Use of telehealth and digital technologies to improve the care of older adults living in RACFs and the community.
Tracks
Harbour View 1
Dementia
Implementation
Mental Health
Non-pharmacological interventions
Psychology
Residential
Technology
| Wednesday, November 13, 2024 |
| 10:45 AM - 12:15 PM |
Speaker
Prof Viviana Wuthrich
Professor, Director Of Lifespan Health & Wellbeing Research Centre
Lifespan Health & Wellbeing Research Centre, Macquarie University
Use of telehealth and digital technologies to improve the care of older adults living in RACFs and the community.
Abstract
Introduction: The use of telehealth and digital technologies with older adult samples is slowly increasing, however, the effectiveness of these technologies is often mixed. This symposium will review the effectiveness of the use of telehealth and digital technologies to provide psychological treatment for mental disorders to older adults living in residential aged care facilities and living in the community. In addition this symposium will examining the effectiveness of digital stories for increasing the use of person-centred care practices in residential aged care.
Methods: Two systematic reviews will examine the evidence for the use of telehealth and digital interventions to treat mental disorders with one focused on older adults living in the community, and the other for older adults living in residential aged care facilities. The results from a recent multi-site NHMRC-Beyond Blue co-funded clinical trial that utilised telehealth and digital technologies to deliver psychological treatment to older adults through Older Adult Mental Health Services will be presented. Finally, the use of digital stories to increase staff knowledge and use of person-centred care in residential aged care facilities will be presented.
Results & Conclusion: Together these studies provide good evidence for the effectiveness and benefit of a wide range of telehealth and digital technologies services to improve the lives of older adults living in a range of settings. The challenges of using telehealth and digital technologies and demonstrated facilitators for success in using these technologies will be discussed.
Methods: Two systematic reviews will examine the evidence for the use of telehealth and digital interventions to treat mental disorders with one focused on older adults living in the community, and the other for older adults living in residential aged care facilities. The results from a recent multi-site NHMRC-Beyond Blue co-funded clinical trial that utilised telehealth and digital technologies to deliver psychological treatment to older adults through Older Adult Mental Health Services will be presented. Finally, the use of digital stories to increase staff knowledge and use of person-centred care in residential aged care facilities will be presented.
Results & Conclusion: Together these studies provide good evidence for the effectiveness and benefit of a wide range of telehealth and digital technologies services to improve the lives of older adults living in a range of settings. The challenges of using telehealth and digital technologies and demonstrated facilitators for success in using these technologies will be discussed.
Biography
Viviana Wuthrich is a Professor of Clinical Psychology, Director of the Lifespan Health & Wellbeing Research Centre at Macquarie University, and a Medical Research Future Fund Emerging Leadership Fellow. Her expertise is in developing and evaluating psychological interventions for treating depression and anxiety in older adults through clinical trials. Sunil Bhar is a Professor of Clinical Psychology and Director of the Wellbeing Clinic at the Swinburne University of Technology. His expertise is in treating depression and anxiety in older adults living in residential aged care facilities. Aida Brydon is a PhD student in psychology at the Swinburne University of Technology. Her PhD is focused on mental health in older adults living in residential aged care facilities.
Prof Viviana Wuthrich
Professor, Director Of Lifespan Health & Wellbeing Research Centre
Lifespan Health & Wellbeing Research Centre, Macquarie University
Using stepped care to increase access to psychological interventions for depression and anxiety in older adults: A multi-site trial
Abstract
Introduction/Background:
There are no rigorous evaluations of clinical effectiveness, cost savings, feasibility or acceptability of stepped care in older adult mental health services. Stepped care delivery of psychological services can potentially balance clinical outcomes and service costs. Stepped care relies on provision of low intensity (lower cost) services first, followed by higher intensity (higher cost) services only if needed. The use of remote delivery options (internet, telehealth, self-help) in the early steps offers the potential to increase access to psychological interventions in isolated participants, especially those living in rural and remote areas. This co-funded NHMRC-Beyond Blue multi-site clinical trial compared stepped care treatment approaches for anxiety and depression delivered through older adult mental health services to usual care.
