JMIR Publications

ABSTRACT

Objective:

To collate data and critically assess data on the effectiveness, applicability, safety, and cost-efficiency of telemedicine and telehealth technologies in dementia care, providing a comprehensive summary of evidence spanning clinical, psychological, socio-economic, and operational impacts for both persons living with dementia and their caregivers. Design: Overview of systematic and scoping reviews. Data Sources: Five primary databases were searched for eligible reviews (MEDLINE®, Embase®, Scopus, Epistemonikos, and Cochrane Database of Systematic Reviews), along with a supplementary search of Google Scholar for Grey Literature. Utilized searches were performed by a senior information librarian affiliated to the Cochrane Collaboration on February 20, 2024. Eligibility Criteria for Selecting Studies: The review included both Cochrane and non-Cochrane systematic reviews, as well as scoping reviews. To be eligible, studies were required to report pre-defined outcomes related to telemedicine and telehealth interventions aimed at providing integrated care for individuals living with neurogenerative disorders or dementia diseases, including Alzheimer’s disease, vascular dementia, Lewy body dementias, and frontotemporal dementias. The primary outcomes of eligible reviews assess the effects of specific interventions on mental health (i.e., psychiatric and psychological), quality of life, physical activity, hospitalization rates, financial costs, safety, social isolation, and motor function progression. Secondary outcomes evaluate how well the findings and concepts in the reviews align with the principles of the WHO Age-friendly Cities and Communities Framework and Dementia-Inclusive Societies Framework as reflected in their reporting. Data Extraction and Synthesis: Key characteristics of each review, including identifiers, journal and year of publication, and reported outcomes, as well as data on primary and secondary outcomes, were independently extracted by nine reviewers. The findings were synthesized using the TAME methodology, which combines thematic and lexical analyses with single-proportion meta-analysis to enhance understanding and visualization of both qualitative and quantitative data, enabling a comprehensive mixed-methods synthesis. The methodological quality of systematic reviews was assessed using the AMSTAR-2 framework, while the confidence in evidence for primary outcomes was appraised using the GRADE-CERQual approach.

Results:

Ninety-one reviews met inclusion criteria, providing a diverse range of 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 the reduction of depression and anxiety in people living with dementia and a decrease in caregiver burden (Relative Frequency of Occurrence [RFO]: 65% [95% CI 54% to 75%], moderate certainty of evidence). Furthermore, 57 studies highlighted the positive impact of telemedicine and telehealth on satisfaction and quality of life for (older) people living with dementia, caregivers, and healthcare providers (RFO: 63% [95% CI 52% to 73%], moderate certainty of evidence). Remote technology-related interventions for reduction of falls and managing behavioral symptoms were also frequently reported among the included (RFO: 33% [95% CI 23% to 44%], moderate certainty of evidence). These interventions additionally showed promising effectiveness in alleviating social isolation and feelings of loneliness (RFO: 31% [95% CI 22% to 41%], moderate certainty of evidence). However, the methodological quality of the included systematic reviews varied significantly, with the majority rated as low or critically-low quality due to methodological limitations.

Conclusions:

Telemedicine and telehealth have demonstrated to be effective and valuable tools in dementia care, offering significant benefits across psychological well-being, quality of life, and social impacts for both (older) people living with dementia patients and caregivers. However, the variability and heterogeneity in quality and reporting highlights the urgent need for more rigorous, and high-quality research in this area. This overview contributes to the existing body of literature by providing methodologically robust evidence, offering practical insights for clinicians, researchers, policymakers, and caregivers. It 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). Funding: None to declare. Review Registration: PROSPERO CRD42024511241