Virtual Capacity Evaluations May Provide Distinct Safeguards for Geriatric Patients

Virtual capacity evaluations provide a number of protective benefits for elderly patients by revealing potential abuse or neglect and providing access to community resources, according to a recent study in Health Services Research. New findings from Cleveland Clinic show that telehealth assessments may help geriatric patients remain in their homes, connect with local support services, and consult with primary care providers as well — or better — than in-person visits.

The primary goal of virtual capacity evaluations, which are often initiated by adult protective services (APS), gauge an individual’s cognitive status and ability to make medical and financial decisions. However, medical literature offers only limited guidance on how to implement such assessments, and there is little data on the effects of using virtual approach, explains Ronan Factora, MD, a staff physician at the Cleveland Clinic Center for Geriatric Medicine.

“This presents a problem for geriatricians, who are frequently asked to measure the decision-making capacity of individuals at risk for elder abuse,” says Dr. Factora, who led the study. “The benefits of telehealth visits are well established, especially in older patients, but we wanted to understand how these interactions could be used to improve access to social support and transitions to higher levels of care.”

The isolation imposed by the COVID-19 pandemic further highlighted a need to better understand how virtual encounters could be used to reach — and safeguard — particularly vulnerable patients, he notes.

Analyzing the data

Dr. Factora’s team began by conducting a retrospective chart review to evaluate the efficacy of virtual capacity evaluations. The investigation, which was conducted in collaboration with Cuyahoga County APS, entailed analyzing the agency’s database to determine the outcomes of individuals who underwent a virtual capacity evaluation between May 2020 and September 2021.

Researchers evaluated a number of patient variables and documents, including statements of expert evaluation, guardianship assignments, access to community services, transfers to higher levels of care and the establishment of primary care. The study, which assessed the outcomes of 54 homebound patients suffering from suspected elder abuse, neglect or financial exploitation, found that virtual capacity evaluations increased the likelihood that patients could remain safely at home.

“We not only showed that a virtual evaluation can be just as effective as an in-person visit, we also found that the virtual approach can help people overcome a number of barriers, including transportation issues and reluctance to visit the doctor,” explains Dr. Factora. “Additionally, older individuals are frequently dealing with chronic health issues, and our program can help them begin or re-establish primary care. Ultimately, our goal is to help patients maintain their independence and reduce the strain on caregivers by finding resources that align with their individual needs.”

Looking ahead

In the near future, Dr. Factora plans to delve deeper into virtual capacity evaluations and how they compare to routine, in-person visits. Are virtual evaluations more advantageous than in-person visits? Are health concerns resolved more quickly when addressed virtually? Do virtual assessments improve the ability of elderly patients to remain in their own homes?

Dr. Factora aims to answer these questions and more. “APS is also looking for ways to improve their own processes — a need that will foster our ongoing collaboration,” he notes. “The enthusiastic response we’ve received from local agencies highlights the importance of our work to geriatric patients, many of whom are isolated and suffering from some form of abuse, neglect or financial exploitation.”

Cuyahoga County’s success with virtual capacity evaluations has prompted APS representatives in other Ohio counties to adopt the model. “I think this is only the beginning,” says Dr. Factora, who hopes to expand the program through partnerships with local APS agencies and the Elder Abuse Commission.

“Building the program will involve identifying other geriatricians and physicians who can perform these capacity evaluations, develop a clinical standard and serve as a resource for other participating counties,” he explains. “This is simply one more way that clinicians can use technology to improve the wellbeing of patients statewide.”