AMERICAN PSYCHOLOGICAL ASSOCIATION 2014

Marlene M.  Maheu Ph. D.
TeleMenta|  Health Institute

www. Te| ehea| th. Org
Videoconferencing Technologies

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American Telemedicine Association

Videoconferencing Guidelines — Emergencies (2009)

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Feasibility and Impact of Telemonitor-Based Depression Care Management

for Geriatric Homecare Patients

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American Telemedicine Association

Videoconferencing Guidelines — Emergencies (2009)

Elderly Populations: 

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Pilot Study on Remote Care

Tom Sheeran,  Ph. D.
Cornell / Brown Medical School

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A-VU Media

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The family member can sit in background and observe. ...
American Telemedicine Association

Videoconferencing Guidelines — Emergencies (2009)

Elderly Populations: 

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Pilot Study on Remote Care

Tom Sheeran,  Ph. D.
Cornell / Brown Medical School

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Working with Disabled Geriatric Patients
ATA Blueprint for Telerehabilitation Guidelines

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Working with Disabled Geriatric Patients
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u. s. MEDIA & socIAL
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PUBLICATIONS TOPICS PRESENTATIONSINTERACTIVES KEY
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Marlene M.  Maheu, 
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contact@te| ehea| th. org
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Advanced Technologies for Risk Management in Telegerontology With Diverse Populations -- Marlene Maheu

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Advanced Technologies for Risk Management in Telegerontology With Diverse Populations
American Psychological Association Annual Convention, August 8, 2014

To invite Dr. Maheu to speak to your group about these issues, please send an inquiry at www.telehealth.org/contact

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Transcript of "Advanced Technologies for Risk Management in Telegerontology With Diverse Populations -- Marlene Maheu"

