Suitable e-Health Solutions for Older Adults with Dementia or Mild

Cognitive Impairment: Perceptions of Health and Social Care

Providers in Quebec City

Marie-Pierre Gagnon

1,2

, Mame Awa Ndiaye

, Mylène Boucher

, Samantha Dequanter

Ronald Buyl

, Ellen Gorus

, Anne Bourbonnais

, Anik Giguère

and Samira Abbasgholizadeh Rahimi

7,8

Faculty of Nursing sciences, Université Laval, Québec, Canada

Research Center on Healthcare and Services in Primary Care of Université Laval (CERSSPL-UL), Québec, Canada

Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Vrije Universiteit Brussel, Belgium

Faculty of Medicine and Pharmacy, Department of Gerontology, Vrije Universiteit Brussel, Belgium

Faculty of Nursing Sciences, Université de Montréal, Montréal, Canada

Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada

Department of Family Medicine, Mc Gill University, Montréal, Canada

Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada

Keywords: e-Health, Information and Communication Technology, Aging, Cognitive Impairment, Dementia, Healthcare

Providers, Perceptions.

Abstract: e-Health solutions offer a potential to improve the quality of life and safety of older adults with dementia or

mild cognitive impairment (MCI). In making better decisions for using eHealth technologies, health

professionals should be aware and well informed about existing tools. Recent research shows the lack of

knowledge on these technologies for older adults with dementia. In Quebec, current market offer for these

technologies is supply-based, and not need-based. This study is part of a larger project and aims to understand

the perceptions and needs of health and social care providers regarding e-health technologies for older adults

with dementia or MCI. One focus group was carried out with six health and social care professionals at the

St-Sacrement Hospital in Quebec City, Canada. The focus group enquired about the use of Information and

Communication Technology (ICT) with older adults with cognitive impairment. Relevant examples of ICTs

were presented to assess their knowledge level. The discussion was tape-recorded and transcripts were coded

using the Nvivo software. Results revealed that aside from fall safety technologies, there is a lack of

knowledge about other e-Health technologies for this population. Respondents acknowledged the value of

ICTs and were willing to recommend some of them. Economic reasons, blind trust on ICTs and lack of

confidence in patients’ capacity to use the solutions were the major limitations identified.

1 INTRODUCTION

Worldwide, population is ageing rapidly. The

proportion of people over 65 years old is expected to

grow from 900 million to 2 billion by 2050 (World

Health Organization, 2017). The number of older

adults suffering from cognitive problems, seen on a

continuum from mild cognitive impairment to severe

dementia is expected to grow from 36 million in 2010

to 115 million in 2050 (Lindbergh et al., 2016;

Alzheimer Society of Canada, 2011). In Canada, the

proportion of adults over 65 years old with dementia

was 9.2% in 2014, representing 564,000 people. This

number is estimated to rise to 937,000 people in 2031

(Chambers et al., 2016). In Quebec, the number of

older adults with dementia was approximately 23 000

in 2008, and is estimated to rise to 45 500 in 2030

(Ministère de la Santé et des Services Sociaux, 2016).

This huge rise is putting pressure on public health

systems and on informal caregivers. Among the

biggest challenges are the sustainability of healthcare

and social services delivery (Illario et al., 2015), the

burden on informal caregivers, who are responsible

for 75% of the care of the elderly (Lou et al., 2015)

and the increase of risks for physical and

psychological problems (Institute of Medicine,

2008).

172

Gagnon, M., Ndiaye, M., Boucher, M., Dequanter, S., Buyl, R., Gorus, E., Bourbonnais, A., Giguère, A. and Rahimi, S.

Suitable e-Health Solutions for Older Adults with Dementia or Mild Cognitive Impairment: Perceptions of Health and Social Care Providers in Quebec City.

DOI: 10.5220/0009489001720175

In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 172-175

ISBN: 978-989-758-420-6

Dementia is an umbrella term used to describe a

range of neurodegenerative diseases and is

characterized by progressive cognitive decline and

dependency of basic activities of daily living (ADLs)

(Hattink et al., 2016). Mild cognitive impairment

(MCI) rather refers to a cognitive decline resulting in

difficulty with concentrating, memory and

orientation. However, the person remains functional

and independent and his/her cognitive abilities can

improve over time (Alzheimer Society of Canada,

2014). Policy makers, health providers and older

adults living with MCI or dementia are in favor for

staying at home or in community as long as possible,

to fully participate in life (Jin et al., 2015), to avoid

additional costs (World Health Organization 2017).

