A video visit can spare a person with dementia a trip that disrupts their behavior, but joining the visit may take help from a family member or paid caregiver. In a large New York City home-based primary care program, 82% of patients having a first-time video visit needed that help. The report included patients with dementia, but did not say which tasks required assistance.
Getting the video visit started can take support
The New York City program's report covered April through June 2020. In that period, 35% of patients had a first-time video-based visit. Their mean age was 82.7, and 46.6% had dementia. Among those first-time video visit patients, 82% needed assistance from a family member or paid caregiver, according to the authors.
That finding describes a home-based primary care program and its patients. It does not mean every person with dementia needs help, or specify whether the assistance involved setting up the visit, staying with the patient, or something else. A caregiver's presence may be useful to arrange, but the patient's needs can differ.
Home can make the appointment less disruptive
Families in Lauren Moo's GeriPal podcast discussion valued home video visits because coming to a clinic could disrupt the behavior of the person with dementia. They reported less disruption when the visit took place at home and lasted about half an hour.
Moo also said families valued avoiding travel. She noted that a person's primary family caregiver is often a spouse who is also an older adult, and travel in bad weather can be hard. A video visit may reduce that burden while still allowing the clinician and family to meet.
Plan for connection help when scheduling
For a practice, one concrete step is to ask when scheduling whether a family member or paid caregiver can be available to help with the video visit. That gives the team a chance to plan around the support the patient has, while keeping the appointment at home when that is useful to the family.
Access can be a separate hurdle. Moo said the most common reason people declined early home video visits was that they lacked a computer or internet access at home. A caregiver may be willing to help, but that alone does not provide the equipment or connection.
"More than one-third (35%) of patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020. The majority (82%) required assistance from a family member and/or paid caregiver."
Moody K, Kalicki A, Gliatto P, Franzosa E, Ornstein K., Providers' Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
Can a phone visit cover the same ground as video?
In two geriatric clinics, video visits averaged 7 minutes longer and included 1.2 more visit diagnoses than telephone visits, according to the authors. Rates of advance care planning were similar for the two formats.
Can people become more comfortable with video over time?
At one geriatric assessment center, video visits rose from 6% of scheduled visits in the last full week of March to 24% in the last week of May. The authors suggested growing familiarity and comfort with the technology may have contributed.
What if there is no computer or internet at home?
Moo said lack of a computer or internet access was the leading reason people declined early home video visits. The discussion did not describe other connection options.
Sources
- Providers' Perceptions of Telehealth Barriers Among Homebound Adults in in a Home-Based Primary Care Practice (Innovation in Aging)
- The Geriatric 5M Approach to Telemedicine Assessment: A Podcast with Lauren Moo (GeriPal podcast (Harvard))
- Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis (JMIR Aging)
- Telemedicine Uptake in a Geriatric Assessment Center During the COVID Crisis (Innovation in Aging)
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