Feasibility of a Video Telehealth Functional Assessment for Veterans with Dementia
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Background. Veteran access to an assessment of day-to-day function is vital to enable aging-in-place. Older Veterans are more likely to have dementia, which results in progressive functional decline requiring caregiver assistance. While early assessment of day-to-day function is critical to preventing functional losses due to dementia, Veterans face barriers to a functional assessment due to rurality or difficulty traveling to the clinic. The gold standard of functional assessment involves observing Veterans completing a day-to-day task such as tooth brushing or medication management. While telehealth increases Veteran access to care, video has not been used to assess Veteran daily life function, particularly for those at highest risk of disability and functional decline. Specific Aims and Method. We will develop and pilot test the feasibility and acceptability of an assessment of Veteran day-to-day function adapted for VA Video Connect (VVC). The target population is older Veterans (age ≥65) with a diagnosis of dementia receiving dementia care at VA Bedford HCS and their caregivers. This will be accomplished over two aims: Aim 1. Develop protocol for assessment of Veteran day-to-day function adapted for VVC delivery. We will identify assessments of Veteran daily life function applicable to dementia and develop protocols for VVC delivery. We will then seek feedback on preliminary protocols via stakeholder interviews, utilizing rapid analysis to gather themes that inform further adaptation to protocols. This will be achieved via two sub-aims: Aim 1a. Identify and develop protocols for VVC delivery of day-to-day tasks. We will select ADL tasks (e.g., tooth brushing) and Instrumental ADL tasks (e.g., medication management) from assessment batteries utilized in dementia care, based on criteria such as feasibility for VVC delivery. We will develop protocols including step-by-step instructions for video delivery of the task-based assessments. Aim 1b. Adapt VVC protocols based on input from stakeholders, namely, interviews with experts in dementia, tele-rehabilitation, and caregivers. Interview topics will include protocol structure, content, and dementia relevance. VVC protocols for day-to-day tasks will be further adapted based on stakeholder input. Aim 2. Pilot test and gather the feasibility and acceptability of day-to-day tasks adapted for VVC delivery with 20 community-dwelling Veterans with dementia and their caregivers (N=40), and based on feedback, finalize VVC protocols for tasks. Feasibility and acceptability will be gathered through semi-structured interviews with participating Veteran-caregiver dyads, satisfaction surveys completed by the assessor and the dyad, and visit field notes and session checklists completed by the assessor and a trained observer, and will include domains such as technological challenges, ability to see and hear during the assessment, and session duration. We will also gather baseline Veteran-caregiver data to inform our subsequent trial. Based on synthesized data, we will select tasks for which we will refine VVC protocols. Impact. This project will develop and pilot test assessments of Veteran day-to-day function adapted for VVC delivery to Veterans with dementia and their caregivers. Increasing Veteran access to functional assessment allows for more targeted intervention, which may minimize the cascading effects of dementia and disability- related deficits to Veterans, caregivers, and VHA, thereby aligning with RR&D’s mission to maximize Veterans’ functional independence. Data from this project will inform development of a fully-telehealth version of the evidence-based dementia program, Tailored Activities Program (TAP) in a future MERIT.