  1. 1. AMERICAN PSYCHOLOGICAL ASSOCIATION 2014 Marlene M. Maheu Ph. D. TeleMenta| Health Institute www. Te| ehea| th. Org
  2. 2. Videoconferencing Technologies ‘s _. v > -- . -x. . -. .‘ ,1 . I 4- _ 7 _/ I ‘f . ~: —. ' V’ ‘V -I, -— g.
  3. 3. Telephone Technologies
  4. 4. APRlL3. 2014 9 Older Adults and Technology Use Maln Flndlngs Percent vfadvlts who 90 online America's seniors have historically been late ‘J pfidum adapters to the world of tedmologi compared " to their younger compatriots, but their 3% movement into digital life continues to §; j_‘°" deepen, according to newly released data from the Pew Rmearch Center. In this report, we take advantage of a particularly large survey to conduct a unique exploration not only of technology use between Americans ages 65 or older and the rest of the population, but within the senior population as well. 2000 2006 2013 REPORT MATERIALS - complete Report 5 | TABLE OF CONTENTS Overview Main Findings Usage and Adoption Attitudes, Impacts. and Barriers to Adoption Appendix—Detailed Demographic Tables Methods RELATED
  5. 5. ara A mum at mt usaumm. ran mo-amam scum: CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE Aging and Information Technology Use Potential and Barriers Neil Charness and Walter R. Boot Florida State University ABS'l'ltAC'I‘—Why are older adults reluctant to adopt new technology, such as the Internet, given its potential to im- prove the quality of their lives? We review evidence indi- cating that attitudes and abilities are among the most powerful predictors of technology use. We conclude that normative age-related changes in ability must be taken into account when designing products and training programs for aging adults, and we discuss new tools to support de- signers. The most promising emerging technologies likely lie in training cognitive abilities and augmenting or sub- stituting for impaired abilities. We discuss reasons to ex- pect that the lag in technology adoption between younger and older adults may lessen but will not disappear in future generations. Kl-2YWORl)S—age; technology; attitude; ability; cognition We are experiencing two important sociocultural trends. The first or may widen the so-called “digital divide” favoring younger adopters. For the purposes of this review, we focus on information technology. We define such technology to mean any tool or sys- tem that contains a microprocessor chip. Since the production of the first chip, there has been an exponential increase in such products, with microchips estimated to outnumberpeople on our planet. (Check this claim by counting the chips in the digital devices that you currently carry, or have discarded, such as watches, phones, or music players. ) Technology can play important roles in work and leisure and in health care provision. One role is in prevention ofage-associated impairments. That is, technology such as a lifting device might prevent a back injury early in a blue-collar worker's career, permitting entry to old age in sound health. A second role is augmentation. Large high-contrast monitors can display legible text for those with diminished visual acuity. Augmentation might also come in the form of a computer game designed to train
  6. 6. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) <i A patient site assessment shall be undertaken, including obtaining information on local regulations & emergency resources, and identification of potential local collaborators to help with emergencies (. Emergency protocols shall be created with clear explanation of roles & responsibilities in emergencies
  7. 7. American Telemedicine / -ssocia'tion Videoconferencing Guidelines - Emergencies (2009) (' Determine Outside <’ Be familiar with local emergency coverage civil commitment regulations and have arrangements where possible to work with local staff to initiate/ assist with civil commitments r Establish guidelines for determining at what point other staff and resources should be recruited to help manage emergencies
  8. 8. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) ° Be aware 0t the impact - Be aware of safety issues Oi t9m0te Cate 0h with patients displaying provider's perception of strong affective or C0htF0i (OF iaCi< theF€0tl behavioral states upon Wet the Ciihicai conclusion of a session, interaction, and how and new patients may this might impact then interact with PF0Vid€r'5 mahagemeht remote site inhabitants
  9. 9. Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients Thomas Sheeran, Ph. D., M. E., " Terry Rabinawitz, M. D., D. D.5.,2 Jennifer Lotterman. BA, ’ Catherine F. Reilly. BA, M. P.H. ,’ Suzanne Brown, R. N.. ‘ Patricia Donehower, M5.N. , R. N.,5 Elizabeth Ellsworth. RS, ‘ Judith L Amour, MA, ’ and Martha L. Bruce, Ph. D., M. P.H. ’ 'Rhode island Hospital and Alpert Medical School of Brown University. Providence, Rhode island. ’University of Vermont College of Medicine and Fletcher Allen Health Care. Burlington, Vermont. ’ Weill Comell Medical College, White Plains. New York New York. ‘Wsiting Nurse Services in Westchcster, White Plains. New Yorlc swsi ting Nurse Association of Chittenden and Grand lsle Counties, Colchester, Vermont ‘United Homecare Services, Miami. Florida. Abstract Objective: The objective of this study was to test the feasibility, acceptability. and preliminary clinical outcomes ofa method to leverage existing home healthcare telcrnonitoring technology to deliver depression care management (DCM} to both Spanish- and English-speaking elderly homebound recipients of hamecare ser- vices. Mataials and Methods: Three stand-alone. nonprofit com- munity homecare agencies located in New York. Vermont, and Miami participated in this study. Evidence-based DEM was adap- ted ta the telemonitor platform by programming questions and educational information on depression symptoms. antidepressant adherence. and side efieets. Recruited patients participated for a minimum of3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. 