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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 10
| Issue : 3 | Page : 89-93 |
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Challenges for technology adoption towards primary geriatrics services
B S Nanda Kumar1, Shivananjiah P Shalini1, Y Medha Rao1, Pia Hedberg2, Per-Daniel Liljegren3, Anette Edin-Liljegren4
1 Department of Community Medicine, Head Division of Research and Patents, M S Ramaiah Medical College, Bengaluru, Karnataka, India
2 Umea University, Umeå, Sweden
3 Regionförbundet Västerbottens län, Umeå, Sweden
4 Department of Nursing, Vårdvetarhuset Hus A, Umeå, Sweden
| Date of Submission | 08-Feb-2022 |
| Date of Decision | 10-Apr-2022 |
| Date of Acceptance | 06-Jun-2022 |
| Date of Web Publication | 21-Feb-2023 |
Correspondence Address:
Shivananjiah P Shalini
Department of Community Medicine, M S Ramaiah Medical College, Bengaluru 560054, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/DYPJ.DYPJ_13_22
Background: The telemedicine-based approach facilitates remote health and social care for maintaining autonomy, thereby improving quality of life for geriatric patients with associated morbidities. Thus, the present study focusses on various challenges encountered during the use of technology-based model for geriatric care in urban as well as rural settings. Materials and Methods: The present operational research-based study was conducted on 2531 elderly individuals from rural and urban settings. The HUB and spoke model have been developed using cloud-based teleconsulting as well as mobile-based teleconsulting approaches which were setup up in rural and urban areas in India and Sweden for teleconsulting of elderly population. The rural and urban elderly population were screened using the telemedicine-based model. Feedbacks were taken from elderly subjects in both rural and urban settings to assess various challenges encountered during the use of technology-based model for geriatric careResults: Of 2531 elderly individuals, 701 (27.7%) individuals belonged to the urban population, while 1830 (72.3%) individuals belonged to the rural population who were examined with the help of model developed using telemedicine technology. Majority of persons screened were in the age group of 60–69 years with mean age 69.7 ± 7.90 years. Some of the challenges faced implementation of this tele-geriatrics model includes non-availability of accurate patient history, limitations over clinical examination, etc. have been highlighted working upon which would further improve this model. Conclusion: This teleconsultation-based model developed through this study provides practical evidence for its use in treating elderly population and associated challenges thereby improving their quality of life. Keywords: Geriatrics, hospitalization, morbidity, primary healthcare, telemedicine
How to cite this article:
Kumar B S, Shalini SP, Rao Y M, Hedberg P, Liljegren PD, Edin-Liljegren A. Challenges for technology adoption towards primary geriatrics services. D Y Patil J Health Sci 2022;10:89-93 |
How to cite this URL:
Kumar B S, Shalini SP, Rao Y M, Hedberg P, Liljegren PD, Edin-Liljegren A. Challenges for technology adoption towards primary geriatrics services. D Y Patil J Health Sci [serial online] 2022 [cited 2023 Mar 23];10:89-93. Available from: http://www.dypatiljhs.com/text.asp?2022/10/3/89/370111 |
| Introduction | |  |
In recent times, various advancements in the medical field have contributed to higher life expectancy.[1],[2] Of the entire Indian population, the number of senior citizens has increased from 5.4% in 1950 to 9% in 2020.[3] In the Indian population, a tremendous rise has been evident in the proportion of elderly population ranging from the year 1991 to 2001. It has also been estimated that the elderly population in India will reach 324 million by the year 2050.[4],[5] Population aging is the most significant result of demographic transition. Projection studies indicate that the proportion of individuals above 60 years of age in India will increase to 198 million in 2030. India is in a phase of demographic transition and trends reveal that the population of the elderly is growing faster than the general population.[6] Thus, increased proportion of elder population has given rise to the field of geriatrics involving healthcare of the elderly. Elderly people with multiple chronic illnesses are at greater risk of developing functioning limitations and disabilities. These challenges can have a negative impact on the treatment they receive during hospitalization, transfer to home or other environments, health outcomes and usage patterns of in-hospital patient care after discharge.[7],[8] There is lack of geriatric medical expertise throughout the world which causes inadequate supply of practitioners or remoteness. In rural or remote areas, there may be insufficient caseload for justifying full-time presence of a geriatrician. As a result, this important resource is usually unavailable especially in the rural areas.[9]
With the aging of the population and the increasing prevalence of long-term illnesses, use of remote care is increasing for helping the elderly in maintenance of their independence for continuing to live in their own homes.[10],[11],[12] There is a major contribution of technological advancements in increasing use of remote care due to its cost effectiveness and ease of use in comparison to the healthcare facilities incurring high costs. Although telemedicine interventions began a few years ago and have grown well so far, detailed economic evaluations of such projects remain insufficient.[13],[14] Previous research has concluded that telemedicine is effective and has a positive impact. These include treatment effects, greater efficiency of health services, and practical usability. Other identified benefits include greater access to health services, cost-effectiveness, better educational opportunities, better health outcomes, better quality of care, better quality of life, and greater social support.[15]
