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Promoting Technology and Virtual Visits to Improve Older Adult Mental Health in the Face of COVID-19

  • Christine E. Gould
    Correspondence
    Send correspondence and reprint requests to Christine E. Gould, Ph.D., ABPP-Gero, VA Palo Alto Healthcare System, Geriatric Research, Education, and Clinical Center, 3801 Miranda Ave, Palo Alto, CA 94304.
    Affiliations
    Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA

    Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
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  • Nathan C. Hantke
    Affiliations
    Department of Neurology, Oregon Health and Science University, Portland, OR

    Department of Mental Health and Clinical Neuroscience Division, Veteran Affairs Portland Health Care System, Portland, OR
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      Prior to COVID-19, technology-delivered mental health services were a novel, innovative approach poised to potentially increase access to care among older adults. Now, these services are imperative in nearly all care. These services must be offered to older adults, who are especially vulnerable to COVID-19, loneliness, social isolation, and subsequent depression. Services include video telehealth, which has a robust evidence base including among older adults.
      • Gentry MT
      • Lapid MI
      • Rummans TA
      Geriatric telepsychiatry: systematic review and policy considerations.
      Internet interventions and mobile app interventions utilize a more automated approach than telehealth. In these interventions, the user views and interacts with preloaded content such as mindfulness practices, prompts to engage in behavior activation, guided imagery, and psychoeducation. Internet-delivered cognitive behavioral therapy produces large reductions in anxiety and depression among older adults.
      • Titov N
      • Fogliati VJ
      • Staples LG
      • et al.
      Treating anxiety and depression in older adults: randomised controlled trial comparing guided v. self-guided internet-delivered cognitive-behavioural therapy.
      Apps are rarely tested with older adult samples, but apps hold promise if evidence-informed, such as the new COVID Coach app from the U.S. Department of Veterans Affairs that contains mental health self-management tools to use during the present pandemic.
      The majority of older adults do own a device and go online; unfortunately, device ownership does not translate to knowledge and comfort with devices.
      • Fang ML
      • Canham SL
      • Battersby L
      • et al.
      Exploring privilege in the digital divide: implications for theory, policy, and Practice.
      Use of these devices presumes understanding of various symbols, gestures, and jargon. To accommodate sensory impairment accompanying aging, older users may need to increase the font size, change the boldness of the font, and make other adjustments to the device settings. Furthermore, many older adults are less aware of available mental health apps. A multipronged approach is needed to address these barriers, as described in Table 1.
      TABLE 1Proposed Clinician Guidelines to Facilitate Technology Use in Older Adults
      GoalsProposed Approach
      Increase access to technologyReduced cost or free home broadband or mobile devices with data plans are essential to improving access. Locate local programs that facilitate technology access for low-income individuals.
      Promote technology literacyTo ascertain, ask patients questions such as: Do you have a smartphone? Do you have Wi-Fi at home? Have you downloaded an app? Do you use FaceTime [or other video chat apps]? When needed, provide education materials to teach mobile device basics.

      Stay Connected During COVID-19 [VA Geriatrics and Extended Care Web Site]. 2020. Available at:https://www.va.gov/GERIATRICS/docs/Mobile_Device_Info_Apple.pdf and https://www.va.gov/GERIATRICS/docs/Mobile_Device_Info_Android.pdf. Accessed April 24, 2020

      Increase patient buy-inPromote technology use to cope with social isolation, stay active, and manage anxiety. When offering information, explain why the app, video conferencing tool, or other technology is useful.
      Be familiar with the toolsTake the time to get to know the recommended tool before suggesting it. The recommendation should encompass both the usefulness of the tool and its usability, which comprise two critical aspects underlying technology adoption.
      • Davis FD
      Perceived usefulness, perceived ease of use, and user acceptance of information technology.
      Technology holds the potential to connect us, yet numerous barriers threaten to leave certain groups out of this age of connectivity. Many older adults need more knowledge, education, and support to use these resources. Clinicians can help span these gaps by asking questions, providing assistance, and teaching about free, evidence-informed interventions that may be used to manage mental health symptoms on one's own or with guidance. COVID-19 highlights that technology access and literacy are unexpected and crucial aspects of disaster preparedness.

      Author Contribution

      Dr. Gould and Dr. Hantke both significantly contributed to this submission.

      Disclosure

      Views expressed in this article are those of the authors and not necessarily those of the Department of Veterans Affairs or the Federal Government.
      Dr. Gould received research support from Meru Health, Inc, for an investigator-initiated trial. Dr. Hantke reported no financial relationship with commercial interests.

      References

        • Gentry MT
        • Lapid MI
        • Rummans TA
        Geriatric telepsychiatry: systematic review and policy considerations.
        Am J Geriatr Psychiatry. 2019; 27: 109-127
        • Titov N
        • Fogliati VJ
        • Staples LG
        • et al.
        Treating anxiety and depression in older adults: randomised controlled trial comparing guided v. self-guided internet-delivered cognitive-behavioural therapy.
        BJPsych Open. 2016; 2: 50-58
        • Fang ML
        • Canham SL
        • Battersby L
        • et al.
        Exploring privilege in the digital divide: implications for theory, policy, and Practice.
        Gerontologist. 2019; 59: e1-15
      1. Stay Connected During COVID-19 [VA Geriatrics and Extended Care Web Site]. 2020. Available at:https://www.va.gov/GERIATRICS/docs/Mobile_Device_Info_Apple.pdf and https://www.va.gov/GERIATRICS/docs/Mobile_Device_Info_Android.pdf. Accessed April 24, 2020

        • Davis FD
        Perceived usefulness, perceived ease of use, and user acceptance of information technology.
        MIS Q. 1989; 13: 319-340