Telehealth for Residential Aged Care Facilities: A Pragmatic Controlled Trial

A comprehensive geriatric assessment will be carried out via videoconferencing. The geriatric consultation is a direct interaction between the resident and the doctor. Generally the facility nurse is also available during the consultation. Residents will be referred for assessment by their GP, or a clinical practice nurse. Assessment data will be collected by the facility nurse and made available for the geriatrician for a single assessment. The assessment data is a modified version of the interRAI Long Term Care Assessment tool. It includes information about geriatric syndromes, function and cognition, medications, and activities of daily living. The facility nurse will also make available to the geriatrician the GP referral letter, any recent pathology results, and facility documentation if there is key health information applicable to the issue under consideration (ie. a behavior chart, if the resident is being assessed for BPSD). The geriatrician will assess the resident via video conference. The geriatrician reads all the documentation provided by the GP and/or the facility nurse. The video conference then includes discussion with the resident and family (if the family is present). The geriatrician will ask questions to prompt responses that illicit additional information that is required. The geriatrician may ask the resident to walk so that gait can be observed. This consultation is very similar to what would happen if a resident went for a private consultation with a geriatrician in an out patient clinic. The duration is usually one hour, but may be more or less depending on the needs of the resident. The resident will undertake on geriatric consultation via video conference. After that, there may be additional consultations in response to the medical needs of the resident (i.e. if the geriatrician recommends a change in medication, it is possible that a review will be scheduled to ensure that change is positive). All consultations are optional for the resident. The intervention will be facility based (available to all residents at the facility who would benefit from a geriatric consultation). Consent for the evaluation of the intervention will be sought from individual residents. The study will continue for 2 years or until the total sample has been recruited (whichever occurs first). 88 residents will be recruited from each site (both new residents and existing residents).