According to the Government of India statistics, cardiovascular disorders account for one third of elderly mortality. Respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%. Neoplasm accounts for 6% and accidents, poisoning and violence constitute less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal (GI) and genitourinary infections. Instead of pyrexia and leucocytosis, the acute infections in elderly may present in an atypical way with impaired intellect/memory, incontinence, instability or immobility. Malnutrition, occult hypothyroidism, renal failure, depression and sexual problems are also common in the elderly.[16],[17] The proportion of the sick and the bedridden among the elderly is found to be increasing with advancing age. Therefore, policy interventions that include social and human, as well as economic investments is the need of the hour to prevent unnecessary dependencies of the aging populations. In India, various schemes have been developed to address promotional, preventive, curative and rehabilitative services in an integrated manner which include the National Programme for Health Care of the Elderly (NPHCE). These programmes focus upon health promotion, preventive services, diagnosis and management of geriatric medical problems (out and in-patient), day care services, rehabilitative services and home-based care as needed.[3] They have also encouraged use of technology-based approaches in efficient management of geriatric care as well as problems associated with it so as to ensure acceptance throughout the masses.
Thus, the present study focusses on various challenges encountered during the use of technology-based model for geriatric care in urban as well as rural settings.
| Materials and Methods | | |
This operational research-based study was conducted on 2531 elderly individuals from rural and urban settings during the period from September 2017 to September 2019. The model was developed using cloud-based teleconsulting as well as mobile-based teleconsulting approaches. Initially HUB and spoke model was adapted in both rural and urban areas following which mobile-based technology was developed to increase accessibility. The project team recruited urban and rural study participants of age 60 years and above for screening from the urban and rural field areas, old age homes and walk-in patients to the HUB and satellite clinics. However, elderly people who were not willing to participate in the study for their personal reasons were excluded from the study. The scientific committee approved the proposal and ethical clearance was obtained from the institutional ethics committee as per the standard guidelines. Written informed consent in local language was obtained from all the respondents.
Description of the model
Local health functionaries such as Anganwadi workers, auxiliary nurse mid wife, ASHA workers, medical doctors, family physicians in urban and rural areas were sensitized through workshops and training programs to identify, refer and provide supportive guidance to elderly and their care givers for seeking help at the satellite centers. In case of medical treatment at higher centres, the patients were referred to the HUB hospital for specialized care of the morbidity as per the institutional guidelines at geriatric ward. Elderly patients from urban and rural areas who participate in the present study were subjected to focus group discussions to identify their needs and demands. Feedback was further taken from the rural and urban elderly participants as well as local health functionaries based upon questionnaire preliminary designed to understand the experience imparted upon use of this model and identify the associated challenges faced during adapting to the teleconsultation model for geriatric care.
| Results | | |
The technology-based model for geriatric care was conceptualized, tested and validated in rural as well as urban settings. First, HUB and spoke model was used. It was seen that the elderly population was not using the same. Hence, mobile-based technology was developed to increase patient accessibility. The present study has been conducted on a total of 2531 elderly individuals, out of which 701 (27.7%) individuals belonged to the urban population as well as 1830 (72.3%) individuals belonged to the rural population who were examined with the help of model developed using telemedicine technology.
Focus group discussion in urban and rural settings was undertaken to identify specific health needs and demands. User satisfaction was one another outcome evaluated in this study. Respondents expressed several advantages, and benefits they had from the project chiefly the avoidance of travel time and cost to avail services. The elderly in both urban and rural areas were highly satisfied with the services provided and requested continuance of facilities and services on the long run. In the urban area, various health needs and requirements were identified during focus group discussion. A dedicated team for elderly care, comprehensive geriatric assessment screening for new registrants, evidence of care plans for the elderly and systems or standardized methods to identify problems specific to the elderly population were lacking. Only random blood sugar assessments were being done in primary care centres. There was non-availability of lipid profile tests and spirometry for COPD assessment. Patients were referred either to the nearest laboratory or to MS Ramaiah hospital which is approximately 5 km away. Lack of appropriate referral protocols once a problem was identified (Most of them were advised to visit the district hospital or tertiary center which was difficult for the elderly to access/afford) and awareness among the people about specific geriatric services or management was observed.