Since e-health solutions are promising to support

older adults with dementia and their caregivers, it is

important to offer them relevant information adapted

to their needs and preference. Such technologies, if

adequately implemented and used, have the potential

to reduce costs and improve the quality of life of

people with MCI or dementia and their caregivers

(Hattink et al., 2016).

The rapid development of ICT dedicated to health

and wellbeing (e-Health) offers an unprecedented

potential to assist, maintain and improve older adults

living active, healthy and independent lives. e-Health

solutions can also allow older adults and their

caregivers to receive timely health and social care in

their homes, which diminishes the burden on them.

Therefore, e-Health interventions are increasingly

being recognized as promising solutions to answer the

challenges of the aging population. However, little

scientific evidence is available on the effectiveness of

most e-Health interventions available and more

research is needed in this field (Abbasgholizadeh

Rahimi et al., 2017). Moreover, older adults and their

caregivers are not necessarily aware of these solutions

and may lack relevant and adapted information to

make informed decisions on their use (Teles et al.,

2017).

In several countries, large investments are made

by governments to develop eHealth solutions

targeting older adults and their caregivers. Despite the

huge potential of these technologies, they are often

underused. Technologies need to be adapted to end

users’ needs and should provide an additional

leverage to empower them.

2 OBJECTIVES

The main objective is to get a deep understanding of

the perceptions and needs of health and social care

professionals with regard to the use of e-Health

solutions intended for older adults with dementia or

MCI. We will present the preliminary results based

on a focus group session carried out with health and

social care professionals in Quebec City, Canada. As

part of a larger project, this study aimed to: 1) explore

providers’ perceived facilitators, motivators, and

barriers in the use of e-Health by older adults with

dementia or MCI; 2) assess their level of knowledge

on e-Health solutions for older adults with dementia

or MCI; 3) identify which currently available e-

Health solutions could best match end-users’

expectations.

3 METHODS

One focus group was conducted at the St-Sacrement

Hospital in Quebec City with six health professionals:

two occupational therapists, one physiotherapist, one

social worker, one clinical nurse in geriatrics and one

special education technician. All participants were

female. Participants were recruited from a list given

by the direction of the “Support for the autonomy of

the eldery” service. The selection criterion was being

a professional health or social care provider working

in the mental health sector, caring for older adults

with cognitive impairments of varying degrees. The

research coordinator reached them to confirm their

eligibility and availability. The focus group lasted for

approximately 60 minutes, facilitated by the research

coordinator. The discussion was taped-recorded and

transcribed. The transcripts were then analysed by

another research coordinator involved in the project

by using qualitative data analysis software (Nvivo

12). During the focus group discussion, relevant

examples were shown to get an idea of what

respondents already knew about e-Health”.

4 PRELIMINARY RESULTS

4.1 Poor Knowledge on e-Health

Solutions

Results show that health and social care providers

have generally low knowledge on technologies for

older adults with cognitive impairment. They know

the most popular, such as detection or registration

falls (electronic bracelet), but admit their

unfamiliarity with other e-Health solutions. Most of

them have the perception that they lack capacity to

properly support patients with suitable tools. Often,

Suitable e-Health Solutions for Older Adults with Dementia or Mild Cognitive Impairment: Perceptions of Health and Social Care Providers

in Quebec City

173

the request of using some e-Health solution comes

directly from patients and informal caregivers. They

rely on health professionals to find some support,

receive information in the use of these technologies,

but in many cases, health professionals are not well

qualified to assist them. They often don’t know where

to find reliable resources to adequately inform their

patients.

