhaug A, Asbjørnsen RA, Westeng M, Ødegaard M, Eide H. Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review. J Med Internet Res 2019; 21:e14255. [PMID: 31573934 PMCID: PMC6789428 DOI: 10.2196/14255] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/05/2019] [Accepted: 08/18/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is growing evidence of the positive effects of electronic health (eHealth) interventions for patients with chronic illness, but implementation of such interventions into practice is challenging. Implementation strategies that potentially impact implementation outcomes and implementation success have been identified. Which strategies are actually used in the implementation of eHealth interventions for patients with chronic illness and which ones are the most effective is unclear. OBJECTIVE This systematic realist review aimed to summarize evidence from empirical studies regarding (1) which implementation strategies are used when implementing eHealth interventions for patients with chronic illnesses living at home, (2) implementation outcomes, and (3) the relationship between implementation strategies, implementation outcomes, and degree of implementation success. METHODS A systematic literature search was performed in the electronic databases MEDLINE, Embase, PsycINFO, Scopus, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Studies were included if they described implementation strategies used to support the integration of eHealth interventions into practice. Implementation strategies were categorized according to 9 categories defined by the Expert Recommendations for Implementing Change project: (1) engage consumers, (2) use evaluative and iterative strategies, (3) change infrastructure, (4) adapt and tailor to the context, (5) develop stakeholder interrelationships, (6) use financial strategies, (7) support clinicians, (8) provide interactive assistance, and (9) train and educate stakeholders. Implementation outcomes were extracted according to the implementation outcome framework by Proctor and colleagues: (1) acceptability, (2) adoption, (3) appropriateness, (4) cost, (5) feasibility, (6) fidelity, (7) penetration, and (8) sustainability. Implementation success was extracted according to the study authors' own evaluation of implementation success in relation to the used implementation strategies. RESULTS The implementation strategies management support and engagement, internal and external facilitation, training, and audit and feedback were directly related to implementation success in several studies. No clear relationship was found between the number of implementation strategies used and implementation success. CONCLUSIONS This is the first review examining implementation strategies, implementation outcomes, and implementation success of studies reporting the implementation of eHealth programs for patients with chronic illnesses living at home. The review indicates that internal and external facilitation, audit and feedback, management support, and training of clinicians are of importance for eHealth implementation. The review also points to the lack of eHealth studies that report implementation strategies in a comprehensive way and highlights the need to design robust studies focusing on implementation strategies in the future. TRIAL REGISTRATION PROSPERO CRD42018085539; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=85539.
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Affiliation(s)
- Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Olöf Birna Kristjansdottir
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Saskia M Kelders
- Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Heidi Andersen Zangi
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Health, VID Specialized University, Oslo, Norway
| | - Elin Børøsund
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Karen Elizabeth Weiss
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Rikke Aune Asbjørnsen
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research and Innovation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marianne Westeng
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Marte Ødegaard
- University of Oslo Library, University of Oslo, Oslo, Norway
| | - Hilde Eide
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
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