Melissa Andison, @mjandison
We are no strangers to the well-rehearsed issues of the ageing population and the alarming statistics of conditions that effect cognition such as Dementia and Alzheimer’s disease. Healthcare services are touched daily by the desperate need to increase diagnosis rates and ensure better care for older people with cognitive disorders. General population trends are telling us that the adoption of mobile technology is ever increasing. As I have previously shared in my last blog, mobile devices have the potential to disrupt the landscape of community healthcare. However, many older adults are yet to experience the benefits of such innovation in their care.
The Community Rehabilitation Service I work with conducted a mobile working pilot. The ability to provide healthcare anywhere, irrespective of time and place was our goal for the mobile working initiative. The clinicians were provided with tablets that had 4G sim cards and an application that integrated with the patient electronic record. For the pilot a range of electronic multidisciplinary forms were built that allowed the clinicians to carry out assessments using a tablet. The forms included a cognitive screening tool which covered the domains of attention and concentration, executive functions, memory, calculations and orientation.
I wish to share some example scenarios of introducing a mobile device into the practice of cognitive assessment and stimulation for older adults.
Mobile assessment of cognition to guide therapy
A client of 77 years is referred for rehab’ after surgery on his fractured hip. The client mentions he is becoming more forgetful and you noticed that he is struggling to carry over techniques from one session to the next. You suggest assessing the client’s cognition using a mobile device. He agrees. The client has had little exposure to technology in his working life so you explain what the tablet is and how the stylus pen works on the screen. The client completes the cognitive assessment tasks on the tablet. The assessment helps to identify the client’s cognitive strengths and weaknesses and to restructure future therapy sessions to match his cognitive needs.
Mobile assessment of cognition to guide support and referral options
A client of 79 years is referred from A&E due to having many falls. He shares with you that he is not managing his busy outpatient appointment schedule and he is worried that he has often forgets where he leaves his wallet. This results in missing crucial medical appointments and having to cancel his bank cards. The client agrees to participate in the mobile cognitive assessment. The client is able to experience a rapid assessment of his cognition and receive results at the point of expressing his concerns. You are able to have a prompt discussion of the support options based on his assessment results. You are also able to refer the client to the specialty memory service in a timely manner.
Mobile assessment of cognition and stimulation
A client of 83 years returns home after a long hospital admission. She reports forgetting a newly learned skill of how to access her emails. The mobile cognitive assessment identified impairment with concentration and short term memory. You carry out a 6 week programme using a variety of cognitive stimulating apps on a tablet. You observe improvements in the client’s functional performance. She is now independent with accessing her emails to read and send. The client demonstrates increased concentration during sessions, improvement in app scores that record working memory and an overall sense of cognitive confidence.
As frontline clinicians, I believe we can play a big role in raising the awareness of the benefits of mobile technology and ensure our older clients are not digitally excluded. Sustaining independence as we age is highly dependent on good cognitive health. It is my prediction that mobile technologies will facilitate much needed rapid diagnosis of cognitive impairment and in turn contribute to more personalised healthcare. Finally, I hope that by sharing some mobile working scenarios I can help to dispel the myth that age is a barrier to the use of mobile technology in community healthcare practice.
Melissa Andison is Director OTTech Healthcare Consultancy / Transformation Clinical Lead at Central London Community Healthcare NHS Trust / Occupational Therapist / Mobile Working Advocate