We faced several challenges in planning and implementation process. Phone calls facilitated history taking, discussion of mood, chronic condition management, medication discussions, dementia management, caregiver support conversations, and discussion of goals of care. Video consults were necessary for dermatologic issues, wound care, and other conditions where visual examination adds crucial information. While less clear than in-person assessments, physical examinations via video were still significant. Video consultation helped visualize living situations and support socially isolated patients and caregivers. However, these consults were more challenging when internet connectivity was poor than a telephone consultation. Virtual visits were challenging for patients with hearing impairment and difficulty staying on topic.

Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities

Education, Health, Information and Communication, Labour, Long-term care

Government, Health Care

Older people were part of the process at multiple or all stages

In response to this evidence, HMC, in collaboration with the Ministry of Public Health and Primary Health Care Corporation (PHCC), has established a comprehensive plan to help protect this vulnerable group of society. The plan includes comprehensive public education and awareness campaigns to inform elderly citizens and their families about adhering to important guidelines for their safety. The pandemic has necessitated a change in how healthcare services are delivered to all people, especially older citizens. It includes limiting face-to-face exposure to reduce the risk of infection spread. The establishment of telemedicine facilities for various specialties has proven very successful. Virtual consultations have been delivered to people over 60, from medical consultations to providing physiotherapy advice. Recognizing the importance for people with chronic conditions to continue taking their medication, the government has supported the program for medication deliveries to people at home. HMC and PHCC pharmacy teams dispensed medication orders to ensure patients had the medicines they needed. We established a telephone outreach service for the elderly has provided another vital channel to connect with older patients more at risk. Staffed by members from the Geriatric and Long-term Care Department, the team proactively calls those aged 60 years and over to offer advice on how to stay safe during this period. We recognize that loneliness from social isolation can sometimes be as difficult to bear as any other illness, especially for vulnerable older people have therefore set up a call center staffed with geriatricians and nurses.

We delivered telemedicine to this vulnerable group and examined the experience of these visits using feedback. The potential impact of this project was to control the spread of COVID-19 and its related mortality in older people. Providers, patients, and caregivers expressed high satisfaction over the time efficiency, travel time saved, and cost savings of virtual visits. The Geriatric Helpline service offered telephone medical consultations to people over 60 years during this COVID-19 pandemic 13,214 calls have been received so far on this helpline by December 31st, 2020. Geriatric Telephone Reassurance Service contacted people over 60 years old over the phone to provide them with information regarding the COVID pandemic and new services to address any health-related concerns. This service reached out to more than 20,000 people. National Alzheimers and Memory services Helpline -RAHA took care of 3000+ Services users in 2020 and reaching over 10000 currently. Geriatric Tele-Pharmacy was launched, offering older adults above seventy years to order home delivery of their medication in the safest, quickest, and easiest way possible. Geriatric-Dermatology virtual clinic is a joint clinical service addressing older adults with dermatological issues provided 329 virtual encounters. Comprehensive public education and awareness campaign took place during the COVID pandemic through regular SMS messages to over 100,000 people, including people over 60 and their carers, regarding the safety precautions to be taken during this COVID-19 pandemic.

It was a highly structured organizational process to transform the existing work culture into a virtual clinic. Leadership support and stakeholder involvement were present throughout, enabling the team to identify the barriers and eliminate those with consistent communication and meetings with the team. We faced several issues in telephone versus video consults for tele-geriatrics care. Phone calls facilitated history taking, discussion of mood, chronic condition management, medication discussions, dementia management, caregiver support conversations, and discussion of goals of care. Video consults were necessary for dermatologic issues, wound care, leg edema, and other conditions where visual examination adds crucial information. While less clear than in-person assessments, physical exams via video were still adequate. Video consults helped visualize living situations and support socially isolated patients and caregivers. Topics covered via telephone could also be covered during video consults, provided the internet connectivity and video quality remained adequate. When internet connectivity was poor, video consultations were more challenging than telephone consultations. Virtual consultations were challenging for patients with hearing impairment, impulsivity issues, or difficulty staying on topic, but similar challenges are present with in-person visits.

1) The COVID-19 pandemic provided the opportunity to deliver telemedicine to this elderly group and examine the experience of these visits using feedback from all involved participants: patients, caregivers, doctors, nurses, and psychologists. 2) Providers, patients, and caregivers expressed a high degree of satisfaction over the time efficiency, travel time saved, and cost savings of virtual visits. The average time savings is very significant for older patients, who often have mobility limitations and may depend on others to accompany them to in-person visits. 3) Multiple patients expressed that although they value in-person visits, they would like the option of continuing some telemedicine appointments after the pandemic.

N/A