They also lack training for current e-Health

solutions suitable for their patients. The scarcity of

these trainings initiated or supported by health

institutions is seen as a major limitation. Some

presentations are made by e-Health solutions

companies, but few professionals attend these types

of events because they take place during their

working hours. Occasionally, professionals directly

reach the manufacturers when they have specific

questions about the use of a product, but most of the

time, the company representatives do not speak

French. Information sharing on the existence of e-

Health solutions and their way of use is done

informally between colleagues, and more often with

family members of patients who introduce them to

new tools. Finally, health and social care providers

feel it is hard to keep up to date with all e-Health

solutions available for their patients, and do not feel

qualified for now to recommend these technologies to

older adults with cognitive impairment.

The only e-Health solutions they used on a daily

basis are mainly related to safety and fall prevention

for the elderly. Those for taking medication are also

known by some health professionals. In hospitals,

electronic beds equipped with multiple detectors and

sensors are also used. There are some controlled tools

to unlock doors remotely for professionals who come

to provide home care. These technologies are useful

for people who want to limit their movements on

stairs or in less safe places. One health professional

mentioned the use of a teaching platform to learn how

to do physiotherapy exercises. This web platform

provides explanations, photos and videos and is

available any time by therapists who can access

patient data and send also further information.

4.2 Motivators and Barriers to the Use

of e-Health Solutions

Despite poor knowledge on suitable e-Health

solutions for older adults with cognitive impairment,

health professionals have a favourable perception

about their use. They consider that e-Health solutions

should be part of their "toolbox" to support their

patients. They also point out that e-Health solutions

can promote a safer and more adapted return to home

for older adults with cognitive impairment who have

been hospitalized.

The most cited limitation is the high cost of these

tools, which represents the major obstacle for the

patient. Besides, the ability of patients to use these

technologies was seen as a potential limitation.

According to those health professionals, the more

cognitive health is affected, the more difficult it

would be for them to use these tools. They also

indicate that the earlier e-Health solutions are

introduced into their practice routine, the more

acceptability increases. The lack of information

support for isolated patients is also mentioned as a

limitation. The blind trust in these technologies might

be a disadvantage because the use of monitors

equipped with a camera could lead to spacing out

visits by relatives or friends. Despite these limits,

health and social care professionals are in favour of

recommending and using e-Health solutions and

consider the idea of training as a need.

5 DISCUSSION

e-Health solutions offer access to health information

and could contribute to empower, engage, and

educate older adults (Hall et al., 2012). They can also

allow them to receive timely health and social care in

their homes, which diminishes the burden on them

and their informal caregivers. However, little is

known about the effectiveness of these technologies.

A recent systematic review confirms the scarcity of

evidence regarding the effectiveness of e-Health

solutions for older adults with cognitive impairment

(Dequanter et al., 2019). Results from this focus

group confirm health and social care providers’ lack

of knowledge to support older adults with cognitive

impairments and the necessity to have a deep

understanding of patient needs before recommending

the use of e-Health solutions. Thus, a professional

evaluation should be conducted before

recommending these solutions. For participants in

this study, it is essential to analyze the patient’s

situation in order to find a balance between the use of

these technologies and their real needs. To proceed to

this evaluation, professionals suggest four criteria to

take into account: 1) financial resources; 2) user-

friendliness of the e-Health tool, 3) level of support

(social network); 4) benefits of a safer return to home.

The decision of using such technologies should only

be made on a case-by-case basis.

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

174

6 CONCLUSION

Health professionals agree on the fact that they lack

information to support adequately older adults with

cognitive impairment in their use of e-Health

solutions. The lack of accessible training and service

in their language by e-Health companies are the

biggest challenges encountered by health and social

care providers. In addition, a greater flexibility in

their work schedule could help them to get more

familiarised with e-Health technologies. They

unquestionably recognise the value of such

technologies for elderly patients, and are willing to

recommend them, but not without an evaluation of the

patient financial and social conditions, needs and

suitable solutions for their situation. Future research

is needed on how to properly train and support

professional care providers in order to facilitate the

use of e-Health solutions for elderly patients.

ACKNOWLEDGEMENT

This work was made possible through funding from

the Fonds de Recherche du Québec (FRQ, Canada)

and Fonds Wetenschappelijk Onderzoek (FWO,

Belgium). The authors declare no conflicts of interest.

