WHEN COVID-19 forced the closure of the Dementia Care Center in Gangdong-gu, South Korea, Gangdong-gu Mayor Lee Jung-hun launched a “remote medical assessment” pilot for dementia patients in the city, combined with visiting nurse services.

This telemedicine service has not only helped to fill the huge gap left by the centre’s closure, but has also helped resolve unequal access to health care in the city, said the World Health Organization (WHO).

Since its launch, the telemedicine service has greatly eased the situation of older people awaiting dementia assessments. In 2020, 227 people received a remote dementia examination and 1,100 people benefited from the visiting nurse services.

A city with a good dementia response track record

Gangdong-gu already had a good reputation nationally for its efforts to prevent and overcome dementia. The Gangdong-Gu Dementia Care Center was opened in 2007 to pre-empt the needs of an ageing population and an associated rise in the number of dementia patients, and in 2019, the district strengthened public-private cooperation to conduct pilot projects for dementia care – this included public guardianship for dementia patients in 2018 and a dementia safe village in 2019. The remote assessment initiative – partly driven by the need for contact-free services because of COVID-19 – is the latest in an impressive list of dementia initiatives.

Remote assessments, helplines, and cognitive stimulation kits: a comprehensive package

To receive the service, patients or carers make an appointment for a nurse to make a home visit to evaluate their primary cognitive functions and conduct an in-depth consultation with the patient. Based on the results of this first home visit, a second visit is made, followed a more detailed remote examination and clinical evaluation by a doctor.

The remote clinical assessments are conducted every Tuesday and Wednesday. Laptops, programmes, and other equipment required for the assessments are provided by the Gangdong-gu Center for Dementia, and since patients are older and generally not used to digital gadgets, staff accompany them during the evaluation to overcome any technical problems.

In addition to the remote assessments, the Gangdong-gu district has expanded the availability of web and phone-based consultation services for vulnerable groups such as senior citizens living alone and the families of dementia patients. It has also made available networks of cognitive health centre visitors and local volunteer residents as part of a community safety net for dementia patients. The district also checks on the health status of target groups and provides COVID-19 prevention education. The district has also minimised the gap in dementia care by providing customised cognitive stimulation kits for patients to use at home, and online dementia classes for residents.

As well as the remote assessments, customised case management was conducted for 261 people living alone and/or on basic incomes. Tailored to the individual, this has included support with daily living, emotional support, assistance with basic health-care needs, nutrition, and housing. And for patients with difficulties resulting from diminished decision-making ability, a public guardianship system for dementia was introduced – an initiative highlighted as best practice by the Korean Ministry of Health and Welfare for outstanding performance in dementia care services.

Building future resilience: expanding the service to non-digital users

To minimise any limitations in using the service as it evolves, one-to-one care and home visit services will be provided in 2021 for those unable to receive the telemedicine service because they cannot use digital technology or do not have Internet access. Outdoor programmes will also be offered to reduce the risk of virus transmission.

“The remote screening is introduced as a model for future examinations to resolve the gap in dementia care, and we will actively support the elders who are at high risk with dementia to overcome this difficult time,” said Gangdong-gu Mayor Jung Hun Lee.

Source: WHO