Jo Dorhout, President of Virtual Interactive Families, presented at The University of Texas at Arlington Research Institute's Symposium on Biomedical Technologies

1. Passport to
the World
An Intervention to
Depression
With VI Families
© Passport to the World by VI Families

2. The power of connections
© Passport to the World by VI Families

3. The power of connections
ALS Ice Bucket Challenge:
 $107.4 million as of Sept. 3
 Compared to less than $3 million over the
same 1 month period last year
 3 million donors = because their friends told
them to
 Innovative use of technology and social
connections that would not have been
possible 10 years ago
© Passport to the World by VI Families

4. © Passport to the World by VI Families
Passport to the
World
An Intervention to Depression

5. Staying connected
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6. Staying connected
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7. Staying connected
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8. Staying connected
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9. 55% of
communication
is visual
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10. Virtual Interactive Families
 Telehealth
 Hospice
 Palliative care
 Senior health care
 Telemental services
 Pediatrics home health care
 Care coordination
 World health care
 India
 Africa
 Education
 National Association of Activity
Professionals
© Passport to the World by VI Families

11. The expectations
 Younger generation expects technology
 Senior generation accepts technology
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12. The results
 93% of family hospice caregivers indicated a
video-visit was as good as an in-person
conversation
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13. Depression
 Loneliness is a major precipitant of depression
 18.8 million Americans; 9.5% of adult
population
 One of the most common mental health
disorders in U.S.
 Third most common cause of hospitalization in
the U.S. for 18-44
 80% = some level of functional impairment
 27% = serious difficulties in work and home
 $43 billion each year
© Passport to the World by VI Families
(Psychology Today – July 1, 2003) (CDC) (NIMH) (NAMI.org)
(American Association of Geriatric Psychiatrists)

14. Depression in seniors
 20% of those 55+ have mental health issues
 Most prevalent mental health problem
among older adults
 Depressed residents transferred 50%
sooner
 2.1 times the rate of dying within the year
 Suicide rate for 85+ is highest of any age
group in the nation
© Passport to the World by VI Families
(CDC) (Watson, et al., 2003) (American Association of Geriatric
Psychiatrists)

15.  I am:
 Lonely
 Bored
 Does any one care?
Does any one listen
when I talk?
 Place-bound
 I want:
 Be with my loved
ones
 Learn new things
 Contributing my
great ideas
 Fulfill my ‘bucket-
list’
© Passport to the World by VI Families
Depression

16. Related industries
 $2.4 billion A DAY
 $18.2 billion
 $632.1 billion
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17. Seniors
 2014: 42 million
 2030: 76 million
 20% of U.S. population
 85+ will comprise the most rapidly growing
segment of the U.S. population
© Passport to the World by VI Families
(American Association of Geriatric Psychiatrists)

18. Seniors and spending
 Baby Boomers outspend other generations
by $400 billion
 In the next 10 years, annual spending on
wellness-based services = $1 trillion
 Outspend younger generations online 2:1
 Boomers: 27 hours/week; Millennials: 25
hours/week
© Passport to the World by VI Families
(US Government Consumer Expenditure Survey) (Paul Zane Pilzer,
The Next Trillion) (Forrester Research) (WSL/Strategic Retail)

19. All about the experience
 Seniors spending is growing in:
 Education
 Experiences
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20. Passport to the
World
An Intervention to Depression
© Passport to the World by VI Families

21. Fall 2006
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22.  I want:
 Be with my loved
ones
 Learn new things
 Contributing my
great ideas
 Fulfill my ‘bucket-list’
 I am:
 Lonely
 Bored
 Does any one
care? Does any
one listen?
 Place-bound
© Passport to the World by VI Families
Depression
Technology

23. © Passport to the World by VI Families

24. April 2006
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27. © Passport to the World by VI Families

28. Testimonials from residents
© Passport to the World by VI Families
 “Wait until I tell my son and grandson
what I did today!”
 “I feel like I’ve benefitted from it because
of all the things that I’ve learned. Just
learning! I love learning.”

29. Testimonials from residents
© Passport to the World by VI Families
 “I learn everything I can. In 85 years, I have
a little bit of knowledge.” (laughs)
 “…now I feel so YOUNG – like NEW!”
 “What is the Acropolis?”