In the rural area, the public health centre (PHC) offered general health examination, treatment for common morbidities, dental health services, and preventive, curative services under various National Health programs. There is dedicated medical, dental and nursing health personnel along with good infrastructure as per the prevailing norms. However, the health needs and demands were identified. Geriatric patients were required to travel on an average 15–20 kms either to Chintamani Taluk/Chikkaballapura or private hospital/labs for certain diagnostic assessments and higher treatment. Lack of specific investigations (HbA1C, lipid profile, spirometer or lung function tests) in the PHC posed challenges for effective management of hypertension, diabetes mellitus and chronic pulmonary obstructive diseases. The absence of physiotherapy and rehabilitation services posed difficulties in addressing the functional mobility and physical rehabilitation problems of the elderly in rural areas. Non-availability of personal health records made a continuum of treatment challenging. Apart from these problems, overall challenges which have been encountered during the development and implementation of the tele-geriatric model have been elaborated in [Table 1].
| Discussions | | |
The healthcare of elderly individuals is challenging. In old age, individuals commonly experience one or more morbidities. The actual focus of geriatric care remains the management of these morbidities as well as slowing down their progression so as to increase the quality of life for elderly population.[18],[19] The longitudinal care of elderly individuals focusses at early diagnosis, limiting progression of morbidities, slow down deteriorating condition so as to bring about improvement in patient’s comfort levels.[20] Incident care involves recurrent interventions as well as long stays at the hospitals incurring huge economic costs. Telemedicine strategies have been undertaken so as to reduce these challenges by providing services at marginally increased cost while minimising the commutation expenses of physician and the patient.[21],[22] In India, various schemes have been developed to address promotional, preventive, curative and rehabilitative services in an integrated manner which include the National Programme for Health Care of the Elderly (NPHCE). These programmes focus upon health promotion, preventive services, diagnosis and management of geriatric medical problems (out and in-patient), day care services, rehabilitative services and home-based care as needed. However, such approaches have been highly adapted only in developed countries. Even though there are huge number of reports where technology-based models have been used for geriatric care in developed countries, this approach still remains underutilized in case of developing countries which have limited resources.[23] Thus, the present study was undertaken to analyse the challenges encountered during development as well as implementation of such tele-geriatric models in Indian scenario for both urban as well as rural settings.
There have been many reports where teleconsultation approaches have been reported to be advantageous in geriatric care. Ure et al. has highlighted the significance of well-timed conversation to save complications especially in old age patients. The conversation benefits have been pronounced from distinct views in which subjects were glad with the ability to reciprocate with their healthcare professionals treating them.[24] Whereas in other study, a few nurses were not very comfortable with the teleconsultation approaches as they felt it limits their potential to recognize the affected person’s situation and their associated ailments.[25] In another study on Greek population, teleconsultation resolve shortage of medical help as well as economic crisis especially in case of rural population.[26] Similar results have been reported in the present study, where the elderly population found in advantageous to use teleconsultation-based approaches as it is highly economical, saves time as well as ensures timely medical aid. Though another study reported affirmative responses of patients using teleconsultation, but it also described that teleconsultation transfers responsibility away from hospitals to teleconsultation centres.[27] Hence, there is need to study the structural framework, process settings along with patient outcomes before implementing teleconsultation-based approaches into routine practice.[28]
However, there are some limitations associated with the study. Being a technology interventional assessment, ensuring follow up of all registered patients was not possible. Hence, clinical effectiveness is not available for all screened participants. Ensuring availability of drugs required for all participants was a challenge as the supplies were not planned to be provided through the project. Hence, attributing the control of the clinical outcomes among the follow up patients to the intervention alone may be erroneous. Many patients referred to higher centres did not provide feedback regarding the visit or follow up. Hence, information regarding the patient outcomes from referral is limited to only those visiting the Hub centres or returning to the satellite after visiting the higher centres. In spite of all these shortcomings, the current study provides a lot of insights which will be useful for translation and validation of the teleconsultation-based models for geriatric care.
| Conclusion | | |
Telemedicine-assisted applications for geriatric care provides promising alternative for managing the ever-increasing elderly population. In this study, development and successful implementation of a feasible and economic model to be used for teleconsulting of elderly population has been reported in rural and urban areas. The opportunities and challenges encountered while development and implementation of this tele-geriatrics model have been highlighted working upon which would further improve this model. Thus, this telemedicine-based model proves to be a promising technology to be applied in urban as well as rural settings by contributing to patient satisfaction via managing their morbidities ultimately improving their quality of life.
Financial support and sponsorship
This project is funded by the ICMR- FORTE; India and Sweden collaborative grant in 2018.
Conflicts of interest
There are no conflicts of interest.
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[Table 1]
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