An overview of reviews on telemedicine and telehealth in dementia care : mixed methods synthesis

Abstract

Background: Population aging has intensified the global burden of dementia, creating significant challenges for patients, caregivers, and health care systems. While traditional in-person dementia care faces barriers, digital health technologies offer promising solutions to enhance accessibility, efficiency, and patient-centered care. However, evidence on applicability, safety, and effectiveness in dementia care remains fragmented, underscoring systematic evaluation.

Objective: This study aims to assess the effectiveness, applicability, safety, and cost-efficiency of telemedicine technologies in dementia care, providing a comprehensive summary of evidence spanning clinical, psychological, socioeconomic, and operational impacts for persons living with dementia and their caregivers and assess alignment with the World Health Organization (WHO) Age-friendly Cities and Communities’ Framework and Dementia Inclusive Society Framework.

Methods: An overview of systematic and scoping reviews was conducted following a search in 5 databases (MEDLINE, Embase, Scopus, Epistemonikos, and Cochrane Database of Systematic Reviews), with a gray literature search on February 20, 2024. Eligible studies reported predefined outcomes related to telemedicine interventions for integrated dementia care, including effects on mental health, quality of life, physical activity, hospitalization, financial costs, safety, social isolation, and motor function. Screening and data extraction were performed by 10 reviewers. The findings were synthesized using the Thematic Analysis in Meta-Evidence (TAME) methodology, combining thematic and lexical analyses with single-proportion meta-analysis for comprehensive qualitative-quantitative synthesis. The methodological quality was assessed using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews), with GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) for outcomes’ confidence in evidence.

Results: Ninety-one reviews provided evidence on the impact of telemedicine in dementia care. The most frequently reported outcomes were the effects of remote interventions on psychiatric and psychological well-being, particularly depression and anxiety (relative frequency of occurrence [RFO]=65%, 95% CI 54-75, moderate certainty of evidence). Fifty-seven studies highlighted the positive impact of telemedicine and telehealth on satisfaction and quality of life for persons living with dementia, caregivers, and health care providers (RFO=63%, 95% CI 52-73, moderate certainty of evidence). Remote technology- related interventions for reducing falls and managing behavioral symptoms were also frequently reported (RFO=33% 95% CI 23-44], moderate certainty of evidence). These interventions showed effectiveness in alleviating social isolation and loneliness (RFO=31%, 95% CI 22-41, moderate certainty of evidence). The methodological quality of the included reviews varied significantly, with the majority rated as low or critically low quality.

Conclusions: Telemedicine and telehealth have been demonstrated to be effective and valuable tools in dementia care, offering significant benefits across psychological well-being, quality of life, and social impacts for persons living with dementia and their caregivers. This supports the adoption and implementation of telemedicine in dementia care, aligning with the strategies outlined in the United Nations Decade of Healthy Ageing (2021‐2030).