Thursday, March 08, 2012

[Vital Signs Column] TeleGeriatric Nursing: Caring for the elderly the digitized way

Vital Signs, is the FIRST newspaper for the medical community. It caters to doctors, health workers and other healthcare professionals, bringing them the latest health news, scientific updates, as well as opinions, and commentaries on current issues impacting healthcare delivery in the country. You can read Alvin Dakis' columns on nursing & social issues named Nurse's Notes in every Vital Signs newspaper published every 1st & 15th of the month. 

The Philippines is a country where the family bond is so strong where children would grow and have families on their own but still lives with their parents. Did you notice this as well? Where our lolos and lolas would play with their grandchildren, some even spoil them. Regardless of social class, the Filipino family loves their old parents hanging around the house. 

We are currently considered a “young population” where only 6.8% of the entire population belonging to the elderly (NSCB, 2010) but is expecting a rise in numbers in 2050, where the country will be considered as an “ageing population”. It is also in this study that reveals 1 out of 5 households have a senior citizen. In 2010, the regions that have the highest number of elderly belong to NCR, Regions 3 & 4. 

This culture is distinct to the Filipinos but as a nurse, I asked myself if how efficient our elderlies get supplemental care at home. According to the National Statistics Office study in 2005, there are 34.93% elderly people who are also disabled or suffering from disability and there about 5.4% of them living alone. Considering these, my question would somehow be valid.

The Elderly Challenge
Another interesting fact to look into is that the elderly population has a 16.2% poverty incidence and that one elderly will be supported by every 15 working persons. These data are essential in looking into how elderly people access healthcare and how it is related to their living conditions.

The elderly also would need specialist aged care provider like gerontologists or geriatricians and geriatric nurses because there are many elderly persons that are incapable of traveling outside their homes and or need assistance because of their cognitive incapability.

The World Health Organization in 2004 identified barriers to care for older people:

·   Transport to health center or care facilities may be unavailable or too expensive for them or their family members. That is why many of Filipino elderly people tend to stay in their homes and not seek professional medical help;
·  Many elderly wait in long queues in health centers and when it is their time for consultation, the healthcare provider only has a small time left for consultation;
·  They also have difficulty completing required forms because of either a decreased physical or cognitive abilities;
·  Another barrier is that there are overburdened health providers or staff. Overburdened staff would have lesser time to interact with each patient and would tend to give less attention to their needs; and
·  The elderly person may not understand why to take his/her medications, understand its side effects and how to manage adverse effects as well.

Considering the WHO identified barriers, we can say that some of these are present in a household with an elderly person. How can we then monitor their health condition properly when adults go to work, and students to school? Using a simple but new technology may help us ease that problem.

Telehealth – a new promise for health access
Health monitoring & early detection of a disease or disorder can be made using telehealth – bridging healthcare service delivery using digital gadget, software or hardware and any other technological innovation. Telegeriatric is then a technological innovation that a nurse can utilize to assess, diagnose, plan, implement and evaluate interventions for the elderly client.

Telegeriatric nursing is an emerging trend of advance nursing practice in the Philippines. It does not aim to replace traditional doctors or nurses for that matter but this can be a tool to better our services to our elderly clients especially in the underserved areas and where the elderly would not or cannot access the nearest health center. This tool can be used to further make informed decisions.

Recently, I met with Ayala Foundation/ACCESS Health International together with the Zuellig Foundation, Asian Institute of Management and other partners for a possible project Ayala Foundation is eyeing on – a mobile healthcare project for elderly clients. This project will be piloted by volunteer nurses that will monitor elderly persons for six (6) months and develop a business model out of the initiative.

The initial name of the project is SILVERLINC and aims to test the operational, personal and cost effectiveness of telehealth to the elderly population in an urban setting. The SILVERLINC project was conceptualized around 2 years ago but it was last year when the project took off after it has developed its learning platform and software with its partners.

