4065 — Delivering Tele-dementia care to Older Veterans During the Covid-19 Pandemic

Lead/Presenter: Victoria Ngo,  COIN - Palo Alto
All Authors: Ngo V (Center for Innovation to Implementation, VA Palo Alto Health Care System), Humber MB (Center for Innovation to Implementation, VA Palo Alto Health Care System) Trivedi R (Center for Innovation to Implementation, VA Palo Alto Health Care System; Dept of Psychiatry & Behavioral Sciences, Stanford University School of Medicine) Chen P (Geriatric Research, Education, and Clinical Center, VA Cleveland Health Care System) Pallaki M (Geriatric Research, Education, and Clinical Center, VA Cleveland Health Care System) Brodrick M (Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System) Gould CE (Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Dept of Psychiatry & Behavioral Sciences, Stanford University School of Medicine) Iyer S (Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Division of Primary Care and Population Health, Geriatrics Section, Stanford University School of Medicine)

Objectives:
To understand veteran caregiver experience of virtual teledementia care during the Covid-19 pandemic.

Methods:
This qualitative, observational study explored informal caregivers’ perceptions of tele-dementia care for Veterans seen at 2 sites, Palo Alto and Cleveland, via semi-structured interviews. Thirty caregivers (Mean age = 67y, SD = 12y, 88% women) were interviewed over telephone following a tele-dementia visit.

Results:
Four major themes that emerged from the interviews were (1) Transportation (2) Time and effort savings (3) Communication and (4) Ideal dementia visits. Transportation issues encompassed much more than the drive from home to clinic. Significant physical challenges that made leaving the home for appointments difficult included balance issues, incontinence, and difficulty getting into vehicle. Cognitive challenges were described, such as difficulty following instructions, agitation in traffic, and inability to wait unsupervised at the clinic while caregiver parks. Caregivers hope to continue using tele-dementia services beyond the pandemic due to the convenience, especially as the disease advances and getting out of the home becomes increasingly difficult. Caregivers interviewed saved 2.6h±1.5h (Range: 0.5 to 6h) of travel time. Multiple caregivers described disruption of routines as difficult and appreciated the limited preparation and immediate return to routine post virtual visit as positives for this type of care. Caregivers described the positives of communication via virtual care.

Implications:
Caregivers believe that tele-dementia care is convenient, helpful, and timesaving. A combination of both in-person and virtual visits would be an ideal future state dementia care.

Impacts:
Virtual care provides needed specialty dementia care access to these patients with complex needs in their homes, and its uptake has increased during the pandemic. This dementia specialty care provided virtually into the home complements long term support services to help older Veteran age place. The transportation and communication issues described here have potential impact in designing care services for this population. The cognitive and physical barriers describe why car or van access would not solve transportation issues to get Veterans with dementia and their caregivers to usual in-person care appointments, even if specialty care access was available nearby.