Sir,
Older adults require frequent consultations with respective physicians/psychiatrists for close monitoring to ensure safety, treatment response, and continuity of care. Previous studies reported the underutilization of mental health services through in-person consultation in older adults compared to young (48 vs. 61%).[1] The low follow-up rates could be due to mobility issues, physical illnesses, cognitive impairment, and logistic reasons. There is emerging evidence on virtual follow-up as a supplement to conventional follow-ups in India.[2] However, there is a paucity of literature on virtual follow-ups in older adults. A recent study from our facility on using direct video consultation for follow-up in psychiatric illness reported good acceptance, feasibility, and satisfaction level.[2] In this study, we have investigated the profile of older adults who were using direct to patient bidirectional interactive video-based telepsychiatry aftercare (TAC) clinic from March 2018 to May 2019.
During the study period, thirty older adults availed TAC. The mean age of the patients was 64.57 (standard deviation [SD]: 8.50), with a gender ratio of 1.7 with male predominance. The mean number of years of education was 13.73 (SD: 3.71). The majority of them were married (96.7%), retired (60%), and from an urban background (83.3%). Among the patient's illness profiles, neuro-cognitive disorders (30%), depressive disorders (30%), bipolar disorder (26.7%), and others (13.3%). The total number of TAC conducted was 112. The mean number of consultations per patient was 3.73 (SD - 2.36). Reasons for choosing TAC from patient/family member's perspective were financial constraints (16.7%), lack of personnel (36.7%), mobility issues (60%), severe symptoms (66.7%), easy access to technology (96.7%), affordability (100%), convenience (100%), and wanting to review with the same doctor (100%).
Our sample predominantly consists of older adults, with most of them living with the spouse, from middle/upper socioeconomic status in urban/semi-urban areas. Neurocognitive and neuropsychiatric disorders were the primary diagnoses in two-fifth of the sample. The majority of our sample had medical comorbidities. In most cases, the choice for TAC was made because of the patient/family member's request and logistical reasons including the amount and time spent on travel. The need for medication adjustment, monitoring for adverse effects, and the course of illness were the predominant reasons for the treatment team to opt for TAC. In the majority of them, there were multiple reasons for choosing TAC.
In our study, two-fifth of patients had cognitive issues as main symptoms, and the rest of the patients had a severe mental illness. The majority of patients in our study were not able to use digital technology due to the reasons mentioned above; we utilized the assistance from a close family member to facilitate the digital medium for consultations, followed by a psychiatrist reviewing the patient along with a family member. There are also few positive aspects of involving family members where we concur with an improvement in family's understanding of older adults' problems and active involvement in their care.[3]
Earlier studies reported a positive attitude and acceptability of technology in health care among older adults.[45] Similar study from our center found positive results on acceptability and feasibility of TAC in adult patients.[2] A narrative review on online medical consultation reported that convenience, changes in disease patterns, cost-effectiveness, privacy, and the need for a second opinion as to the common reasons for the increase in online tele-consultations.[6] These benefits were similar to our study. The common reasons for patient/family members to opt for TAC consultations were convenience, affordability of technology, and preference of consultation with the same doctor regularly. These are particularly relevant considering the scarcity of geriatric services across the country.
There are several challenges in using technology-assisted interventions for older adults in the Indian context, and it has not been studied adequately. Among the many barriers include sensory impairment, cognitive impairment, severe behavioral problems, and severe medical illnesses.[7] Another one is the acceptability of the technology in place of a conventional visit to the doctor. There are other contentious issues such as confidentiality and security of the information being shared using the technology medium.[8]
We acknowledge that we have explored the feasibility of this method of consultation, primarily in urban patients with higher education and socioeconomic status. There is a need for further evaluation of the feasibility and utility of this approach in a rural context in future. There is also a need for studying personal preference and satisfaction of the older adults in prospective comparative studies.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
Authors acknowledge the assistance of staffs of Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
REFERENCES
1. Gilmer TP, Ojeda VD, Fuentes D, Criado V, Garcia P. Access to public mental health services among older adults with severe mental illness Int J Geriatr Psychiatry. 2009;24:313–8
2. Das S, Manjunatha N, Kumar CN, Math SB, Thirthalli J. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital Asian J Psychiatr. 2020;48:101886 doi: 10.1016/j.ajp.2019.101886.
3. Hanson E, Magnusson L, Sennemark E. Blended learning networks supported by information and communication technology: An intervention for knowledge transformation within family care of older people Gerontologist. 2011;51:561–70
4. Cesta A, Cortellessa G, Rasconi R, Pecora F, Scopelliti M, Tiberio L. Monitoring elderly people with the robocare domestic environment: Interaction synthesis and user evaluation Comput Intell. 2011;27:60–82
5. Frennert SA, Forsberg A, Östlund B. Elderly people's perceptions of a telehealthcare system: Relative advantage, compatibility, complexity and observability J Technol Hum Serv. 2013;31:218–37
6. Singh AP, Shanker Joshi H, Singh A, Agarwal M, Kaur P. Online medical consultation: A review Int J Community Med Public Health. 2018;5:1230–2
7. Sivakumar PT, Mukku SS, Kar N, Manjunatha N, Phutane VH, Sinha P, et al Geriatric telepsychiatry: Promoting access to geriatric mental health care beyond the physical barriers Indian J Psychol Med. 2020;42:41S–46S
8. Mostaghel R. Innovation and technology for the elderly: Systematic literature review J Bus Res. 2016;69:4896–900
