Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Qualitative Study (Preprint)

BACKGROUND Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be employed to meet the needs of geriatric care professionals in providing care to frail older patients and their caregivers, and families. OBJECTIVE This study aimed to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and families, and how to maximize the benefits of this method of providing care. METHODS We conducted a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine and participate in a semi-structured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS We obtained quantitative and qualitative data from 30 practicing geriatric care professionals (22 geriatricians, 5 geriatric psychiatrists, and 3 geriatric specialist nurses) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (Complexity, Design quality and packaging, Patient needs and resources, Readiness for implementation, and Culture) and 13 CFIR contextual facilitators (Relative Advantage, Adaptability, Tension for Change, Available Resources, Access to Knowledge, Network and Communications, Compatibility, Knowledge and Beliefs, Self-Efficacy, Champions, External Agents, Executing, and Reflecting and Evaluating). The CFIR concept of External Policy and Incentives was found to be a neutral construct. CONCLUSIONS This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person, but is less useful in providing specific aspects of geriatric care to frail older patients and their caregivers, and families.

A dire need for recruitment of rehabilitation professionals for provision of geriatric care

This editorial is an introspection of recruitment of rehabilitation professionals. The rapid surge in Pakistan’s population has highlighted the dearth and demand of rehabilitation professionals. This has also highlighted the largely ignored geriatric care. Hence, it is imperative that the need of recruitment of rehabilitation professionals especially keeping in view the geriatric population.

Role of diet in old age

The average human life expectancy has increased in recent times, so there is more focus on aging, age-related disease, and geriatric care in society. Older malnourished adults are more likely to have poorer health outcomes, longer hospital stays, and increased mortality, so there is a need to provide a nutritious and healthy diet to the old age population.Recent studies have shown that some medicinal herbs are effective in the intervention or prevention of aging-associated neurological disorders. Unani System of Medicine is one of the old traditional medicines in the world providing health care to humanity for centuries successively through natural safe, effective, and economic herbal medicine.Diets recommended for the old age population have been highlighted in this article with special emphasis on the traditional diets mentioned in the USM for geriatric care. There is a need to explore USM for better care of old age population and to find out an effective, safe, and economic treatment for old age diseases like Parkinson's disease and Alzheimer's disease, etc.

An Inter-University Virtual Geriatric Case Competition to Build Interprofessional Collaboration Skills

Developing positive learning experiences in team-based geriatric care is challenging. This presentation will highlight an inter-University geriatric case competition for developing interprofessional competencies in health professional students sponsored by the Geriatric Workforce Enhancement Programs at Saint Louis University and the University of Minnesota. The virtual competition involved teams of 4-5 undergraduate and graduate students from multiple health professions who designed a comprehensive care plan using a simulated complex geriatric patient case. Students were assigned to an interprofessional team with a faculty or community expert coach, attended an orientation, and developed a 20-minute recorded presentation. A panel of judges rated team presentations using a scoring rubric based on the Core Competencies for Interprofessional Collaborative Practice. Local competitions included a first and semi-final round, with the winning teams presenting at the inter-university competition held via live videoconferencing that involved a question-and-answer session. Prizes were given to the top teams. Students, coaches, and judges completed evaluation surveys focused on satisfaction with the competition format/procedures and achievement of interprofessional competencies. Twenty-one teams and 117 students from 12 disciplines participated. Team scores ranged from 2.2 to 4.3 (overall mean 3.1) on a 1-5 scale. Judge, coach, and student evaluations were positive, indicating students learned valuable lessons in group dynamics, team-based care, and geriatric care. Most students (82%) preferred the virtual competition format or had no preference on format. The virtual case competition provided a positive, engaging experience to introduce health professional students to geriatric team-based care and develop their readiness for collaborative practice.