Methods:
122 older adults (>65 years) with clinically interfering symptoms of depression and/or anxiety were randomised to stepped care or usual care at one of six older adult mental health services including public, private, urban and rural services. Participants completed demographic, self-report symptom measures, semi-structured clinical interviews conducted by reviewers blind to treatment allocation, quality of life and economic measures, pre-treatment, 13 and 26 weeks post baseline and at 12 month post baseline. Acceptability to clinicians and consumers was also evaluated.
Results & Conclusion:
The final follow-up assessments have been completed and data analysis is underway. The findings of the clinical and cost-effectiveness of this stepped care model for addressing older adult mental health will be presented. Clinical and consumer feedback, barriers and facilitators of this health model will be discussed.
There are no rigorous evaluations of clinical effectiveness, cost savings, feasibility or acceptability of stepped care in older adult mental health services. Stepped care delivery of psychological services can potentially balance clinical outcomes and service costs. Stepped care relies on provision of low intensity (lower cost) services first, followed by higher intensity (higher cost) services only if needed. The use of remote delivery options (internet, telehealth, self-help) in the early steps offers the potential to increase access to psychological interventions in isolated participants, especially those living in rural and remote areas. This co-funded NHMRC-Beyond Blue multi-site clinical trial compared stepped care treatment approaches for anxiety and depression delivered through older adult mental health services to usual care.
Methods:
122 older adults (>65 years) with clinically interfering symptoms of depression and/or anxiety were randomised to stepped care or usual care at one of six older adult mental health services including public, private, urban and rural services. Participants completed demographic, self-report symptom measures, semi-structured clinical interviews conducted by reviewers blind to treatment allocation, quality of life and economic measures, pre-treatment, 13 and 26 weeks post baseline and at 12 month post baseline. Acceptability to clinicians and consumers was also evaluated.
Results & Conclusion:
The final follow-up assessments have been completed and data analysis is underway. The findings of the clinical and cost-effectiveness of this stepped care model for addressing older adult mental health will be presented. Clinical and consumer feedback, barriers and facilitators of this health model will be discussed.
Biography
Viviana Wuthrich is a Professor of Clinical Psychology, Director of the Lifespan Health & Wellbeing Research Centre at Macquarie University, and a Medical Research Future Fund Emerging Leadership Fellow. Her expertise is in understanding and treating depression and anxiety in older adults, and developing interventions to help older adults to age well. She has expertise in clinical trial methodology, systematic reviews and experimental research. She is passionate about translation of research into practice.
Prof Viviana Wuthrich
Professor, Director Of Lifespan Health & Wellbeing Research Centre
Lifespan Health & Wellbeing Research Centre, Macquarie University
Efficacy of low intensity interventions for geriatric depression and anxiety
Abstract
Background: The is limited understanding of the efficacy of low intensity interventions for treating depression and anxiety in older adults.
Methods: Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression against any control condition in any setting. Inclusion criteria: the study examined low intensity psychological interventions that were primarily self-help, included support from trained practitioners/facilitators with <6 hours total contact time (typically <30 min p/contact) and targeted anxiety and/or depression as primary outcomes. The review was preregistered on PROSPERO.
Results: Seven studies consisting of 304 older adults (65–78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. Five studies compared a low-intensity intervention to a waitlist control, one to general supportive email. All low intensity interventions utilised cognitive behavioural therapy. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = 0.62) and large effect sizes for anxiety (Cohen's d = 0.84) at post-treatment.
Conclusion: There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. Results are limited due to the small sample size. The efficacy of low intensity interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown.
Methods: Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression against any control condition in any setting. Inclusion criteria: the study examined low intensity psychological interventions that were primarily self-help, included support from trained practitioners/facilitators with <6 hours total contact time (typically <30 min p/contact) and targeted anxiety and/or depression as primary outcomes. The review was preregistered on PROSPERO.
