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Impact of telemedicine on remote health and well-being of dementia patients in the UK
  • 2

  • Course Code: PHE7032
  • University: Birmingham City University
  • Country: United Kingdom

1.0 Introduction

Given the current circumstances, it is more imperative to have efficient healthcare management that is accessible to all individuals. Standards of care do not always help sick people who are stuck in their homes, either mentally or physically. Telemedicine might make memory care a lot better by filling in these gaps.

An in-depth look at how telemedicine has helped people with dementia in remote parts of the UK stay healthy and happy. There are many things one needs to fully understand about telemedicine, such as how it works, which methods work best, and what one needs to know that needs more study (Su et al., 2022). 

1.1 Background

Alzheimer's disease is a brain disease that makes it challenging to think straight. The overall health status of the United Kingdom is deteriorating as a result of this. The prevalence of dementia in the UK is estimated to be 850,000 individuals, resulting in an annual expenditure of over £25 billion for the country (Bradbury et al., 2022).

This makes it very important to find healthcare options that work and do not cost much money. People with dementia, especially those who live in remote places, can have a hard time getting care. Telemedicine has come up as a possible solution.

1.1.1 The Burden of Dementia in the UK

In 2023, the Alzheimer's Society said that by 2025, there would be more than a million people in the UK who had dementia. This is very scary. Getting older and being better at diagnosing are to blame for this trend. People with dementia have a much worse quality of life as they age.

Memory loss, mental decline, and acting in strange ways are all signs. It is hard for parents to care for their kids' mental and financial health (King's College London, 2019). The National Institute for Health and Care Excellence (2018) says that the old ways of caring for people with dementia are tricky because they are hard to reach, take place in the wrong places, and do not have enough experts.

1.1.2 The Promise of Telemedicine for Dementia Care

Telemedicine, which lets people get medical care far away, could improve memory care in several ways. Thanks to telemedicine, patients can talk to their doctors at any time, even if they live too far away or cannot make it to meetings in person (Scottish Government, 2022).

These days, many people have devices and telemedicine systems that let them check on symptoms and vital signs from a distance. This helps find issues quickly and motivates people to take steps to avoid them (NHS England, 2022). 

1.2 Scale and Scope

From individual to society, this paper discusses every possible angle of the rising caseload for dementia in Britain. The year 2023 is a special point of reference to consider. My aim is to look at the economic consequences of rising cases-projections by Britain’s Alzheimer’s Society predicts nearly a quarter million over 65 will suffer from dementia.

A Kings College London study in 2019, on which this one was based is particularly enlightening as to its cost for companies. In the workplace, dementia costs £ 25 billion a year. In addition, the study also examines difficulties in getting routine medical care (National Institute for Health and Care Excellence, 2018).

These barriers are more acutely felt among people in the countryside, and those already suffering from pre-existing medical conditions. According to the comments made by National Institute for Health and Care Excellence as early as 2018, these obstacles directly imply serious consequences that impact both a person's money and their minds if one goes through the process of being caregiver in dementia persons (NHS England, 2022).

Besides, the study also explores possible mediating effects here--those recommended by NHS 

1.3 Rationale

In light of the fact that by 2023 dementia cases in the UK are expected to number more than 850,00 persons (estimated by Alzheimer's Society), this research study is an urgent need. This study is necessary because of the exacerbating financial burden outlined in a 2019 investigation jointly carried out by Kings College London: it costs businesses £ 25 bn.

Comprehending the complexities of this financial cost is critical for policymakers, businesses and healthcare providers to put in place interventions that are well targeted as resources can be allocated appropriately (Quail et al., 2021).

One issue that falls within the remit of this study is a question highlighted by the National Institute for Health and Care Excellence in 2018, concerning barriers to people's ability to access mainstream healthcare. Knowing what obstacles block access to healthcare is the key for developing strategies that meet the special needs of dementia patients, particularly those in rural areas or dealing with chronic illness.

It will examine the obstacles that these populations may be facing specifically. This information can help indicate possible differences between various groups and give ideas for interventions to make healthcare services more accessible (Yardley et al., 2020). The study will also explore the various effects on people who have care for dementia-affected persons.

The concerns raised by the National Institute for Health and Care Excellence highlight just how pressing it is to understand, identify, and resolve care-giver support needs. With telemedicine rapidly transforming the medical landscape, it is important that this field also be incorporated within the study (Caprioliet al., 2023).

A study to determine the acceptability and practicality of telemedicine for dementia patients will reveal what value it could be in enabling us both truly to transform relations with dementia (Dickens et al., 2019).

Aiming to provide a complete picture of dementia and the value-added of telemedicine, the study examines three areas: economic; healthcare accessibility; care suppliers. Informing evidence-based policies, interventions and healthcare strategies: This knowledge is crucial to prepare for the future.

