In parallel with the worldwide aging of the population, the prevalence of both dementia and multimorbidity increase. Multimorbidity can be defined as the presence of two or more long-term health conditions. Management of multimorbidity is complex, it is usually associated with a poorer quality of life and increased risks of mortality, polypharmacy, adverse drug reactions, falls and hospital admissions[1]. Care of patients with multimorbidities becomes even more challenging, when multimorbidity is associated with dementia, which is quite common in multimorbid older adults[2]. Cognitive impairment can impact the severity and burden of multimorbidity while multimorbidity may speed dementia progression which creates a vicious cycle[3]. Mild cognitive impairment (MCI) and mild dementia can also be a challenge for patients’ capability for effective management of multiple conditions.

The need for a Patient Empowerment Platform

Management of long-term conditions introduces challenges for the patients: successful management requires active involvement of the patients in their healthcare and treatment via self-management activities[4]. Patients living with multiple long-term conditions are expected to make significant lifestyle changes such as following a strict diet and exercise plan, adherence to complex treatment regimens, managing medications, monitoring themselves and reacting in case of problems[2],[3]. All of these become more complex and challenging in case of mild cognitive impairment (MCI) and mild dementia, where patients have difficulties in following a daily routine.

As a response to these challenges, the CAREPATH project aims to deliver a Patient Empowerment Platform (PEP) focusing on supporting self-management activities for older multimorbid patients suffering from mild dementia or MCI. The mobile PEP application aims to provide personalized assistance and guidance to patients, send reminders about care plan goals and activities, present educational materials for reinforcing treatment adherence, and collect feedback from the patients via Patient Reported Outcome Measures (PROMs) for carrying out geriatric assessments.

Main features envisioned

The CAREPATH Patient Empowerment Platform consists of several functionalities that help older patients with mild dementia or MCI to manage their complex long-term conditions. These include:

• Presenting a clear view of the daily tasks of the patient. These include activities such as medication intake, appointments, filling in a simple questionnaire to measure subjective well-being of patient, taking home measurements. It can also list the custom tasks that were created by the patient and/or his/her informal caregiver as a part of daily plan. Through this view, patients are reminded about the pending activities, mark the activities as completed, and provide feedback about the activities
• Specific medication plan view for older patients with mild dementia or MCI who often forget to take their medication on time
• Push notifications to remind patients doing a task on time.
• Diet and exercise plan management where the patients are clearly guided about their diet and exercise regimens as defined by healthcare professionals based on their comorbidities
• A monthly calendar view for management of scheduled appointments between care team members and patients, and custom tasks which are activities outside the care plan

Conclusion

Design of a patient empowerment platform for older adults with mild dementia or MCI is challenging: their specific needs need to be taken into account, especially considering their capabilities and limitations introduced by their conditions. To ensure this, we have followed human-centered design process with the involvement of patients, informal caregivers, and healthcare professionals via the clinical pilot sites of the CAREPATH project. We have created mockups based on the user requirements, key scenarios, collected from end users.

The feedbacks received from users have been utilized to update the mockups in an iterative manner. On top of these, we have followed Web Accessibility Initiative (WAI) of the World Wide Web Consortium (W3C) in the Web Content Accessibility Guidelines (WCAG) 2.1[1], which has specific guidance for older patients. We paid special attention to building each screen in the same design format, to ensure consistency across the application, which is beneficial in improving patients’ cognitive function in daily use[2]and to minimize the amount of information patients with dementia need to remember and learn as much as possible[3]

We used clear and concise language on all screens and avoided complex expressions and abbreviations, which might be confusing for patients with dementia[4]. Finally, scrolling feature is avoided as much as possible as dementia can cause motor impairment resulting in difficulty to use scrolling[5].

Implementation of CAREPATH PEP is still ongoing, which will be finalized at month 14, by August 2022, which will then be validated with the help of end-users during technical validation and usability studies.