1. Telegerontology Update for Research in Progress Dec. 10 th, 2014 INVESTIGATORS: Dr. Roger Butler, Dr. Gerard Farrell, Dr. Michelle Ploughman, Dr. Susan Mercer, Dr. Cathy Hickey, Ms. Ann Hollett, Ms. Elizabeth Wallack, Ms. Chelsea Harris

2. Why? 1. Realization the current system is in crisis. ALC rise. 2. Dementia doubling rate will exhaust NH capacity. 3. Lack of alternative housing options. 4. Lack of community home supports. 5. High rate of poverty in seniors. 6. The catalyst.

3. Funding Partners Alzheimer Society. NLCAHR. Government of Newfoundland and Labrador. NLMA. eHealth Research Unit, MUN. Lawson Foundation (Dr. Maxwell House). Health Care Foundation (Dr. Gerard Farrell).

4. Some Key Questions Can a remote team help manage a patient with dementia in their home and improve their care, reduce caregiver burden and enhance the caregiver family physician dyad? What are the caregiver features which help sustain people with dementia in their home? What supports are necessary? Can we prevent visits to ER and subsequent NH admissions (premature)?

5. The Home Assessment Introductions / Circle of Care / Consent. Home video / OT assessment. Caregiver Hassle scale IV about patients functional status / supports FIM Patient Cognitive status: MMSE / MOCA Gait and balance: Get up and go Executive function and safety: Kettle test Computer instruction for caregiver / patient with APPS.

6. Telegerontology Home Assessment Video

7. Control Same intervention as the test group. All patients receive iPads with apps. All patients invited to receive Alzheimer’s first link program. All patients invited to Alzheimer’s educational series via skype. The Test group receive a weekly call from Dr. Butler or team member to discuss concerns if any, and to tabulate data.

9. Lessons Learned 1. Good app development requires excellent communication between the computer specialist and the clinician. Dr. Gerard Farrell has been essential in this area. 2. Caregiver profiles. 3. Support patterns 80/20. 4. Which computers and which apps. 5. Contact frequency / time per week per family.

10. Patient Scenarios Cornell scale picking up depression. Falls and system navigation are key features. Patient aggression at home / validation and help with the Cohen Mansfield. Controls also looking for help / advice given and directed to help.

11. Next Steps 2 nd group recruitment. 2 student projects analyzing data for family physician needs (MD focus groups) and patient / caregiver interviews qualitative data. 6 month data collection point. 18 month pilot study. Big picture.