REFERENCES

Abbasgholizadeh Rahimi, S., Menear, M., Robitaille, H., &

Légaré, F. (2017). Are mobile health applications

useful for supporting shared decision making in

diagnostic and treatment decisions? Global health

action, 10(sup3), 1332259.

Alzheimer Society of Canada. Guidelines for Care: Person-

centred care of people with dementia living in care

homes, 2011. http://www.alzheimer.ca/~/media/Files/

national/Culture-change/culture_change_framework_

e.pdf

Alzheimer Society of Canada. Mild Cognitive Impairment,

2014. http://alzheimer.ca/sites/default/files/Files/

national/Other-dementias/other_dementias_MCI_e.pdf

Chambers LW, Bancej, C., & McDowell, I. (2016).

Prevalence and monetary costs of dementia in Canada.

In: Canada ASo, ed. Toronto, 2016.

Dequanter, S.; Gagnon, M.; Ndiaye, M.; Dion, J.; Gorus,

E.; Bourbonnais, A.; Giguère, A.; Rahimi, S.; Fobelets,

M. and Buyl, R. (2019). e-Health Solutions for Aging

in Place with Cognitive Impairment: Preliminary

Results of a Systematic Review. In Proceedings of the

5th International Conference on Information and

Communication Technologies for Ageing Well and e-

Health - Volume 1: ICT4AWE, ISBN 978-989-758-

368-1, pages 267-273. DOI: 10.5220/

0007746402670273.

Hall, A. K., Stellefson, M. & Bernhardt, J. M. (2012).

Healthy Aging 2.0: The Potential of New Media and

Technology. Preventing Chronic Disease, 9.

Hattink, B. J. J., Meiland, F. J. M., Overmars-Marx, T., de

Boer, M., Ebben, P. W. G., van Blanken, M., ... & v/d

Leeuw, J. (2016). The electronic, personalizable

Rosetta system for dementia care: exploring the user-

friendliness, usefulness and impact. Disability and

Rehabilitation: Assistive Technology, 11(1), 61-71.

Illario, M., Vollenbroek-Hutten, M., Molloy, D. W.,

Menditto, E., Iaccarino, G. & Eklund, P. (2015). Active

and Healthy Ageing and Independent Living. J Aging

Res, 2015, 542183.

Institute of Medicine (US) Committee on the Future Health

Care Workforce for Older Americans. (2008).

Retooling for an Aging America: Building the Health

Care Workforce. Washington (DC): National

Academies Press (US); https://www.ncbi.nlm.

nih.gov/books/NBK215403/

Jin, K., Simpkins, J. W., Ji, X., Leis, M. & Stambler, I.

(2015). The Critical Need to Promote Research of

Aging and Aging-related Diseases to Improve Health

and Longevity of the Elderly Population. Aging Dis, 6,

1-5.

Lindbergh, C. A., Dishman, R. K., & Miller, L. S. (2016).

Functional disability in mild cognitive impairment: a

systematic review and meta-analysis. Neuropsychology

Review, 26(2), 129-159.

Lou, Q., et al., (2015). Comprehensive analysis of patient

and caregiver predictors for caregiver burden, anxiety

and depression in Alzheimer's disease. J Clin Nurs,

24(17-18): p. 2668-78.

Ministère de la Santé et des Services Sociaux. (2016)

Alzheimer et autres troubles neurocognitifs majeurs.

Orientations ministérielles. http://www.msss.gouv.

qc.ca/professionnels/maladies-chroniques/alzheimer-

et-autres-troubles-neurocognitifs-majeurs/

Teles S, Bertel D, Kofler AC, Ruschler SH, Paul C. A

Multi-perspective View on AAL atakeholders’ Needs:

A User-centred requirement analysis for the active

advice European Project. ICT4AWE Conference, Porto

(Portugal), April 28-29 2017.

World Health Organization. (2017). World population

Ageing: Highlights. Retrieved from https://

www.un.org/en/development/desa/population/publicat

ions/pdf/ageing/WPA2017_Highlights.pdf

Suitable e-Health Solutions for Older Adults with Dementia or Mild Cognitive Impairment: Perceptions of Health and Social Care Providers

in Quebec City

175