Feasibility of a technology readiness level 6 web application for monitoring postoperative cognitive dysfunction in older adults: a pilot study
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Abstract
Postoperative cognitive dysfunction (POCD) is a common yet underrecognized issue in older surgical patients. Long-term cognitive follow-up is often absent in standard care. The COVID-19 pandemic highlighted the need for remote monitoring tailored to aging populations. Therefore, this study presented a web-based platform, developed under World Health Organization’s Integrated Care for Older People (ICOPE) framework and evaluated at Technology Readiness Level 6 (TRL-6). The objective of this study was to design and commission the development of the web application, and to assess its feasibility among older surgical patients within a clinical setting. The study was conducted in two phases: system development based on literature-guided risk factors and ICOPE principles, and a prospective cohort study to evaluate feasibility by assessing data completeness, user input capability, and follow-up adherence after surgery. Patients aged ≥60 years who underwent elective surgery under anesthesia were enrolled. Exclusion criteria were included having severe sensory deficits or inability to use a smartphone. POCD was defined as a ≥2-point decline in the Montreal Cognitive Assessment (MoCA) score from baseline. This study found the platform featured (1) communication via a LINE official account (LINE OA), (2) risk screening with tailored educational video clips, and (3) automated reminders for postoperative assessments. Ten participants (mean age 70.90 ± 6.14 years; 70% female) were recruited between April and July 2024. Retention rates were 100% at 1 week and 70% at 3 months. POCD was observed in 2 of 10 participants at 1 week and 2 of 7 of participants at 3 months postoperatively. In conclusions, this TRL-6 pilot shows the feasibility of integrating a digital cognitive tool into perioperative care, with potential to enhance follow-up and early POCD detection in older patients.
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