RESNA 27th International Annual Confence
The Feasibility of Using Videophones for Assessing Cognitively Impaired Seniors in Their Homes
The feasibility of using a plain old telephone system (POTS) based videophone for assessing cognitively impaired seniors in their homes was examined. Eight participants with Alzheimer Disease (AD) and their spouse caregivers were recruited through a local Alzheimer's society. Alzheimer participants did the Mini-Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) with an interviewer face-to-face, and with another interviewer via videophone. Caregivers did the Safety Assessment Scale (SAS) and the Global Deterioration Scale (GDS) also in the two conditions. Paired t-tests showed no differences between the scores of the two conditions for both mental status examinations. Caregivers scored their spouses slightly worse for the SAS in the videophone condition. Most participants with AD and their caregivers were satisfied with their ability to use the videophone. They would use it again or recommend for others to use it, but the majority would not purchase or rent one.
Cognitive assessment, videophones, telehealth, homecare, dementia
Time required to visit clients with dementia in their homes is a challenge faced by health professionals. Therefore, interviews, assessments and follow-up are commonly done over the telephone to enhance the effectiveness of home visits. In a study using ISDN videophones we found that palliative home care clients appreciated the videophones because the visual image added a level of comfort and support to the quality of interactions (1). One limitation of the ISDN-based videophones is that installation of the lines into most clients' homes is expensive and inconvenient. An ideal and affordable solution would be an “off the shelf” technology that operates like a regular telephone in client's homes. Such technologies are coming into the market such as the Starview 2000 Videophone which uses the POTS (Plain Old Telephone System) or standard telephone lines (2).
The concept of usability evaluation is applied in industry and assistive technology. Informal methods of evaluating usability can be applied to existing products (3). These methods may include talking with existing users, user questionnaires, observation of existing users, and ‘expert appraisal' of the product (p. 115). To our knowledge, there is no publication to date on the usability, user-satisfaction or feasibility of using POTS based videophones for the purpose of interviewing and assessing older adults with dementia living at home, and their caregivers.
The purpose of this study was to examine the feasibility of using a POTS based videophone for interactions between health professionals and older adults with dementia and their caregivers. Our research questions were (a) was there was a difference between scores obtained from tests done in person versus those done via the videophone; and (b) was the videophone usable according to the clients, caregivers and health professionals?
Starview provided four units of the Starview 2000 VideoTelephone (2) on loan for two weeks. This model uses standard telephone lines and allows the user to make or receive calls to ordinary telephones. Features include on-screen user setup, hands free speaker phone and the screen provides full color, real-time video at 15 frames per second.
Participants were recruited through the Alzheimer Society of Edmonton. Two interviewers (an occupational therapist and a social worker) administered scales to each participant and caregiver face-to-face or via videophone.
The interviewers administered the Mini-Mental State Exam (4) and the Modified Mini-Mental State Exam (5) with the participants with Alzheimer disease. The interviewers used the Global Deterioration Scale (6) and the Safety Assessment Scale (7, 8) with the caregivers. At the end, participants and their caregivers responded to a 12-item questionnaire that was administered face-to-face by one of the interviewers when she picked up the videophone. The questionnaire consisted of 9 questions which required “yes” or “no” responses, and 3 open-ended questions that allowed respondents to provide comments. The interviewers also provided individual “expert-appraisals”.
Paired t-tests were used to compare MMSE, 3MS and SAS scores in the two conditions, and frequency counts were used to describe the responses to the questionnaire.
The time between interviews ranged from 1 to 2.5 days. Five participants were administered the tests face-to-face first, and the other three did their interviews via the videophone first. Both genders were represented equally (50% males), and all caregivers were spouses of the participants. The average participant age was 73.8 years, and ranged from 61 to 83 years. Three of the participants did not complete the mental status exams either face-to-face or via videophone, or both. Paired t-tests based on data of the remainder 5 participants showed that there was no statistically significant difference between the test scores in the two conditions. One caregiver did not complete the GDS and SAS via videophone because a connection could not be made. Based on the results of the other seven caregivers, a paired t-test showed that the differences in SAS scores were statistically significant (p=.048), but the difference was very slight (mean SAS was 19.86 face-to-face, and 20.29 via videophone. The GDS stages ranged from 4 to 6. Despite the short time between interviews, only two of the seven caregivers were consistent in their GDS ratings. It is not known if these differences in caregiver ratings of SAS and GDS were due to the conditions or inter-administrator differences.
In response to the questionnaire statement “I was satisfied with my ability to use the videophone”, 5/7 participants and 6/7 caregivers stated yes. For the statement “I had technical problems”, all 7 participants and 6/7 caregivers agreed. To the statement “I would use the videophone again”, all 6 participants who responded, and 6/7 of the caregivers said yes. When asked to respond to the statements on whether they would purchase or rent a videophone, the majority in both groups said no. The expert appraisals provided detailed insights on the benefits and challenges of the technology.
The results suggested that it was feasible to use a videophone for conducting interviews and cognitive screening tests using a POTS based videophone. The videophone was not designed specifically for home health care, but if the technical challenges identified by users in the study are addressed by manufacturers, then the technology becomes more universally acceptable by the general population. This study only applied the videophone for administration of interviews and brief cognitive screening tests. A future study using a larger sample could examine the reliability of assessment tools administered via videophones, similar to what has been done with some telephone versions of some tests. As well, studies could examine other applications of videophones such as allowing caregivers to communicate with other caregivers, or participate in support groups and information sessions from their homes, when travel is a challenge.
This study was funded by the EFF Support for the Advancement of Scholarship (Small Faculties Research Grant Program) University of Alberta. We thank Starview for providing the videophones, Arlene Huhn for recruiting participants and Alison Douglas for assisting with data collection and entry.
Lili Liu, PhD,
University of Alberta
2-64 Corbett Hall
Edmonton, AB, Canada T6G 2G4
Phone (780) 492-5108