1.4 Uncertainties in the Literature

The study also points to some of telemedicine's strengths. But there are still many major research gaps in today 'literature on it as well. For example, Hedges et al. (2019) believes that most existing evaluations of telemedicine do not use representative samples or proper scientific methods; so, it is almost impossible to get accurate answers as to which side is right-let alone asking if the results are believable.

In addition, Yardley et al. (2020) also highlight that telemedicine requires not only patient involvement but caregiver participation as well. How to get excellent engagement from both sides has yet to be explored in any systematic form, though. This gap must be bridged if we want to see the full potential of telemedicine in treating dementia.

Future work should also define how telemedicine interventions can actively involve patients and caregivers. Second, a study on dementia care itself concedes that there is great potential for synergy within different ideas and tools of such care in all regions of the UK (Kairy et al., 2020). 

2.0 SR Question

What is the impact of telemedicine on remote health and well-being of dementia patients in the UK?

2.1 Aim

The aim of the research is to analyse the impact of telemedicine on remote health and wellbeing associated with dementia patients in UK.

2.2 Objectives

•    To examine the impact of telemedicine on remote health and well-being of dementia patients in the UK
•    To analyse the challenges faced while providing telemedicine on remote health and well-being of dementia patients in the UK
•    To suggest strategies to overcome those challenges faced while providing telemedicine on remote health and well-being of dementia patients in the UK
 

PEO Factor Search Strategy Database/Tool
Population: Dementia patients 65+ in UK ("dementia" OR "Alzheimer") AND ("UK" OR "Britain") AND age:[65 TO 120] MEDLINE, CINAHL, Cochrane Library
Exposure: Telemedicine consultations ("telemedicine" OR "telehealth" OR "remote care") AND ("consultation" OR "appointment") MEDLINE, CINAHL, trial registries (ClinicalTrials.gov, EU)
Exposure: Remote monitoring ("remote monitoring" OR "telemonitoring") AND ("vital signs" OR "health data") MEDLINE, CINAHL, grey literature repositories (OpenGrey, NICE Evidence)
Exposure: Medication management & adherence support ("medication management" OR "adherence support") AND ("telemedicine" OR "remote care") MEDLINE, CINAHL, targeted searches (NHS Digital, Alzheimer's Society website)
Outcome: Improved cognitive function & memory ("cognitive function" OR "memory") AND ("improvement" OR "enhancement") MEDLINE, CINAHL, forward & backward referencing
Outcome: Reduced behavioral & psychological symptoms ("behavioral symptoms" OR "psychological symptoms") AND ("reduction" OR "decrease") MEDLINE, CINAHL, qualitative research databases (e.g., COQUAL)
Outcome: Enhanced quality of life & independence ("quality of life" OR "independence") AND ("dementia" OR "Alzheimer") AND ("telemedicine" OR "remote care") MEDLINE, CINAHL, targeted searches (UK dementia organizations)










2.3 Framework

PEO Framework

Population (P) Exposure (E) Outcome (O)
1. Dementia patients aged 65 and over in the UK 1. Telemedicine consultation with specialists 1. Improved cognitive function and memory
2. Living in rural or underserved areas 2. Remote monitoring of vital signs 2. Reduced behavioral and psychological symptoms
3. Diagnosed with mild to moderate dementia 3. Virtual support groups and caregiver training 3. Enhanced quality of life and independence
4. Access to internet and technology 4. Medication management and adherence support 4. Decreased caregiver burden and stress

Table: PEO Framework
Source: (Hedges et al. 2019)

3. Methods of the Review

3.1 Search Strategy

PEO Factor Search Strategy Database/Tool
Population: Dementia patients 65+ in UK ("dementia" OR "Alzheimer") AND ("UK" OR "Britain") AND age:[65 TO 120] MEDLINE, CINAHL, Cochrane Library
Exposure: Telemedicine consultations ("telemedicine" OR "telehealth" OR "remote care") AND ("consultation" OR "appointment") MEDLINE, CINAHL, trial registries (ClinicalTrials.gov, EU)
Exposure: Remote monitoring ("remote monitoring" OR "telemonitoring") AND ("vital signs" OR "health data") MEDLINE, CINAHL, grey literature repositories (OpenGrey, NICE Evidence)
Exposure: Medication management & adherence support ("medication management" OR "adherence support") AND ("telemedicine" OR "remote care") MEDLINE, CINAHL, targeted searches (NHS Digital, Alzheimer's Society website)
Outcome: Improved cognitive function & memory ("cognitive function" OR "memory") AND ("improvement" OR "enhancement") MEDLINE, CINAHL, forward & backward referencing
Outcome: Reduced behavioral & psychological symptoms ("behavioral symptoms" OR "psychological symptoms") AND ("reduction" OR "decrease") MEDLINE, CINAHL, qualitative research databases (e.g., COQUAL)
Outcome: Enhanced quality of life & independence ("quality of life" OR "independence") AND ("dementia" OR "Alzheimer") AND ("telemedicine" OR "remote care") MEDLINE, CINAHL, targeted searches (UK dementia organizations)


