New ideas for old problems: How seniors can benefit from the latest tech
When it comes to health care, the imbalance between adequate, timely care provision and receipt is at its most stark for older people.
Canada, alongside other nations, are navigating health care (among many, many other areas) with a population where the number of seniors now exceeds the number of children for the first time ever. To some, seniors are considered the most difficult patients to manage: they often have multiple chronic conditions, are greater users of health care services and resources (e.g. hospital stays), and they are less able, in general, to stave off ailments that a younger person may have a better chance at. Also, unsurprisingly, all of these challenges faced by older people and those who care for them are exacerbated when seniors are low income, lack adequate social support, or manage mental health conditions.
Not only are nations struggling with how to manage the sudden silver tsunami, they’re also struggling to manage the specific health and well being needsto this population composition. It is not always immediately obvious that technology can offer a host of potential remedies given the fact that seniors are not digital natives and can trend towards lower (device) adoption. In fact, health care technology may find massive value, if not it’s greatest use, in helping older people manage their health and well being. This is not amiss to Amazon, who has just hired a geriatrician, Martin Levine of Iora Health. Iora is rethinking primary care by merging innovative care and payment models with technology.
Aging in Place and the Caregiving Cliff
Some people might argue we need technology — and that without it we simply will not be able to meet demand for care. In the United States, AARP (American Association of Retired Persons) uses the term “caregiving cliff” to describe the gap that is gradually expanding. One driving reason behind demand outstripping supply is that older people want to remain in their own homes as they age — the notion of ‘aging in place’. Whereas recent decades have seen the medicalization of aging with care for older people the remit of retirement or nursing homes, older people have more recently been seeking alternatives to institutionalization. If older people wish to be in their homes, this means the services and resources that have traditionally not been available to older people and their carers will need to be adjusted.
Coincidentally, here comes the gig economy. Many services unavailable a decade ago are now well-positioned to address some of the key problems of aging at home, including grocery delivery, pervasive video chat software — from FaceTime to Amazon Alexa’s drop-in feature. Logistical challenges including transportation are being tackled through health care facilities partnering with Lyft and Uber. Staggering statistics on patient absenteeism showing a significant amount of medical appointments are missed due to a lack of available, reliable transportation. Both companies offer a way for health care facilities to request and pay for rides for patients without the patient needing a smartphone or the app downloaded. And they recognize this need and opportunity, with Uber launching ‘Uber Health’ last month.
The Value-Add of Digital Health for Older People
As has been widely discussed and debated, longer life expectancies don’t necessarily imply healthy years lived. Research done in developed nations has shown, for example, that from about 80 years of age, 1 in 5 people will experience some form of dementia, meanwhile 1 in 4 will suffer from deterioration in vision and 4 in 5 will develop hearing problems.
Older adults, in particular, are more susceptible to multimorbidity — the occurrence of different conditions at the same time — and, as a result, the potential polypharmacy that comes along with trying to manage these conditions via medication. Some doctors comment that it is not unusual for them to see patients who are taking as many as 20 different medications, whether they be for heart disease, arthritis, insomnia, or acid reflux. Polypharmacy puts patients at risk on a number of different levels, including medication interactions and adherence issues. Technology has the potential to help address some of the implications of multimorbidity, for example, through drug-free pain management. Getting seniors off at least some of their medications — particularly when they tend to make them drowsy or nauseous — can have a significant influence on quality of life.
Virtual reality (VR) is also proving to be a fruitful means to improve health and wellbeing outcomes with some companies beginning to create senior-based applications. The Travelers Companies recently announced a partnership with Cedars-Sinai, Samsung Electronics America, Bayer and appliedVR to help address lower back pain from sore and aching muscles due to strain using virtual reality. “The opioid crisis doesn’t just cost money, it also costs lives,” commented Dr. Spiegel, Director of Health Services Research at Cedars-Sinai in a Samsung press release. “We need to find ways to stem the tide without relying entirely on medicines. Health technology, like virtual reality, has tremendous potential to improve outcomes while saving costs, which is why we’re so excited about this collaboration among academia and industry.”
Some senior living facilities are using VR to help its residents revisit memorable childhood locations or explore places they’ve never been. Researchers hope to better understand how this form of VR application affects rates of depression in the senior patient population, and in addition, how VR might be used to help diagnose early-stage cognitive impairment and its feasibility as a treatment method (in fact, there is already evidence in support of this).
