PICOT template

Directions:
Identify a particular real-world problem in the health care using a PICOT template
provided. Include the particular clinical setting and potential health/disease issue
you will examine. Identify and fully describe the research that has taken place
within the last 5 years.
Write a 1100 words documents that address the following base on the instruction above.
Your case report must include the following:

  1. Introduction with a problem statement.
  2. Brief synthesized review.
  3. Description of the case/situation/conditions.
  4. Proposed solutions describing the validity and reliability of the research you have read.
  5. Conclusion.

Case Report

Introduction
The elderly population is increasing in the United States of America. Currently, the USA
population is composed of 15 % of individuals aged above 65 years. The elderly population is
expected to rise by 50% by the year 2035. The prevalence of cognitive impairment is 28%
among the aged patients receiving home-based care. The care for the elderly requires a specific

CASE REPORT 2

type of services tailored for the aged. Therefore, the care for the elderly presents an additional
economic burden to the healthcare system. The use of technology is widely applied in all health
care settings. The aim of implementing technology in health is to reduce the cost of care, to
improve the patient’s health outcome and safety — the elderly present with cognitive conditions
such as the Alzheimer’s disease, memory loss, delirium, and Parkinson Disease (Wu et al.,
2018). The impact of technology in health has been reported in several studies. The studies have
focused on various long-term conditions including hypertension and diabetes. Studies have
generally described an increase in patients’ outcomes and reduction in the cost of home care.
Cognitive impairment presents with reduced activities of daily living, and thus, self-care. One of
the aims of home-based care is to foster patient self-management (Shea et al., 2013). While
literature sources document various benefits of healthcare technology in home care in general,
the impact of healthcare on aged patients with cognitive impairment is not known. The purpose
of this descriptive project is to investigate the relationships between health technology and
patients’ self-care among patients aged 65 years and above diagnosed with cognitive impairment
and receiving home care. Healthcare technology application will be measured through the
number of healthcare technology applications used while patient outcomes will describe by the
level of self-care. 
Synthesized Review
Johnston, Weeler, Deuser, & Sousa, (2015) evaluated the effectiveness of video
conferencing to homecare patients receiving care against hypertension. According to the results
of the study, remote video conferencing involves the ability of the patients to provide self-care.
The long-term impacts of remote video conferencing were evaluated. Video conferencing was
found to reduce the total costs of offering healthcare services to patients within the homecare

CASE REPORT 3

setting. The study does not report on the impact of the technology on self-care among the aged
populations.
Similarly, Shea et al. (2013) investigated the impact of telemedicine among diabetic
patients aged 65 years and above. The study focused on a patient’s ability to carry out measures
aimed at controlling diabetic symptoms. The study did not report on the impacts of cognitive
impairment on the effectiveness of telemedicine technology.
The application of technology in providing care to the cognitively impaired patients
improves monitoring of symptoms, patient safety and in implementing healthcare interventions
(Darragh et al., 2017). The study evaluated telehealth applications such as video conferencing
and Skype in managing dementia and memory loss. According to the survey, technology
facilitates the process of identifying exacerbating manifestation of symptoms and promotes the
clinician-initiated and guided interventions in a home-based setting. Clinicians can carry out
assessments of patients with cognitive impairment during identification the presenting
symptoms. The interventions are carried out with the support of the caregivers in the home
setting. Clinicians based in the hospital setting are capable of monitoring interventions carried on
aged patients with cognitive impairments. The study, too, does not describe the impact of
telehealth on the ability of cognitively impaired to carry out self-care interventions.
Electronic medical records for home-based care for aged patients with cognitive
impairment facilitate quality of care. Rangraz, Jeddi, Akbari, & Rasoli, (2016) described the
documentation that is carried out for the home-based care for the aged with the memory loss.
According to the findings of the study, clinicians facilitating home-based care utilize the
electronic health records as part of the assessment process. However, according to the study,
aged populations with cognitive impairment were faced with difficulties in understanding