GeriPOP: Older Adults Population Health Serious Game

Health professionals have limited opportunities to learn about population health in their curriculum. With a shortage of geriatricians nationwide, health care systems need different ways to provide evidence-based geriatric care. To address both these shortcomings, a serious game, called GeriPOP has been developed to allow trainees to explore the impact of assessment and management of principles of geriatric care (the 4Ms+) on quality of life, health, longevity, and health care costs by applying them to a virtual older adult population. Trainees assume the role of a system manager who is asked to explore ways to optimize health outcomes and lower costs. They develop their population health plan around a framework of Geriatric 4Ms+ and apply it in a virtual panel of older adult patients that move longitudinally into different age bands (65-74; 75-84; 85+). As the game progresses, a dashboard helps trainees track the impact of their treatment decisions across the population. Several levels of play allow trainees to explore various issues intersecting with aging such as gender, diversity, social determinants, and multiple chronic conditions. Periodic debriefings and explanatory pop ups during the game allow trainees to further explore evidence–based Geriatrics. The game engages health care trainees to strengthen their knowledge of Geriatrics through exploration of systems change. Future study is needed on whether Geri POP changes learner attitudes, future clinical practice or healthcare outcomes.

Internet System Supporting the Work of Nurses in Long-Term Geriatric Care

The development of health sciences along with the continuous technological progress contribute to the emergence of web applications. There exist many applications supporting the work of doctors, whereas the market definitely lacks solutions supporting the work of nurses. This is particularly evident in long-term geriatric home care, in which the nursing specialization is developing rapidly. Care of elderly patients requires the nurse to collect medical documents from each visit. Considering the large number of diseases affecting elderly people and the number of required visits – which should exceed 4 a week – a decision was made to develop an Internet application supporting the work of nurses in long-term geriatric care. The application facilitates the process of geriatric patient description in order to eliminate the need for filling in paper medical records. This study presents the method of developing an Internet application supporting the work of nurses in long-term geriatric care. The software was developed based on an analysis of conclusions from a social study carried out in a group of 42 nurses providing geriatric long-term home medical care services in the district of Białystok, Poland. The aim of the study was to determine the features, functionality, and declarative interest in using the software. Conclusions from the analysis indicated that the attempt to develop the application had been justified. Moreover, conclusions from the social survey formed the basis for formulating the design assumptions. The web application was developed in the following technologies: HTML 5, CSS3, JavaScript, PHP 7, and MySQL. First, a prototype of the solution was tested in a XAMPP environment. After successful tests, the app was tested in a nursing practice. The obtained test results raise high hopes for potential commercialization of the application.

Advancing Age in Africa, the Urgent Need for Institutional Geriatric Care in a Low Resource Setting: A Case Report

Background: The demand for geriatric care has been on the increase throughout the world, especially in the developing, low- and middle-income countries (LMICs), due to increasing life expectancy, improvement in technology in healthcare industry coupled with increasing numbers of healthcare personnel. Nonetheless, these increases in the resources to the healthcare industry are still woefully inadequate in the developing and LMICs, compared to the high demand for such services, thereby exposing the drastic challenges and gaps in geriatric services in these countries. Case Presentation: A 74-year-old woman apparently well, who was relocated from the rural area by her biological daughter, with the intention of giving her better care in a comfortable city environment. She was initially appreciative of the relocation. However, the situation went sour when her daughter and son-in-law resumed work after their annual leave period. They started locking her up in a well-furnished mansion with everything she may need until they returned from work. Consistently for eight working days, she was kept under lock and key because they did not want her to roam around the community, they thought was not familiar to her with the intention of keeping her safe. Everything was fine until they returned from work one day to find that she had soiled the house with her excrement, apparently as a protest against her consistent lock-up. This necessitated their visit to the hospital. A diagnosis of social isolation was made after clinical and mental state examination and appropriate interventions were instituted. The patient consequently became fine in the new environment. Conclusion: This case has been presented in order to emphasize the need to improve the systems for geriatric care which is of public health concern, especially as the life expectancy of the developing, low- and middle-income countries keep improving.