0n—sire trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. Results: An ethnically diverse sample of 48 I: 'nglish- and Spanish~only~ speakina patients participated. alona with seven relehealth nurses. plications for the science and service of telehealth-based depression carefitr elderly patients are discussed. Key words: home health monitoring, telehealth. zelepsychiatry Introduction 3"— he use of home telemonitoring technology is growing at a rapid rate in the homecare industry. There are approximav tely 9.000 Medicare—certified homecare agencies in the ljnited States, serving approximately 5 million elderly pa- tients. ‘ With 21% (1.900) of home health agencies using telehealth disease management systems and an estimated annual growth rate of 17%. telehealth is an area of significant growth. ’ In a recent na« tionwide survey of almost 1.000 representative homecare agendas, the most commonly reported use for home telemonitoring is the management of cardiac disease. followed by respiratory illness and diabetes. respectively. ’ Almost two—thirds of respondents acltnow| « edged that their lelchealth system was part of a chronic disease management program. ’ However. to our knowledge. few home health telemonitor programs include evidence-based depression care management (DCM). With an estimated prevalence of approximately 14% for major depression and another 100*: for minor depression. the rate of this illness in homecare is twice that of primary care and second only to nursing homes. ” A number of studies have documented the suf- fering and adverse consequences of geriatric deprusion, including poor quality of life, higher mortality from illness or suicide. adverse events such as falls and hospitalization. higher healthcare costs. and poor adherence to medical treatments. " '° However. homecare pa- tients often have little access to skilled depression care and must go untreated orinadequately treated. creating a significant public health problem. """ Telehcalth technology in homecaze may offer an oppommity to increase access to depression treatment by incorporating evidence based depression care guidelines into an aKenCv's existing telehealth
  10. 10. fl Pilot Study on Remote Care Study Tom Sheeran, Ph. D. Cornell / Brown Medical School Three clinical skilled nursing sites using video Hispanic geriatric population — Spanish materials Chronic care model for disease management for depression — Education — Depression assessment — Suicide screening — Care coordination with primary care and mental health specialist Acceptance rates were above 80% Hamilton score went down by 5 points
  11. 11. Nursing Homes
  12. 12. Pilot Study on Remote Care Cornell / Brown Medical School "Every 10-year old looks the same, but every 80 year old does not look same. Geriatric patients are inherently a diverse population. The challenge for technology is to meet the broad range of capabilities. Patients can also decline very quickly. ” Tom Sheeran, Ph. D.
  13. 13. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) Elderly Populations: * Sensory deficits, especially visual and auditory, can impair the ability to interact over a videoconference connection. Clinics shall consider the use of technologies that can help with visual or auditory impairment.
  14. 14. Pilot Study on Remote Care Tom Sheeran, Ph. D. Cornell / Brown Medical School ° | nternet—based videoconferencing system to make consult to patients in nursing home ° Technology interface is an issue —use American Well platform for chronic disease management support, light electronic health record, notes, appointment calendaring — Need a telepresenter for patients with sensory impairment
  15. 15. Speaker — Phoenix Duet PCS "’ S200
  16. 16. A-VU Media’s Calendar Appts. Appear on Patient’s T Music Pictures Videos lntemet Contacts Medical Calendlt Name Doctor's Appointment Stan time 9/18/Z012 ' 8:00AM ' End time 9/18/2012 ' 9:00 AM ' Location; Mnona Health Priority: l , Le, ,.L, ,,, e,1,L1L, .,. ,,T Sample Screen Shot Remind“. LT Program calendar events that create reminders on the TV. Reminder Timeout: l5 minutes Description Blood pressure checkup
  17. 17. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) Elderly Populations: ° The inclusion of family members should be undertaken as clinically appropriate and with the permission of the patient. * Interviewing techniques shall be appropriate for a patient who may be cognitively impaired, or find it difficult to adapt to the technology.
  18. 18. A-VU Media The patient can invite family member to join if needed. The family member can sit in background and observe. It takes a lot of mystery and debate out of exchange, because family members can calm and support the patient when needed. John Goodman, CEO
  19. 19. American Telemedicine Association Videoconferencing Guidelines — Emergencies (2009) Elderly Populations: - The geriatric patient often has multiple medical problems, many of which affect cognitive/ behavioral state, require appropriate laboratory, radiologic, and other diagnostic procedures.
  20. 20. Pilot Study on Remote Care Tom Sheeran, Ph. D. Cornell / Brown Medical School ° Using nursing staff to establish collaborative care — communication and collaboration with nursing has to happen, so technology must facilitate the contact a Difficult to win over nursing staff? — Staff is: ° Spread too thin a Nurses have no time — ”Best way to win nursing staff over is to produce results for them. Solve their problems and they will want you there. ” * Parkinson's/ stroke, depression/ anxiety, abruptly moved to nursing home, ECT works for him, but he doesn't want to go for ECT. His team helped and now they are welcomed.
  21. 21. Working with Disabled Geriatric Patients ATA Blueprint for Telerehabilitation Guidelines Comply with all relevant laws and ethics codes Credentialing at both the patient and distant sites, even if over state / provincial lines Documentation requirements Adhere with additional requirements for privacy & confidentiality Education of patients re: their rights
  22. 22. Working with Disabled Geriatric Patients ATA Blueprint for Telerehabilitation Guidelines ° Technological expertise — Use appropriate planning prior to delivering care — Are fully aware of capabilities and limitations of the equipment they use — Impact the chosen technology may have on service delivery ° In all settings, professionals have the appropriate education, training/ orientation and continuing education to be competent. ..
