Telehealth Psychological Interventions for Rural Caregivers: Improving Care to Persons With Dementia

Abstract Geropsychologists are well-suited to assess dementia, assist caregivers in understand the disease and associated behavioral changes and ways to cope with their loved one’s disease. However, majority of these services are offered during in-person clinic appointments in urban settings. This study aims to describe the utilization and potential benefits of providing dementia education telehealth services to Veterans and their families residing in rural mountain and plain areas of Colorado. Psychological intervention was provided via telehealth from the primary VA hospital to small community clinics or to Veterans homes via video mobile application. The present study provides demographics of participants who elect this service and discusses how these challenge ageism and other biases relate to technology use. Further, we examined how engagement in this intervention may impact utilization of geriatric and extended care services as well as use of primary care, emergency room visits, and use of anti-psychotic medications.

In-person visits can be challenging to schedule and complete, particularly in rural areas where there are few specialists. We describe our experience with using telehealth modalities to hold group dementia visits. For the last four years, we have held telegroup appointments with Veterans with dementia and their caregivers. A geriatric psychiatrist and geriatric social worker appear from the main facility, and the Veterans and caregivers are at remote sites. Participants have actively engaged. They have expressed that the structure allows them to support and be supported by peers, and to have frequent contact with care providers. This has led to improved care metrics. The technology requirements are minimal. We discuss the advantages of this approach, including flexibility and maximizing use of specialist resources. We address challenges to scaling up such programs. Megan Gately, and Lauren Moo, Bedford VA Medical Center, Bedford, Massachusetts, United States Home Video Telehealth offers a unique opportunity to support already burdened caregivers of persons with dementia. Veterans Health Administration, through the MISSION Act, is increasingly using video telehealth to provide "care at the right time and in the right place." Little is known about the benefits and challenges of using video telehealth for in-home caregiver support. We present findings from our seven years offering in-home dementia management to caregivers of Veterans with dementia, that includes supporting caregivers through supportive listening, tips for communication and safety strategies, and recommendations regarding nonpharmacologic management of behaviors. Perceived benefits of in-home video telehealth include an 'in vivo' perspective of the family's natural context and remediating barriers to care such as decreased mobility. Perceived challenges include dealing with technology and privacy concerns. By describing considerations for in-home video telehealth to a clinical population with unique care needs, we inform broader application of a promising technology. The TeleDementia Clinic is an interdisciplinary longitudinal telehealth dementia clinic providing care to rural Veterans in Western Pennsylvania with cognitive decline. The TeleDementia Caregiver Support group uses telehealth to provide caregiver support and education to those caregivers with the highest levels of caregiver burden in this population. The support group has caregivers participating in the session at different rural clinics while a multidisciplinary team of professional (geropsychologist, geriatrician, nurse practitioner and others) are located at an urban VA medical center. All can interact via video telehealth connection. Each session provides a short educational session on caregiving topics that then provides a springboard for caregiver discussion about their own experiences. The multidisciplinary clinician team lend their expertise to the education and support of caregivers. Both quantitative and qualitative analysis of effectiveness of this model will be discussed.

ACHIEVING HEALTH EQUITY FOR OLDER ADULTS THROUGH STATE-OF-THE-ART INNOVATIONS
Chair: Karen Fortuna Co-Chair: John Batsis Discussant: Daniel Jimenez As health indicators such as life expectancy have improved for many older adults, some older adults experience a disproportionate amount of preventable disease, death, and disability. The causes of health disparities among older GSA 2020 Annual Scientific Meeting Innovation in Aging, 2020, Vol. 4, No. S1 adults are multidimensional in that disparities are due to multiple, interacting factors such as socioeconomic status, disability status, geographic location, and race/ethnicity. Achieving health equity in late-life requires innovative strategies to address interconnected environmental, sociocultural, behavioral and biological factors that impede opportunities to achieve optimal health and quality of life. This symposium will present state-of-the-art innovations and strategies employed among socially disadvantaged racial, ethnic, and other population groups, and communities. We will discuss innovations in the workforce enhancements with older adult peer support specialists and community health workers, community engagement techniques in program design, and digital solutions aimed at addressing multiple dimensions of health in older adults.