Technology has shown positive results in managing depression and other mental health conditions, particularly in terms of digital cognitive behavioural therapy. A recent study published in the International Journal of Aging and Society found that internet-enabled cognitive behavioral therapy (IECBT) was an effective method of treatment for older people experiencing anxiety and depression.
We’ve done a lot of writing on wearables and what to expect in terms of their capabilities in 2018 but there’s been relatively little discussion around the [immense] potential wearables have in senior care. Consider LEGSys and BalanSens, which seek to evaluate gait and balance disturbances, respectively. Gait and balance challenges are the two most important factors contributing to falls.
Using LEGSys and BalanSens, clinicians can assess gait and balance in virtually any space, including a patient’s home. The technology auto-generates a detailed fall risk and balance assessment, enabling health care professionals can make prompt assessments and recommendations to keep patients safe in their home.
GPS SmartSole offers a novel way to locate an individual — using their shoe insoles. Location data is pushed to a caregiver’s phone every 10 minutes and caregivers can establish geozones whereby they receive a notification whenever the SmartSole wearer enters or exits these areas. A “Concierge Monitoring Service,” is also available which can help caregivers with location-based information and alerting first responder services in the event of an emergency.
There’s a whole host of services and tools within caring for older people that are ripe for disruption — and this was not amiss to Seth Sternberg, a former Google employee, who founded Honor to connect carers and elderly people around the clock, on a pay-as-you-go model. The app has grown to operate in 12 American cities.
Rather than putting technology on the person, integrating technology with our built environments also has serious potential. Sensara, a Dutch company is focusing on a smart home full of sensors and motion detectors which can capture daily patterns and identify when irregularities occur. Reinout Engelberts, of Sensara, notes that “catching little things before they become big discomforts and big costs for the provider” is certainly possible. He explains that increased visits to the washroom, for example, can signal a potential urinary-tract infection — likewise, changes in gait can predict an impending fall. By noticing these small anomalies, the technology can alert the individual and their carers who can then seek to address the problem.
Other features, such as digital locks, often have configurable settings that allow the door to be unlocked or locked at different times of day and different codes can be set up for different people. These devices are particularly helpful for older people who may be hard of hearing or struggle with mobility since the locks and doorbells can be monitored remotely from connected devices.
Though somewhat less discussed than other areas of elderly care, robots are positioned to play an important role in monitoring and supporting the health and wellbeing of older people. ElliQ, for example, was launched in December in the US. the robot is able to track the users pill regimen and connects the user to their family, friends, and medical professionals through video calls and social media. The robot also serves as a companion and get help curb isolation by suggesting activities the user may want to do outside. ElliQ is smart, too. The system leverages machine learning to gradually better understand the user’s preferences to refine its recommendations.
Similarly, a Canadian company’s seal pup, the Paro, has been in Japanese nursing homes for roughly 15 years already. The Paro ecognizes temperature, posture, and light. So far, the Paro has yielded positive results — especially when it comes to mental health.
“We’re already finding that, for some difficult cases of depression, this could be a catalyst that helps people move on and get back to their healthy state,” said Dr. Simon Davies, a staff psychiatrist and clinical scientist at Canada’s Centre for Addiction and Mental Health. “It’s very therapeutic — another approach to use alongside all the regular treatments proving effective in depression treatment.”
Over half (58%) of older Canadians believe that digital technology would help them better connect with their health care — though less than 1 in 5 currently use it to do so. As more and more offerings are made available to older people (and with the proper UX in place) the engagement statistic can be expected to increase. Importantly, as demand increases, ensuring proper funding mechanisms are in place is also crucial since access to invaluable technology aimed at improving health should intuitively not be limited to those who are able to pay out-of-pocket. In addition, a consistent focus on interoperability is also key — as creating the least number of data silos is preferable from the standpoint of purchasing parties as well as from the perspectives of health care professionals and data scientists who can cross-pollinate data sets to uncover more robust findings.
Finally, and a growing (albeit deserving) topic of discussion, technology cannot completely supplant a human connection. Where technology can be leveraged to improve access and experiences (as is the case in pain management), it should be used, though face-to-face contact remains the gold standard.