Innovations using mHealth for people with dementia and co-morbidities in Latin America
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Health systems in LMICs are poorly equipped to care for chronic mental and physical disease, which are rapidly increasing with aging populations. Cognitive impairment challenges health systems on multiple fronts, incurring huge human and financial costs. Latin America has the highest projected increase in dementia incidence globally, and in Peru there are ~300,000 people with dementia (PWD). Many are undiagnosed and lack basic support. Care is often provided exclusively by family members. We present IMPACT Dementia, a new 4-year, ~$5M project funded by the Global Health programme of the UK NIHR, which will tackle inequity in access to dementia care and diagnosis in Peru and beyond using sustainable, integrated, person-centred, community-delivered, technology-enabled innovation.
Our interdisciplinary team includes researchers, policymakers and community representatives working across 5 interrelated work packages (WPs). WP1 (Health System Readiness) will assess the needs of PWD and their carers and the readiness of the health system. WP2 (Diagnosis) will coproduce an mHealth app for community health workers to find cases of dementia and record comorbidities. We will evaluate the acceptability and accuracy of this app in 1600 PWD and controls from four distinct regions of Peru: the capital city (Lima), a coastal semi-urban region, the Andes mountains and the Amazon jungle. WP3 (Intervention) will adapt an existing mHealth intervention to the Peruvian context, including co-morbidity management help, motivation for physical exercise and group-based activities and carer support. Its implementation will be assessed in a feasibility study. WP4 (Health Economics) will estimate the economic burden and impact on quality of life of dementia and comorbidities. WP5 will engage stakeholders and the wider community to increase awareness and tackle sigma.
RESULTS & CONCLUSION
We envisage: i) the diagnostic app being implemented nationwide within the health service; ii) preparing for a full trial of the complex intervention; iii) informing the design of a National Dementia Plan in Peru; iv) adaptation and application of health system readiness tools in other LA countries.
IMPACT Dementia provides a powerful opportunity for transformational change in dementia diagnosis and care in Latin America and a new platform for collaborative innovation across the region.