. Rivier University, Hudson, Massachusetts, United States
PeerTECH is a peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by peers. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation will discuss the feasibility and potential effectiveness of using ecological momentary assessments (EMA) with older adults with mental health conditions to allow us to recognize early signs of loneliness and intervene as early as possible in real-world settings. EMA involves repeated sampling of an individual's behaviors and experiences in real time, realworld environments on the smartphone application. Then, we will discuss the main and interactive effects of loneliness and factors linked to mortality. In conclusion, we will discuss potential effectiveness of PeerTECH with older adults with SMI.

TELEHEALTH-DELIVERY OF A MULTICOMPONENT OBESITY INTERVENTION IN OLDER, RURAL ADULTS WITH OBESITY
John Batsis, 1 Curtis Petersen, 1 Rima Al-Nimr, 1 Tyler Gooding, 2 Summer Cook, 3 and Todd Mackenzie, 1 1. Dartmouth College,Lebanon,New Hampshire,United States,2. Dartmouth Hitchcock Medical Center,Lebanon,New Hampshire,United States,3. University of New Hampshire,Durham,New Hampshire,United States Older, rural residents with obesity aged ≥65 years have reduced access to health promotion programs due to geography. We conducted a 26-week intervention of 24 older obese adults (BMI≥30kg/m2) in a geographically isolated area in Northern New England. The telemedicine delivered intervention consisted of individual, weekly, dietitian visits focusing on caloric restriction, and twice-weekly physical therapist-led group strength training classes. Participants' age was 73.4±4.4years (79% female); pre-post assessments consisted of bioelectrical impedance-based body composition, functional measures, and satisfaction questionnaires. Feasibility was high (50% enrolled, 85% completed). Weight decreased 4.5±3.8kg (4.5±0.5%; 48% achieving ≥5%), 30s sit-to-stand improved (+3.8±4.1repetitions), as did 6-minute walk, +76.2±70.1m (all p<0.001). Appendicular mass did not change (+0.20±2.3kg); % body and visceral fat both decreased (-1.8±2.8% [p=0.009], -1.2±2.7L [p=0.025]). Participants endorsed telemedicine (96%); 78% preferred a home-based study. Satisfaction was high (4.2/5) and only 17% faced difficulties. Despite geography, this intervention holds promise in improving physical function. Daniel Jimenez, University of Miami, Coral Gables, Florida, United States Older Latinos living with HIV have been disproportionately affected by the epidemic and experience compounded health disparities that have deepened over time. Eighteen Latinos living with HIV with a mean age of 60.3 years (SD=6.4) were enrolled in the Happy Older Latinos are Active (HOLA), a community health worker-led, multicomponent, health promotion intervention. Participants were assessed at three time points on measures of cardiometabolic risk and psychosocial functioning. We evaluated the feasibility of recruitment, retention, acceptability, and implementation of HOLA. In 4 months, we met our enrollment target with <5% of eligible participants refusing participation. Participants attended over 70% of sessions and 1 participant was lost to follow up. These results indicate that HOLA is an innovative health promotion program that is uniquely tailored to address the multiple concerns that are prevalent in this community (cardiometabolic risk, psychological distress) in a nonstigmatizing and culturally acceptable manner.

DIGITAL TECHNOLOGIES AS A MEANS TO REDUCING MENTAL HEALTH DISPARITIES: THE ROLE OF ETHNICITY, SES, AND GEOGRAPHY Giyeon Kim, Chung-Ang University, Seoul, Republic of Korea
This presentation discusses the importance of using digital technologies on reducing mental health disparities among older adults from diverse backgrounds. This talk primarily focuses on the role of ethnicity, socioeconomic status and geography. First, the speaker presents the current status of digital technology use among older adults and how different levels of digital technology use affect mental health disparities by ethnicity, SES, and place of residence. Second, the speaker introduces a recently funded government project on developing an IoT-based home system (Internet of Things) to screen mild cognitive function for Korean older adults. Lastly, the speaker discusses potential implications, as well as directions for future research on using digital technologies to reduce mental health disparities among diverse populations.