  23. 23. Working with Disabled Geriatric Patients ATA Blueprint for Telerehabilitation Guidelines ~ to inform and assist practitioners in providing effective and safe services that are based on client needs, current empirical evidence, and available technologies 6 http: //www. americante| emed. org/ resources/ st andards/ ata-standards-guide| ines/ b|ueprint-for- telerehabilitation-guide| ines#. U7DYO41dVss
  24. 24. ew esearc Internet Pro'ect u. s. MEDIA & socIAL POLITICS NEWS memos PUBLICATIONS TOPICS PRESENTATIONSINTERACTIVES KEY INDICATORS INTERNET TECH JANUARY 6, 2014 9 African Americans and Technology Use A Demographic Portrait BY AARON SMITH Main Findings This report on African Americans and technology is the first in a series of demographic snapshots of technology use and adoption among different groups of adults in the United States. Based on a survey of 6,010 American adults, including 664 who identify as African American, it oflers a detailed look at a number of key subgroups within the black population such as: men vs. women, old W». young, low income W). high income, and parents vs. non-parents. The black/ white “dlytal divide" continues to pcrclct, but In not consistent across technology platforms or domographlc youpo African Americans have long been less likely than whites to use the internet and to have high speed broadband access at home, and that continues to be the case. Today, African Americans trail white by seven percentage points when it comes to overall internet use (87% of whitm and 80% of blacks are intemet users), and by twelve percentage points when it comes to home broadband adoption (74% of whites and 62% of blacks have some sort of broadband connection at home). At the same time, blacks and whites are on more equal footing when it comes to
  25. 25. In contrast to intemet use and broadband adoption, blacks and whites are equ y own a cell phone of some kind, and also have identical rates of smartphone ownership. % of black adults are cell phone owners, and 56% own a smartphone of some kind. Ce wnership is much more common than intemet use among older African Ameri s. Just 45% of African Americans ages 65 and older use the intemet, but 77% are cell phone owners (most of these seniors own basic cell phones, as only 18% are smartphone owners). Overall, 72% of all African Americans—and 98% of those between the ages of 18 and 29—have either a broadband connection or a smartphone. The findings in this report are based on data from telephone interviews conducted by Princeton Survey Research Associates International from July 18 to September 30, 2013, among a sample of 6,010 adults ages 18 and older. Telephone interviews were conducted in English and Spanish by landline and cell phone. Findings for African Americans are based on the 664 respondents who identified themselves as black or African American, and not of Hispanic or Iatino background. In the interest of readability, throughout this report African Americans are compared only to whites, and not to other racial or ethnic groups. The Pew Research Center's Hispanic Trends Project has collected data recently on tedmology use among Iatinos, which can be found at http: //www. pcwl1ispanic. org/ .
  26. 26. African American Alzheimer's Caregiver Training & Support Project (1 & 2) (ACTS) * Northern Florida a Served or will serve "300 African American caregivers of older adults with dementia (caregiver average age is 59) * Patients are 70 — 90 years old (average age of 81) FOCUS GROUP: Researchers did focus groups in preparation for a cognitive intervention to determine the preference of older caregivers for mode of training delivery. RESULTS: Participants preferred to received training in the home by telephone as opposed to in-person or Internet- based interventions via video conferencing.
  27. 27. African American Alzheimer's Caregiver Training & Support Project (2) (ACTS) Reasons given for preference of telephone was: * No need to travel * No transportation costs a No need for attendant care 4* Everyone knows how to use the technology * Cost of technology is low ' Familiarity with technology (ease of use) Attrition was significantly greater in the in-person group when compared to controls, despite the fact that the study paid for attendant care
  28. 28. E 0-our Q mm €l)c3'ttIflorkEimr5 R‘ W Silntlflyndvlofi “NV -‘xx The Future of Robot Caregivers Uvi0¥‘IAIn_1N0P< M. » y- mu .1. I-; -('Hhmr I nuke .1 hi» : . : 'gH. l st. » much u Iungvx :1-. :m 1 <)L| l.L1! . lc: m'x I: -:x. v|Iz~1‘: |u. ~.r y-. ._ p: m(n: is ! :nZd1ng :1|§ hund. ur bzvtmlie Q16-'5 mlmg mr rm or-r lhx‘ hrst hmv‘ mhnul wh-‘.1 : u:1! . M.: be-1 1'1 _ lug: u buy‘ at xhm-I, u: hum he: daddx lost [us Job and '. hc . n:h:5 u-rm "-‘I1 and hvr mat? ) 7 In ull at} her ! :.nr mad (hr; mlie-«E plur mm-. .: J .1 mi‘: -d ‘. .-. .x 'u we . - ‘Ia km: to <hnw me am dung. hvn -: m V um- 2.iu, ;' . 'K|1t§lH)l‘§I rs. '2‘ [CI {hilt . ,, r: -1n. rz—< iha! «hr . -.-sr 1L‘1<‘, t- ; iti) frnm hr. - c . .r. zn: )‘, ut; ¢'. e!)r1'~. L': Lex things; ‘.11: zmmn . :; . ~a‘. and End v«'ha{c'rr .1 :5 in (h, dxm 1.-ant oi hx. lxrrhm-n Iran. ml d-, wm: p: I~5r71,‘-nrvn5!-3r ‘* " rm. m. ~.i. .‘, .1pm1.: m~. .t~. ‘« xhm hltlrx . .m'»r . .., . . thi-1«-3 an; di1i«. ms [hm I(J}l| HuIr 31:! days. ianrhncss and cl bzlny Sh. " has a wr!1r I . ‘HY“}fl.1YlI| l'i: l'| .l! y|| l)UI5P’ "1 n mruv. .n um-‘ . : v. '.’11ep,1v! nix-J unur; Swim a week. a {mend ~)‘.1) checks in on he: gxrxc-d_c. a.. . and she guts rrgnhu c. :lls1‘rc-In mlumvrrs mth Lhc Fricndshxp l. '.r' I('s nrmgh L1kr~ sums! : '-Jcr n/ .1u1‘. s,sh-‘ dLn: s.'1' wan‘ 1; N‘ ’| ockrd up . » . xHn. | x'-u~n- . :- um n. ‘ . .u ~. hI- Rzwlx w. ; rur‘lHw « whu an hr : w. !}1err}d'; _»! a5'». s,v«hu w:1I rm and smilr.
  29. 29. 'I'eleMenta'l M, 5 ILIECI/ lh Mow Institute, Inc Marlene M. Maheu, Ph. D. contact@te| ehea| th. org www. te| ehea| th. org

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