Results: Seven studies consisting of 304 older adults (65–78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. Five studies compared a low-intensity intervention to a waitlist control, one to general supportive email. All low intensity interventions utilised cognitive behavioural therapy. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = 0.62) and large effect sizes for anxiety (Cohen's d = 0.84) at post-treatment.
Conclusion: There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. Results are limited due to the small sample size. The efficacy of low intensity interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown.
Biography
Viviana Wuthrich is a Professor of Clinical Psychology, Director of the Lifespan Health & Wellbeing Research Centre at Macquarie University, and a Medical Research Future Fund Emerging Leadership Fellow. Her expertise is in understanding and treating depression and anxiety in older adults, and developing interventions to help older adults to age well. She has expertise in clinical trial methodology, systematic reviews and experimental research. She is passionate about translation of research into practice.
Ms Aida Brydon
Phd Candidate
Swinburne University Of Technology
Emerging needs and viability of telemental health for older adults in residential settings: A systematic review
Abstract
Emerging needs and viability of telemental health for older adults in residential settings: A systematic review
Aida Brydon, Prof Sunil Bhar, Prof Maja Nedeljkovic
Swinburne University
Introduction
The Covid-19 pandemic prompted a rapid adoption of telehealth to support the mental health of older adults in residential aged care facilities. The use of telehealth for mental health care increases accessibility to mental health services, overcoming barriers of distance, lack of transportation, and time constraints. Understanding the implementation of telemental health in residential aged care, including the barriers and facilitators of its use, is crucial for sustaining its use post-pandemic. Without such insight, there is a risk of the de-adoption of telemental health in residential aged care as the safety and health concerns of COVID-19 wane. This presentation discusses the results of a systematic review of the international literature specific to the provision of mental health interventions through telehealth to older adults in residential aged care. We assess the implementation, adoption, perceptions and effectiveness of telemental health interventions delivered to aged care residents.
Methods
The systematic review is conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three electronic databases (ESBCOhost, Web of Science and PsychInfo) were searched for research relating to the use of telemental health in residential aged care.
Results and Conclusion
Screening for this systematic review is underway and results will be presented at the conference. The results of this research contribute to ongoing efforts in enhancing the quality of care for this vulnerable population.
Aida Brydon, Prof Sunil Bhar, Prof Maja Nedeljkovic
Swinburne University
Introduction
The Covid-19 pandemic prompted a rapid adoption of telehealth to support the mental health of older adults in residential aged care facilities. The use of telehealth for mental health care increases accessibility to mental health services, overcoming barriers of distance, lack of transportation, and time constraints. Understanding the implementation of telemental health in residential aged care, including the barriers and facilitators of its use, is crucial for sustaining its use post-pandemic. Without such insight, there is a risk of the de-adoption of telemental health in residential aged care as the safety and health concerns of COVID-19 wane. This presentation discusses the results of a systematic review of the international literature specific to the provision of mental health interventions through telehealth to older adults in residential aged care. We assess the implementation, adoption, perceptions and effectiveness of telemental health interventions delivered to aged care residents.
Methods
The systematic review is conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three electronic databases (ESBCOhost, Web of Science and PsychInfo) were searched for research relating to the use of telemental health in residential aged care.
Results and Conclusion
Screening for this systematic review is underway and results will be presented at the conference. The results of this research contribute to ongoing efforts in enhancing the quality of care for this vulnerable population.
Biography
Aida Brydon is a PhD Candidate (Clinicial Psychology) from Swinburne University, Melbourne. Under the mentorship of Prof Sunil Bhar, Aida's research focuses on the use of telehealth with older adults in residential aged care, aiming to address critical gaps in accessibility of mental health services and quality of care in this vulnerable population.
Through her work, she aspires to drive positive change in aged care environments, advocating for inclusive, person-centred approaches to mental healthcare that prioritise dignity, respect, and quality of life.
