Technology has a significant role to play in improving dementia care, especially in reaching out to isolated communities. But it cannot be seen as a “solution in a box”. Ahead of discussing his experiences of remote care in India and in Scotland when he speaks at next month’s conference, consultant psychiatrist Dr Sridhar Vaitheswaran took some time out of another busy day to speak to INSIGHTS.
Your experiences of dementia care in India will have particular relevance to your UK audience, Sridhar, as you worked in Scotland for a few years?
That’s right. I was involved in psychiatric services provision with NHS Grampian as a consultant for five years and was particularly involved in providing remote dementia services support in the Shetland Islands. If my later experience in India can prove useful to the conference that will represent an appropriate closing of the circle for me. Just because what I learned in Scotland has certainly been helpful in the work I am doing now with my team in Chennai.
What were you doing in the Shetlands?
We had a plan of action from the outset but learned many valuable lessons as we went along. Our objective was to improve accessibility to patients and caregivers who were living in remote places. They had some prior experience of the sort of videoconferencing facilities we believed would work; but we had no experience at first of the sort of training that would be required to get the most out of the technology in dementia care. But all this evolved over time. Having an experienced and excellent nurse on board proved to be extremely useful.
What was it that made the difference as you developed improved dementia care? What was it that you learned as you went along?
It was a combining of technology and training that made it work. In my experience – whatever the health challenge, wherever that challenge occurs – the measured combination of technology applied to a particular purpose, with people specifically trained in getting the most out of that technology: that is really wonderful when it works. In Chennai now our range of technologies is expanding into what can be achieved with smartphone apps on mobile phones, but the constant factor is that alliance of technology with adequate training of the people who use it.
There must be limits to what can be achieved, even with good training, in terms of costs and distances? In reaching out into remote places, do budget constraints matter? And are some remote places just too remote?
It also helps if the implementation of any technology is done with a clear view of what the objectives are, against the realistic costs of investing in doing the job properly, to make that technology work. In these days of pressures on health budgets everywhere, that was an important early lesson. We have to focus on optimising outcomes by getting that balance right between what we want to achieve, the technology that will help us achieve it, and the best training for the people who need to get the most out of that technology.
And how important is the question of distances?
Now that is interesting. There’s probably not one answer to that question. In Scotland we found that a radius defined by two hours’ travelling time was optimal. Much less than that and people find it easier just to come into wherever the centre of care may be. Much more than that and it becomes hard to support the notion of local provision, an identity that remains local enough that it does not slip into being a service that could be coming from anywhere.
How does the Grampian experience translate to Chennai?
That is distance defined more by time-to-get-there than by distance travelled. Chennai may be India’s fourth biggest city but it is as big as London and we serve an area of 600 square kilometres. And what we learned in NHS Grampian – largely, I might add, in working with June Andrews and her Dementia Services Development Centre – has certainly come in useful in extending our services into Chennai district.
And what is it that you are doing with mobile technologies in Chennai? You mentioned a smartphone app?
Yes, we are excited at the potential in this. How far we take this will depend upon the level of funding support we get, but we are looking at a combination of SMS – text prompts – with voice messaging, for reminders relating to various activities, taking medicines, and hydration alerts . . .
All being rolled out with a close dedication to training . . .?
Absolutely. Our focus for now is on healthcare providers and the thousands of semi-skilled training assistants, but we will be expanding soon into family caregivers who assume such a high proportion of the responsibility for caring for people with dementia. Our training there will also be for them and their own needs in addition to their needs in caring for others.
Our two INSIGHTS interviews before this one, with June Andrews in Scotland and with Tara Cortes in the USA, have revealed a sobering similarity in those two countries regarding general levels of dementia awareness and the extent to which dementia training is on the curriculum at medical schools and in nurse training colleges. Would you say India is better off, or on a par in these regards?
Sadly, I would have to say that the push for better academic training in dementia care does not yet find us pushing at a well-greased open door. That’s not to say that things aren’t getting better, but that is largely through the inspirational work of centres of academic excellence such as the DSDC at the University of Stirling in the UK, a significant but small group of organisations such as the Infosys Foundation and SCARF in India, and the sort of sharing of best practice that we see at a growing number of specialist conferences such as we’ll see next month in Birmingham.
We look forward to seeing you there, Sridhar. Thank you for your time.
Alzheimer’s Insights is an online newsletter created for consumers -- primarily patients and carers -- who live with the challenge of Alzheimer’s disease. Based upon intelligent search algorithms that scour the Internet for the most read, relevant and useful stories from around the world, it is curated and published each Tuesday by a team of health and publishing experts. You can subscribe for future weekly newsletters here.