Table: PEO Search Strategy
Source: (Hedges et al. 2019)

3.2 Study Selection

PEO Element Inclusion Criteria Exclusion Criteria
Population Studies involving dementia patients aged 65 and over in the UK. Studies focusing on other neurological conditions or younger age groups.
Exposure/Intervention Studies evaluating telemedicine interventions for dementia care (e.g., consultations, remote monitoring, virtual support groups, caregiver training, medication management). Studies examining in-person care only or non-telemedicine interventions.
Outcome Studies assessing cognitive function, memory, behavioral symptoms, quality of life, independence, or caregiver burden. Studies without relevant outcome measures or outcomes not aligned with the research question.

Table: Inclusion and Exclusion Criteria
Source: (Hedges et al. 2019)

3.2.1 Types of participants

This well-planned review will be about staff members who are affected by dementia, which is a regular problem. People who want to take part must have dementia and be at least 65 years old. To help older people take better care of their health, it is essential to know how telemedicine can help people who have dementia in this age group (Tuijtet al., 2021).

All people who participate in the study must be British citizens and in the proper age range for it to be helpful in their home countries. People who want to participate in the study must be at least 65 years old and a resident or citizen of Britain. The UK is an excellent place to do a population study because it is in a unique physical area (Fisk et al., 2020). One did a complete study to find out if and how video treatments improve the health and well-being of older people with dementia because of these issues.

3.2.2 Types of interventions

The study concentrates on non-clinical public health interventions for improving the quality of elderly dementia care in Britain. This effort includes a great many telemedicine programs.

The traditional medical-centered approach is transcended, and health interventions which promote wellness move into the community environment. These are non-clinical, video programs customized to the needs of elderly folks with dementia (Anthony Jnr, 2021). 

Older persons with dementia do have many needs. The aim of such services is to create a comprehensive, convenient network including outreach programs and day centers as well as home-based support.

Another form of intervention is education, with direct teaching in therapeutic techniques and strategies actually carried out within the community. In the classes, both patients and caregivers learn to prepare for themselves what they need in facing dementia.

This study will look more closely at these interventions, delving into participants 'demographics as well as how often they occur and the methods used (Wong et al., 2022). 

3.2.3 Types of counter interventions

This systematic review has a different kind of counter-intervention because most of it is about non-medical ways to improve public health. There will be no regular fake treatments or virtual therapies used in the comparison of telemedicine programs for people with dementia in the UK aged 65 and up. This comparison will be based on how things usually work, or "common sense."

This study aims to determine how well online treatments work by contrasting them with the current care and support systems for older people with dementia (Roach et al., 2021).

This study aims to find out if online treatments can make a big difference in the health and quality of life of older people with dementia. In order to do this, it will not use a fake or placebo treatment. Instead, it will compare well-known ways of doing things with telehealth.

3.2.4 Types of outcome measures

Through various end measures, the systematic study looks at the health and quality of life of dementia patients in the UK who are 65 years or older. A lot of the info about the results will come from signs of mental and physical health (Nkodoet al., 2022). This section will look at things related to physical health, such as sudden medical events, changes in functional status, and activities of daily living (ADLs).

The review will include signs of mood, affect, and memory, as well as the people's reports of their quality of life (Chirico et al., 2022). The other part of this study checks to see how socially active the patients are and if online treatments help people make new friends and feel less alone.

This group of people has some unique problems. One has used several results measures to understand better what the course needs and how to help them (Cheung &Peri, 2021). These steps help us learn more about how telemedicine impacts the health and well-being of older people with dementia.

3.2.5 Types of studies

In this research researcher go over the findings of qualitative studies that quantify exactly how telemedicine impacts daily life for Britons aged 70 or older with dementia. This group provides the background to this study, which seeks a multifaceted perspective on how people experience telemedicine (Appleton et al., 2021). To achieve this, the study employs three qualitative research approaches: grounded theory, qualitative description research and phenomenology.

These methodologies help the reader gain a multi-layered impression of how patients and nurses necessarily actually communicate when engaging in actual telemedicine, which is difficult to portray directly.

In saying this, the review follows an inclusiveness and scope approach in that any study with something to say about either its date or imposition can be used. It is an integrated approach, aiming to gather a wide range of literature about the effects on older people who suffer from dementia in Britain and explore all possible sides. But the language choice of this study is a limitation.