She also loves to dance salsa and has the most beautiful black labrador named Willow.
Prof Sunil Bhar
Professor
Swinburne University of Technology
Digital Stories Within Residential Aged-care Settings: Implications for Staff Knowledge and Person-Centred Care Practices
Abstract
Introduction
Australian residential aged care quality standards include person-centred care practices. However, staff cannot provide such practices if they do not know the history, preferences, and values of residents under their care. This study investigated if watching digital life stories about aged care residents was associated with improvement in staff knowledge and person-centred interactions with the depicted residents.
Method
Residential aged care staff (n = 61) viewed a resident’s digital life story and completed a measure of their knowledge and understanding of the resident before, after and 1-month following viewing the story. At follow-up, staff were also asked to indicate if viewing the story had improved their interactions and practices with the resident, and to describe changes in practice.
Results
Staff knowledge and understanding of the resident were significantly higher after (M = 23.44, SD = 3.77), than before (M = 19.67, SD = 4.93) watching the story(t(44) = -6.36, p <.001, Cohen’s d = -0.95), and remained stable at follow-up. At follow-up, 76-80% of the sample indicated that viewing the story had improved their relationship, interactions, and effectiveness in working with residents. Staff found the stories helped them to engage more empathically, have more meaningful conversations and personalise activities with residents.
Conclusions
Watching digital life stories was associated with improvements in staff’s knowledge and understanding of residents and helped staff feel more equipped to personalise care practices. A digital story about an aged care resident is a promising tool for increasing person-centred care in residential settings.
Australian residential aged care quality standards include person-centred care practices. However, staff cannot provide such practices if they do not know the history, preferences, and values of residents under their care. This study investigated if watching digital life stories about aged care residents was associated with improvement in staff knowledge and person-centred interactions with the depicted residents.
Method
Residential aged care staff (n = 61) viewed a resident’s digital life story and completed a measure of their knowledge and understanding of the resident before, after and 1-month following viewing the story. At follow-up, staff were also asked to indicate if viewing the story had improved their interactions and practices with the resident, and to describe changes in practice.
Results
Staff knowledge and understanding of the resident were significantly higher after (M = 23.44, SD = 3.77), than before (M = 19.67, SD = 4.93) watching the story(t(44) = -6.36, p <.001, Cohen’s d = -0.95), and remained stable at follow-up. At follow-up, 76-80% of the sample indicated that viewing the story had improved their relationship, interactions, and effectiveness in working with residents. Staff found the stories helped them to engage more empathically, have more meaningful conversations and personalise activities with residents.
Conclusions
Watching digital life stories was associated with improvements in staff’s knowledge and understanding of residents and helped staff feel more equipped to personalise care practices. A digital story about an aged care resident is a promising tool for increasing person-centred care in residential settings.
Biography
Prof Sunil Bhar is a Professor of Psychology at Swinburne University of Technology. He is a clinical psychologist with expertise in the application of psychological treatments to older adults. He is the director of the Swinburne Wellbeing Clinic for Older Adults, a counselling and support service for aged care residents, families of residents and residential care staff. Since 2005, he has led research on the outcomes and mechanisms of psychological treatments for older adults. His research program adopts a comprehensive approach to the development and delivery of effective and sustainable interventions to promote wellbeing in later life. He has extensive experience in behavioural research in depression, suicide and anxiety in older adults. He has won over $12M in research funding to investigate the effectiveness, accessibility and acceptability of psychological treatments for older adults. His research and contribution to practice have been recognised through several awards. In 2014, he was awarded the Alastair Heron Prize for excellence in ageing research and practice by the Australian Psychology Society. In 2015, he was awarded a citation for outstanding contribution to student learning in geropsychology by the Office of Learning and Teaching. In 2018, he won the Swinburne Dean’s award for research, and in 2019, he won Swinburne’s research impact award. Alongside his research and teaching activities, Professor Bhar has maintained a clinical practice for 30 years.
