Telehealth and Geriatrics: How telehealth improves medication management and patient safety in the geriatric patient
College of Nursing and Public Health
What is Geriatrics?
Geriatrics is a subspecialty of internal medicine and primary care that was named in 1909 by Ignatz Leo Nascher.
Geriatrics is that specialty of medicine that addresses the health needs of the elderly.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012).
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Telemedicine is a highly effective and necessary tool in geriatrics.
The global population of elderly people is increasing at a remarkable rate,
This is expected to continue for some time.
Older patients require more care.
The current model of care delivery indicated costs are expected to rise.
Telemedicine is a great opportunity for medical practice to evolve to cost effective and new levels of engagement with patients
Chang, W., Homer, M., & Rossi, M. (2018).
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Geriatics, HIT and Patient Safety
CONCERNS:
SOLUTIONS:
Patient safety is a concern.
Telehealth: Difficult to monitor conditions in a patient’s home.
Safety risks such as falls and inability to get in and out of the tub or shower.
Fewer In-Person Consultations
Doctors worry about technical problems associated with telemedicine. poor broadband connections could lead to “possible patient mismanagement.”
Many physicians and patients alike still like a “personal touch,” and not all procedures – even simple checkups – can be performed digitally.
Difficult to monitor depression or other emotional issues.
Health information technology (HIT) is the future of improving care and outcomes for older adults.
There is a growing program of research. HIT are solutions to improving the safety, quality and efficiency of care.
Gerontological nurse scientists are at the forefront of advancing this work.
Electronic health records (EHRs)and telehealth will blend care of older adults.
Multimedia/advanced directives from HIT provided to patients recovering from critical illness have increased the intent to sign an advanced directive by 25 times
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016).
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The HITECH Act resulted growth in the development and implementation of the EHR.
The impact of an integrated EHR in 29 Kaiser Permanente hospitals was significant on process and outcome indicators for patient falls and hospital acquired pressure ulcers and other measures of patient safety.
The EHR system was associated with improved documentation of falls/pressure ulcers and significant improvements for pressure ulcer risk assessment documentation.
Bowles, K. H., Dykes, P., & Demiris, G. (2015).
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NICHE (Nurses Improving Care for Healthsystem Elders)
NICHE builds decision support within the workflow of nurses caring for older adults.
Decision takes the form of alerts, reminders, or algorithms that guide evidence-based care.
Gerontological nurses partner with nursing leadership to improve care of older adults.
Data is captured in a structured, coded format and provides clinical decision support to ensure older adults receive evidence-based, personalized care.
Decision support interventions employ the EHR as a tool to achieve a learning health system.
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Greenwald, P., Stern, M. E., Clark, S., & Sharma, R. (2018
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Telehealth and diseases of the elderly
Two diseases that frequently strike geriatric patients:
Heart disease (CPD) and chronic obstructive pulmonary disease (COPD).
CPD is a progressive and disabling medical condition estimated to affect 5.7 million Americans consuming $27 billion dollars in annual treatment expenditures.
Both CPD and COPD are common among older adults.
Each causes patients to feel debilitated and unable to physically function at their former high level.
Dementia: Challenge for patients located in a rural location
Can impact on the management of dementia
Telehealth is a viable solution to the problems of transportation and geography
Dementia treatment must be measured carefully for each patient.
Constant monitoring of how a patient is doing on medication can now be tracked electronically.
Provides relief for the patient and family that cannot be with the patient in person.
(Gellis, Kenaley, McGinty, Bardelli, Davitt, Ten, 2012). Glinkowski, Pawłowska and Kozłowska (2013) Chang, Homer, Rossi, 2018).
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Telehealth at home
AT HOME:
Convenience for patients to authorize that they records are sent to specialists for consultations and it cuts down on the number of doctors visits.
Better care for less money and less time consuming activities such as long waiting room hours, transportation costs and general anxiety about having to visit a health care facility.
Still a gap between actual usage of health monitoring technology and the readiness of older people’s homes to use home based health monitoring techniques.
Sending information will require more nurse teaching to patients and more practice before it can be fully and completely integrated into the home health care regimen.
Liu, Stroulia, Nikolaidis, Miguel-Cruz and Rincon (2016)
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Telehealth at the nursing homes
AT THE NURSING HOME:
Nursing home telehealth system has been branded as e-TeleHealth.
Rollabout system houses electronic equipment including a computer, monitor on a moveable arm, and video-conferencing system.
Includes electronic stethoscope, otoscope, dermascope, dentalscope, and EKG
Transmission for the rollabout is a wireless network system and equipment can be plugged into any electrical outlet.
The rollabout was developed to move around in the nursing home allowing it to be taken to a resident’s bedside.
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016).
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References:
Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of health information technology to
improve care and outcomes for older adults. Research in gerontological nursing, 8(1), 5-10.
Chang, W., Homer, M., & Rossi, M. (2018). Use of Clinical Video Telehealth as a Tool for
Optimizing Medications for Rural Older Veterans with Dementia. Geriatrics, 3(3), 44.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012).
Outcomes of a telehealth intervention for homebound older adults with heart or chronic
respiratory failure: a randomized controlled trial. The Gerontologist, 52(4), 541-552.
Glinkowski, W., Pawłowska, K., & Kozłowska, L. (2013). Telehealth and telenursing perception
and knowledge among university students of nursing in Poland. Telemedicine journal and e-health : Official journal of the American Telemedicine Association, 19(7), 523-9.
Greenwald, P., Stern, M. E., Clark, S., & Sharma, R. (2018). Older adults and technology:
telehealth, they may not be who you think they are. International journal of emergency
medicine, 11(1), 2.
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016). Smart homes and home
health monitoring technologies for older adults: A systematic review. International journal of
medical informatics, 91, 44-59.
Sevean, P., Dampier, S., Spadoni, M., Strickland, S., & Pilatzke, S. (2008). Bridging the distance:
educating nurses for telehealth practice. The Journal of Continuing Education in Nursing, 39(9),
413-418.
