At the close of 2022, the issue of timely dementia diagnosis came back into the spotlight with news of a new series of national NHS pilots in care homes.
Launched in recognition of the impact the pandemic has had on the number of people diagnosed with dementia, these trials will see GPs involved in the proactive screening and assessment of individuals in seven regions. The goal is to increase diagnosis and provide opportunities for early intervention. Both goals can be of positive benefit to the individual and the health system.
It is estimated that:
• One in four hospital beds are occupied by a person with dementia.
• The number of short stay emergency admissions for people with dementia increased by 20% between 2014/15 and 2017/18.
• Up to 42% of people over 70 who have an unplanned hospital admission have dementia.
• Four of the five most common comorbidities people with dementia are admitted to hospital for in the UK are for preventable conditions: a fall, a fractured hip or hip replacement, urinary tract infection and chest infection.
A key tool at our disposal in the fight against dementia is digital technology. From utilisation of wearables and monitoring equipment through to telemedicine and virtual wards, there have been many examples of innovative digital programmes in recent times. Here we take a look at four approaches based on case studies within the NHS.
A life-changing impact
As a part of the NHS Widening Digital Participation Programme, the Leeds Dementia Pathfinder has seen the introduction of touchscreen tablets and cloud-based voiced services in a variety of settings including care homes, residences, support groups and wards. Additionally, the programme has also involved training of carers and volunteers as ‘Digital Champions’.
Technology has helped to provide timely reminders for medication and allowed individuals affected by dementia to access health information. In addition to these practical benefits, participants with dementia have cited quality of life improvements such as the ability to spend more time on hobbies and connect with loved ones. Other positive impacts have included increased autonomy, reduced isolation and improvements in wellbeing in carers and individuals.
Certainly one carer in particular shared feedback on the programme noting how it had “changed her and her dad’s life,” illustrating how building digital skills in this patient group can have positive benefits for carers and those living with dementia alike.
Peace of mind
The Technology Integrated Health Management (TIHM) monitoring service has involved the integration of a range of internet-enabled devices within homes.
Sensors, monitors and GPS trackers are used to track data on vital signs, as well as environmental and behavioural metrics to build a holistic picture of the individual. Through a combination of machine learning and data analysis, these tools can help to predict and alert a clinical monitoring team to at-risk individuals. Real-time insights in data dashboards enable early interventions and teams to identify those who need support as quickly as possible.
Results from the programme have included a reduction in symptoms associated with dementia and the development of algorithms to alert clinicians to signs of possible urinary tract infections. One carer noted a sense of “peace of mind” from the support provided by TIHM. While other users remarked how TIHM had “reduced our visits to A&E and put our minds at rest,” and how “it’s like having a doctor’s surgery in your own home so you don’t have to visit the GP so often.”
The patient at the centre of decision making
Elsewhere, models of enhanced care in care homes have helped to facilitate early diagnosis and intervention. These models involve wrap-around care of the individual, provided by an integrated multidisciplinary team of GPs and care coordinators, for example.
Patients who display dementia symptoms are assessed and referred to virtual wards for further diagnosis and treatment if necessary out of hospital, with a goal to reduce avoidable admissions. Patients who require long-term care and display more complex symptoms may then be monitored by a psychiatry team.
In some cases, the model has helped to increase dementia diagnosis in care homes as well as non-drug interventions. While patients and their families are also given autonomy to make decisions about their care in their place of residence with an approach that “sees the patient at the centre of decision making.”
A useful reminder on my condition
In some mental health trusts, nurse management teams have worked with digital providers to develop digital apps that can be integrated within care pathways for elderly patients.
These apps have supported individuals with early onset dementia and mild cognitive impairment symptoms, providing condition management plans for individual users. Information on treatment goals and activities is available as well as tools to help individuals navigate their way through the app or ask any questions.
In terms of impact, individuals using such apps have reported a benefit in helping them manage their condition more effectively, citing its ability to provide reminders, prompts and further information. One app user in particular remarked how it had “served as a useful reminder on my condition as you do forget stuff and then you read it and may find a nugget of information which helps.” While others similarly noted how it had “helped support and prompt” with condition management.
Conclusion
Looking at digital approaches to dementia over the last few years points to the positive potential of such solutions to support screening and ongoing management.
These tools can have a beneficial impact not only for individuals affected by dementia but also the health system. From supporting increased autonomy in condition management through to potential reductions in unnecessary admissions and GP visits.
At a time of increased pressure and stretched capacity within health and care, the integration of digital tools, alongside innovative, integrated ways of working could further help enable delivery of the right care at the right time.
Further information about Livi
Livi delivers teleconsultation services in mental health, primary and urgent care, supporting partners with digital clinical capacity at speed and scale.
Our practice platform, Mjog, provides a comprehensive suite of remote monitoring questionnaires, and tools for patient messaging and reminders.
To find out more, contact partnerships-uk@livi.co.uk.
Article sources
• Nice. Dementia Hospital Care. Available online: www.nice.org.uk/about/what-we-do/into-practice/measuring-the-use-of-nice-guidance/impact-of-our-guidance/niceimpact-dementia/ch3-hospital-care. Accessed January 2023.
• Royal College of Psychiatrists. National Audit of Dementia Care in General Hospitals 2018–2019. Available online: www.hqip.org.uk/wp-content/uploads/2019/07/ref-113-national-audit-of-dementia-round-4-report-final-online-v4.pdf. Accessed January 2023.
• The International Longevity Centre. Dementia and comorbidities; Ensuring parity of care. Available online: https://ilcuk.org.uk/wp-content/uploads/2018/10/Dementia-and-Comorbidities-Ensuring-Parity-of-Care.pdf. Accessed January 2023.
• NHS Digital. Dementia project shows digital technology can make a life-changing difference. Available online: https://digital.nhs.uk/news/2020/dementia-project-shows-digital-technology-can-make-a-life-changing-difference. Accessed January 2023.
• NHS. Technology helps clinicians monitor the health of dementia patients in their homes. Available online: www.longtermplan.nhs.uk/case-studies/technology-integrated-health-management/. Accessed January 2023.
• NHS. Delivering enhanced care across the whole system: dementia ‘virtual ward.’ Available online: www.longtermplan.nhs.uk/case-studies/delivering-enhanced-care-across-the-whole-system-dementia/. Accessed January 2023.
• NHS England. Using technology enabled care to support cognition in early onset dementia. Available online: www.england.nhs.uk/atlas_case_study/using-technology-enabled-care-to-support-cognition-in-early-onset-dementia/. Accessed January 2023.