The project is now on its pilot phase and had been meeting its implementing partners. The initial project will run in six months to test if the project can be sustained and if we can create a new business model from it and of course if the community is open to accept this new way of delivering health monitoring & data management.

The Alliance of Young Nurse Leaders & Advocates will be the provider of nurses who shall participate in the project. Young nurses will have the opportunity to expand their nursing roles and might find telegeriatric nursing their niche. AYNLA will seek to send around 30 nurses for this project.

The project will benefit both the community and the health providers. The elderly community will have improved access to healthcare and have better and updated health statuses therefore leading to a quality of life.
For nurses this initiative can help them expand their knowledge base on geriatric care and might open an opportunity for entrepreneurial ventures. The project might give them entrepreneurial & geriatric nursing skills training for free while in the project.

For community health workers, this would entail lesser workload for them at the same time acquire new knowledge and skills.

The project breaks into three (3) implementation strategy:

·  “Face to face” visits – telegeriatric nurses will have to personally visit their clients in their households to conduct health interviews, monitoring, updating and educating. The nurse would have to bring a mobile device, either an iPhone or an Android phone where the software can be used to input data from the client. This data goes into a data management system which then can connect to geriatricians during referrals. During the personal visits, the nurse can also do some nursing interventions to the client.
·  Teleconsultation – is an online consultation that can be done by the visiting nurse to the referred clinician or geriatrician.
·   Telegeriatric Training – all participating nurses would have to undergo a specialized training including a simulation of the software to use for the project.
The project contains a “12 Health Service Packages” of which a nurse can do during his/her duration in the program:

·         Home Safety Monitoring
·         Hypertension
·         Diabetes Care
·         Dermatology & Wound Care
·         Tuberculosis
·         Rehabilitation & Mobility Assistance
·         Hospice & Pain Management
·         Depression among the Elderly
·         COPD
·         Elderly with Dementia
·         Elderly discharged from hospital facility
·         Elderly living alone

These health packages can be made into a business model, which one of the project partners, the Asian Institute of Management, is looking into. AIM sees the possibility that this project can be self sustaining when the business model has made. Nurses venturing into this practice can now set a standard rate for every nursing intervention made.

Challenges Encountered
While this project is innovative in its nature and is indeed promising, the project has encountered stumbling blocks as well. One of the major blocks it is currently facing is the reception of the Local Government Units (LGUs) toward this innovation. The city government of Makati, where the project is supposed to pilot is taking a long time digesting the benefits of the project, knowing for a fact that the city is known for their comprehensive and wide support to their elderly.

Due to its very technical nature, many of the local leaders would find it a bit off their league when talking about the project and therefore would often receive either a raised or meeting eyebrows. Well, it’s not just the reception to the local chief executives that affect how the project run, but also how the nurses perceive this project would be beneficial to them. Many nurses would still opt to work in the hospital, close to the traditional clinical nursing practice.

Only a few, younger, nurses would understand and grasp what the project is envisioning but then we encounter another stumbling block, this time, logistically-related. Our nurses, do not have an iPhone or Android phones for them to download the software and perform their tasks. They are willing to participate as long the Android phones would be given for free. The project handlers plan to partner or solicit support so that each participating nurse would be given an Android phone each. This is one of the major blocks to project needs to hurdle. However, we are encouraged that the project will find its resources prior to the service.

Another concern is how to make the project sustainable? The project stakeholders are then trying to come up with a project funder or partner to help build the system. Once we are done with our pilot six months implementation, we will be able to gather important data from the ground and work for a better implementation.

Opportunities Ahead
Despite the stumbling blocks the project needs to hurdle. I am optimistic that this project will be successful and that this can be made sustainable for advance practice nursing and at the same time can be used as a business model for those who would want to practice independently.

For those nurse who are interested to join the project, with or without an Android phone but is within the metro, you may send an e-mail to for more details on how to participate.

1 comment:

  1. This is a good project. I'm glad that even the plight and situation of the elderly in the Philippines are being minded by people like you.