Only papers published in English are involved (Liu et al., 2019). But this decision may not let other foreign-language studies come in, at least their study team can feel quite comfortable working in English. The higher the team's level of knowledge, then a more thorough and precise analysis can be made of selected works; this brings us closer to our fondest wish-a complete comprehension. 

3.3 Study Quality Assessment Checks and Procedures

The review adopts a thorough approach, going through each of the methods used in the main study to determine whether they meet up with inclusion criteria. The critical appraisal assessment is based on the JBI Critical Appraisal Checklist for Qualitative Research (Lian & Aranda, 2023), which provides in depth guidance and will ensure that all studies meet strict standards of research.

This checklist is used by the review to make sure that no stone is left unturned-- From study results and impact and quality of data collection, analysis and planning To whether researchers themselves know what they're doing in terms of choosing a research question.

In order to attain a higher level of quality assurance and avoid giving numerical scores, the review comments on strength or weakness in qualitative terms (Escobar et al., 2021). Such a qualitative assessment is essential in order to have a full appraisal of the methods used.

Ratings for total quality of the studies are an important barometer by which to gauge whether or not information on how telemedicine affects life-quality in older folks with dementia from Britain is reliable.

In this way, the review understands that a quantified score is dangerous and emphasizes an assessment by qualities relevant to research methods. Its strength lies in being comprehensive and methodical, which makes it particularly convenient for qualitative studies (Cysique et al., 2022). 

4. Data extraction

Study ID Author(s) Year Aim/Purpose Study Design Participants Intervention Details Key Findings/Themes
1 Li et al. 2022 Examine the effect of regional vs general anesthesia on postoperative delirium in older patients undergoing hip fracture surgery Qualitative Older patients undergoing hip fracture surgery Comparison of regional and general anesthesia Regional anesthesia showed no significant difference in postoperative delirium incidence.
2 Mackenzie et al. 2022 Investigate cardiovascular outcomes in adults with hypertension comparing evening vs morning dosing of usual antihypertensives Clinical Trial Adults with hypertension Comparison of evening vs morning dosing No significant difference in cardiovascular outcomes between evening and morning dosing.
3 Wardlaw et al. 2023 Assess the effects of isosorbide mononitrate and cilostazol treatment in patients with symptomatic cerebral small vessel disease Qualitative Patients with symptomatic cerebral small vessel disease Treatment with isosorbide mononitrate and cilostazol Treatment did not significantly improve outcomes in patients with symptomatic cerebral small vessel disease.
4 Tabrizi et al. 2019 Target huntingtin expression in patients with Huntington's disease Study on Targeted Therapy Patients with Huntington's disease Targeting huntingtin expression The study targeted huntingtin expression in patients with Huntington's disease.
5 Koch et al. 2022 Evaluate precuneus magnetic stimulation for Alzheimer's disease Qualitative Patients with Alzheimer's disease Precuneus magnetic stimulation The study investigated the effects of precuneus magnetic stimulation on Alzheimer's disease.
6 Postuma et al. 2019 Assess the risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder Qualitative Patients with idiopathic REM sleep behaviour disorder Longitudinal assessment of dementia and parkinsonism risk REM sleep behaviour disorder is associated with an increased risk of dementia and parkinsonism.
7 Froggatt et al. 2020 Examine the feasibility of a group intervention to improve the quality of life for people with advanced dementia living in care homes Feasibility Cluster RCT People with advanced dementia living in care homes Namaste group intervention The Namaste intervention showed feasibility for improving the quality of life for people with advanced dementia.
8 Parish et al. 2022 Investigate the effects of aspirin on dementia and cognitive function in diabetic patients Qualitative Diabetic patients Aspirin intervention Aspirin did not significantly impact dementia and cognitive function in diabetic patients.
9 Yulug et al. 2023 Conduct a randomized, double-blinded, placebo-controlled phase-II trial on combined metabolic activators in Alzheimer's disease patients Qualitative Alzheimer's disease patients Combined metabolic activators vs placebo Combined metabolic activators improved cognitive functions in Alzheimer's disease patients.
10 Bajwa et al. 2019 Implement a randomized controlled trial of an exercise intervention promoting activity, independence, and stability in older adults with mild cognitive impairment and early dementia Qualitative Older adults with mild cognitive impairment and early dementia Exercise intervention (PrAISED) PrAISED exercise intervention aimed at promoting activity, independence, and stability.

 

5. Data Synthesis

Thomas and Harden (2008) offered a way to gather qualitative data from the included studies. One will use this method, which is called "theme synthesis."

One looked for themes and connections that ran through all the data and did a complete study on how telemedicine changes the quality of life of people with dementia.

The systematic review will be fuller and more in-depth because this overview combines the findings and points of view from several qualitative studies into one story.
 

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Impact of telemedicine on remote health and well-being of dementia patients in the UK

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