30. Testimonials from
administrators and staff
 “For the second Passport experience,
residents anxiously showed up thirty
minutes early for the activity!”
“Its akin to magic – when they experience
the fun of being there. Their eyes light up,
smiles all over… and they continue to talk
until dinner.”
“It benefitted them because it triggered
memories. It brings out their cognitive...
Saying things like ‘oh, I remember that’ and
they they start remembering things. It’s a
huge benefit.”
© Passport to the World by VI Families

31. Testimonials from administrators
and staff
 “It gave the residents an opportunity to think
about other things, besides ‘I’m here; I’m
alone.’”
 “We have a very difficult time providing
activities that our men enjoy participating
in. Passport would be ideal. Am very
interested in pursuing this further.”
 “It was the most residents we’ve ever had at
an event - and only 1 fell asleep!”
© Passport to the World by VI Families

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33. The Promise of Passport
 Qualitative research indicates the experiences
increase quality of life among individuals in
long-term care facilities:
 The interactive experiences increases an older
person’s attention span, decreases
depression, and lessens the feelings of
loneliness and isolation.
© Passport to the World by VI Families
Parker-Oliver, et al. Rush Medical Center
NIH/NIA Study (Lancet Neurology, J. Nursing
Care Quality, Educational Gerontology, 2010).

34. The Promise of Passport: Beta Results
© Passport to the World by VI Families
Before After
Variable x SD x SD t p
LSNS 11.93 6.47 12.00 6.89 -.024 .98
GD 3.66 3.28 2.46 .83 1.39 .18
PCS 38.95 9.80 40.20 9.36 -.301 .76
MCS 52.98 13.00 62.17 3.97 -2.92 .01
As reported in the: Journal of American Medical Directors Association, 1.2011
All variables before and after the Passport Broadcast Intervention
LSNS – social support; GD – depression: PCS – physical health: MCS – mental health Note:
PCS and MCS comprise the SF-12.

35. The Promise of Passport:
Research results from beta
 Residents were assessed for depression,
social support and general health (physical
and mental)
 “A significant increase in the mental health
subscale was found for residents post-
intervention (p<011). Mean comparisons pre-
and post-intervention also showed decreased
depression and improved physical health and
social support.”
 “Conclusion: This small pilot study
demonstrates the promise of technology as
a viable intervention for resident quality of life
care, as well as a solution to overcoming
institutional barriers such as cost,
environmental disruption, and regulations.”
© Passport to the World by VI Families JAMDA January 2011

36. Supporting research
 Increased social support has been found to:
 promote health and life satisfaction
 decrease social isolation
 decrease depression in long-term care
residents
 Combining medical and social care is
promising practice for long-term care
 Cultural shift limited by cost, senior
leadership resistance, strict regulation and
inadequate number of social service staff
© Passport to the World by VI Families
(Minkler, 2000; Seeman, 2000) (Seeman, 2000; Dalgard, 1998; Frasure-Smith,
2000; House, 1998; Krsihnan, 1998) (Lehning, J Gerontol Soc Work.
Jan:53(1):43-63. (Miller, Gerontologist. Apr:50(2):238-252.; Bern-Khung, Journal
of Aging & Social Policy. 2010:22(33-52).

37. The Promise of Passport:
Research results from beta
“This study provides support for effective
evidence-based practice of the Passport
intervention despite these institutional
barriers.”
“Although attention to resident depression has
primarily been pharmacological, residents
could be better served with the addition of
behavioral interventions thus reducing the
amount of pharmacological care and oversight
needed by facility medical directors and staff.”
© Passport to the World by VI Families
JAMDA January 2011

38. Power analysis
From Dr. Debra Oliver, U of MO Medical School:
The GDS-15 is the primary study outcome and so this is the
variable for which we make our power estimates. To make
credible estimates of power or sample size, one needs a
meaningful absolute effect size as well as estimates of variability.
Brody et al (2006) estimated that a within-subject change of 2
points on the GDS-15 is clinically meaningful and the standard
deviation of the within-subject change at six months was
between 3.3 and 3.8 points. For power calculations, we will also
use 2-points as the minimum meaningful between-group
difference on the GDS-15 with the estimate of the between group
standard deviation being 3.4 points (Koehler et al, 2005). A
reasonable assumption is that the passport intervention will not
increase depression, so alternative hypotheses are one-sided,
i.e. the intervention group is less depressed at follow-ups than
the control group. Under these assumptions, 37 subjects per
group will provide 80% power to detect a group difference of 2
GDS points when testing at the 5% level with a one-sided
alternative. This sample size will also provide better than 80%
power to detect an average within-subject change of at least two
points. Because we anticipate a 10% attrition rate, we will recruit
a minimum of 40 subjects (residents) per group or a total of 80
subjects.
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Natural Progression of
Communication
HUGE ECONOMIC IMPACT

41. What if…
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42. What if…
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44. © Passport to the World by VI Families
What if…

45. Let’s dream further…
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46. Let’s dream further…
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47. Let’s dream further…
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48. Let’s dream further…
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49. © Passport to the World by VI Families
Passport to the
World
An Intervention to Depression