Video-Enhanced Care Management for Medically Complex Older Adults with Cognitive Impairment

Area of Science:

• Gerontology
• Health Services Research
• Telehealth

Background:

• Complex older veterans with suspected mild cognitive impairment (CI) often require ongoing care management.
• Traditional telephone-based interventions may not fully meet the needs of these individuals and their care partners.
• Assessing the feasibility and preference for newer modalities like video-enhanced care management is crucial.

Purpose of the Study:

• To assess the feasibility, acceptability, and usability of video-enhanced care management compared to telephone delivery for complex older veterans with suspected mild CI.
• To compare patient and care partner engagement and interaction between video and telephone care management arms.

Main Methods:

• A pilot randomized controlled trial was conducted at the Durham Veterans Affairs Health Care System.
• Participants included dyads of veterans (aged ≥65, complex conditions, suspected mild CI) and their care partners.
• A 12-week care management intervention was delivered monthly via video or telephone, covering medication management, cardiovascular risk reduction, physical activity, and sleep behaviors.

Main Results:

• Forty dyads were randomized. While call completion was higher in the telephone arm (86.7%) versus video (71.7%), usability of the video platform was rated higher by those familiar with the technology.
• Veterans, care partners, and nurses reported greater engagement, communication, and interaction in the video arm.
• Approximately one-third of veterans were familiar with relevant technology, and over half of internet users were comfortable online.

Conclusions:

• Video-enhanced care management is a feasible and preferred option for some complex older adults with mild CI and their care partners.
• Future research should investigate how to best assess and integrate patient and family preferences for video telehealth interventions.
• Understanding technology familiarity and comfort is key to successful implementation of video telehealth.