CASE REPORT 4

electronically transmitted information. Patients with cognitive impairment had difficulties in
processing the presented information through telemedicine communication. The study described
the benefits of telemedicine in managing patients with diabetes and memory loss. According to
the study, telemedicine helps patients in reducing the level of glycosylated hemoglobin, blood,
and long-term complications. However, according to the findings of the study, telemedicine does
not improve the ability of the patients to control body weight.
In overall, health care technology improves patient outcomes among the elderly receiving
home-based care. However, literature does not provide evidence of improved ability among the
aged population diagnosed with cognitive impairments to carry out self-care activities.
Description of the Case/Situation/Conditions
Age is associated with a decline in cognitive functioning. The cognitive domains affected
by the aged are; memory, reasoning, and decisions are making. The aged patients diagnosed with
such cognitive impairments receive their healthcare from the home setting. The application of
technology in healthcare is increasing. One of the aims of home-based care and the incorporation
of technologies is to foster self-care. Self-care involves the promotion of the patient’s ability,
skills, and knowledge in providing care to themselves. Self-care involves the ability of the
patients to monitor the symptoms, take medication, and notice instances when systems are
worsening. Cognitive impairment affects the ability of patients to comprehend messages from
healthcare providers and caregivers. Since technology is applied widely in home-based care for
the elderly, there is a need to investigate the impact of cognitive impairment on the effectiveness
of healthcare technology.
Proposed Solutions

CASE REPORT 5

One of the suggested solutions to improved self-care through technology to cognitively
impaired patients is the provision of supportive services. According to the recommendation by
Rangraz et al., (2016), caregivers support enables the cognitive impairment patient to decode
clinicians’ instructions offered through telemedicine. Further, caregiver services should include
responses given to clinicians on behalf of the patients. Modification of the mode of delivering
healthcare services through technology is necessary to increase the effectiveness of telehealth for
the aged populations with cognitive impalements. Wu et al. (2018) and Shea et al. (2013) suggest
that the restructuring of the content and the language used by telehealth services is a means of
increasing the self-care capabilities. According to the research studies, the modification is
suitable to the decision-making capabilities of the aged patients with cognitive impairment.
Conclusion
Increase in aged population, health care technology utilization, and home-based care are
predominating healthcare systems. Health care technology is increasingly applied to home-based
care for the aged who are diagnosed with cognitive impairment. However, literature does not
provide sufficient evidence to inform on the impacts of healthcare technology on self-care. The
PICOT question for this project is: What are the impacts of home-based health information
technology on self-care among patients aged 65 years and above diagnosed with cognitive
impairment compared to patients aged 65 years without cognitive impairment within one year.

References

Darragh, M., Ahn, H. S., MacDonald, B., Liang, A., Peri, K., Kerse, N., & Broadbent, E. (2017).
Homecare Robots to Improve Health and Well-Being in Mild Cognitive Impairment and
Early Stage Dementia: Results From a Scoping Study. Journal of the American Medical
Directors Association, 18(12), 1099-e1.

CASE REPORT 6

Johnston, B., Weeler, L., Deuser, J., & Sousa, K. H. (2015). Outcomes of the Kaiser Permanente
tele-home health research project. Archives of family medicine, 9(1), 40.
Rangraz Jeddi, F., Akbari, H., & Rasoli, S. (2016). Older people home care through electronic
health records: functions, data elements and security needs — contemporary nurse, 52(2-
3), 352-365.
Shea, S., Weinstock, R. S., Teresi, J. A., Palmas, W., Starren, J., Cimino, J. J., … & Izquierdo, R.
E. (2013). A randomized trial comparing telemedicine case management with usual care
in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5-year
results of the IDEATel study. Journal of the American Medical Informatics Association,
16(4), 446-456.
Wu, C., Wu, Z., Yang, L., Zhu, W., Zhang, M., Zhu, Q., … & Pan, Y. (2018). Evaluation of the
clinical outcomes of telehealth for managing diabetes: A PRISMA-compliant meta-
analysis. Medicine, 97(43), e12962.

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