Telehealth use spikes with dementia patients during pandemic

Telehealth use soared for people with dementia following the onset of the COVID-19 pandemic, with the most significant increases observed among those with longer drives to a clinic and the oldest patients, according to recent research published in the Journal of General Internal Medicine.

The study by the Kaiser Permanente Division of Research (DOR) and the University of California, San Francisco (UCSF) examined telehealth utilization among dementia patients in the primary care setting. Dementia is the loss of cognitive functioning to the point where a person's daily life is disrupted. According to a 2022 study, almost 10% of U.S. adults ages 65 and older have dementia. Dementia patients are more likely to be older, Black or Hispanic and have lower levels of education.

For the study, the research team examined data on dementia patients receiving care at UCSF and Kaiser Permanente, Northern California (KPNC) in person or via telehealth. The patients had at least one primary care encounter in the pre-COVID period (from March 1, 2019, to Feb. 29, 2020) or post-COVID period (from March 1, 2021, to Feb. 28, 2022).

The researchers observed large increases in telehealth use among dementia patients in the post-COVID period at both the KPNC and UCSF sites.

An analysis of data for 419 UCSF patients showed that the proportion of patients receiving in-person dementia care reduced from 98.99% in the pre-COVID period to 35.08% in the post-COVID period. Meanwhile, the proportion of dementia patients receiving only telehealth-based care grew from 0.34% to 20.05% between the two periods.

Similarly, an analysis of 18,037 KPNC patients revealed that the proportion of patients receiving dementia care in person dropped from 60.47% in the pre-COVID period to 26.95% in the post-COVID period. Concurrently, the proportion of patients receiving care through telehealth alone jumped from 5.45% to 28.97%.

Further, researchers found that greater driving distance between a patient's home and the clinic was significantly associated with higher odds of selecting telehealth over in-person visits. At UCSF, those who lived five or more miles from the clinic used telehealth for 52.69% of visits compared to those with shorter driving distances, who used telehealth for 42.82% of visits. At KPNC, patients living more than five miles from the clinic turned to telehealth for 58.68% of visits versus those who lived closer, who used telehealth for 56.10% of visits.

The study also showed that patients older than 90 were more likely to use telehealth for clinician visits than those younger than 75. At UCSF, 52.41% of visits were conducted via telehealth for those older than 90; at KPNC, that figure was 60.90%.

Location and age were not the only social determinants of health influencing telehealth use among dementia patients. Researchers observed that patients with limited English proficiency were less likely to engage in telehealth visits compared with in-person visits, though the difference in likelihood was modest.

Still, "as additional evidence emerges on the best approach to match modality to clinical need, it will be even more important to ensure equitable access to telemedicine for people with dementia," the researchers wrote.

The study highlights how advanced technology can enhance dementia care. Other examples include artificial intelligence-based digital screening tools for early diagnosis of Alzheimer's disease and other dementias, machine learning tools to predict patient mortality among dementia patients, and smartphone-based tests for frontotemporal lobar degeneration, a rare type of dementia.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.