key: cord-1004522-yey3jd0o
authors: Dai, Ruizhi; Spector, Aimee; Wong, Gloria
title: e‐Mental health care for people living with dementia: A lesson on digital equality from COVID‐19
date: 2020-10-09
journal: Alzheimers Dement (Amst)
DOI: 10.1002/dad2.12100
sha: 2f5c9a3edd57a647af289c96ae1d6016ffbf7b4e
doc_id: 1004522
cord_uid: yey3jd0o

nan

damage to their mental health.

This happens against a background in which otherwise healthy people manage to maintain some normality in everyday life, protected from being completely socially isolated, and being able to access non-urgent services thanks to information communication technology (ICT): virtual meetings, live chats, online learning are flourishing. In theory, the application of ICT to support "non-urgent" care is feasible; for example, initial evidence on the feasibility of videoconferencing for diagnostic interviewing in dementia can be dated back to 2007. 5 Development in e-mental health for dementia has not seen much progress, however, until the recent wake-up call from the dire situation of COVID-19, which forces us to rethink the possibilities of best practice. Recently, we have seen dementia service providers exploring remote services via videoconferencing methods or telephone calls. 4 The pandemic could be the turning point for e-services in health care, 6 catalyzing implementation of e-mental health services, which may prove to be a longerterm solution beyond the current crisis. There remain challenges with e-mental health in dementia care.

Using CST as an example, adaptations and fine-tuning without losing the "active ingredient" when migrating the intervention online are needed, and the online version should be subject to the same validation and evaluation process as with any evidence-based practice development. From an implementation science point of view, broader feasibility and acceptability testing is needed, for example, to address the root causes of digital inequalities (lower mental capacity, IT literacy, affordability, access to stable networks). These barriers in implementation are not insurmountable, for example, through equipment support and capacity building. Even in low-income, low-education settings, largescale implementation of technology-enriched dementia services such as tablet-based cognitive screening has proven feasible. 8 We should take the opportunity to consolidate these experiences to advance dementia care using ICT.

The COVID-19 pandemic will likely be a long-lasting challenge, as will the increase in the number of PLwD worldwide. We need an evidence-based approach to deliver remote services for dementia to better prepare for future crises. Even before the pandemic, service access has been a problem, with regular face-to-face service not always readily accessible due to mobility and logistic challenges (e.g.,transportation, language) and staffing shortages. A remote service could break geographic barriers, bridging people from different places and backgrounds, reducing transportation time and costs, and enabling access to those with mobility and health problems which prevent attendance to groups.

A key lesson from the COVID-19 pandemic is the "slow burn of injustice," 9 with avoidable inequalities such as access to ICT and the e-services it enables. Such technology has been around for decades: the "father of fiber optics," Charles Kao, was himself diagnosed with Alzheimer's disease and had been advocating for Alzheimer's Dement. 2020;12:e12100.

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How to cite this article: Dai R, Spector A, Wong G. e-Mental health care for people living with dementia: A lesson on digital equality from COVID-19. Alzheimer's Dement