Friday, February 12, 2016

Health Technologies & Elder Care

 GeroTechnology: An Introduction

As settings for long-term care become increasingly diversified, it is projected that there will be an increased reliance on family caregivers and technology within one’s home setting, especially during health status changes requiring extended care services.  A relatively new field, GeroTechnology (or GeronTechnology) engages technology companies, engineering and architectural firms, private entrepreneurial enterprises, research universities, governmental representatives, and members of the aging network – all working together to provide services that people need, when they need them, in the place they call HOME (Leading Age, 2016).   Rather than having to bear the expense of a nursing home, technology is being built into housing and products to improve person-environment congruence for older adults experiencing health status changes

As our senior population doubles over the next two decades, we face a daunting mission:  increasing the quality of care for a record number of elders while also striving to reduce the nation’s health care economic woes.  Many professionals argue that if we are to deliver quality care now and in the future, we must embrace the philosophy of a wellness revolution.  In other words, we will need to apply American innovation to wellness technologies that enable prevention, early detection, increased compliance, and new modes of remote caregiving and family support (Eldercare, 2015).

Home Care Technology and Aging-in-Place

By its very definition, home care helps people age-in-place.  In addition, home care technology provides essential tools to individuals on a widespread, cost-effective scale.   Telehealth or remote monitoring, an all-inclusive term, encompasses a range of high-tech applications that involve caring for patients remotely.  For example:

·               Monitoring an individual’s heart rate while that person is working out on a treadmill.

·               Transmitting a patient’s telemetry readings to a nurse via the Internet.

·               Virtually bringing a health care provider into a patient’s home via the digital use of a high-resolution camera.
(Hfaging, 2016).

As hospital stays have been shortened and more home care technology has become available, caregiving at home has come to take on many aspects of a mini intensive-care unit.  One interesting example is the MEDCOTTAGE – a mobile, modular medical home designed to be temporarily placed on a caregiver’s property for rehabilitation and extended care.  As noted on their Web page, the MEDCOTTAGE is a state-of-the-art hospital room with remote monitoring so caregivers can provide quality care and participate directly in their family member’s recovery (MedCottage, 2016).

Enabling Technologies and Chronic Care Management

A growing body of research indicates that care technologies can prevent premature institutionalization (and its related costs) while also giving older adults more control over their own health and living conditions.   The Center for Aging Services Technologies outlined several platforms that have demonstrated value for older Americans coping with chronic conditions.  Some of these include the following:

1.            Medication Optimization 

These platforms address medication non-adherence – a serious problem which is responsible for 33-69% of medication-related hospital admissions and 23% of all nursing home admissions. 

2.            Remembering to Take Medications

Many older adults have problems remembering to take their medications as well as remembering their timing and sequencing.  Medication reminder systems fall into several categories – passive organizers, commercial medication reminder services via phone or e-mail, and software for personal data assistance.

3.            Remote Patient Monitoring

These may include communication devices as well as weight scales, blood pressure monitors, assessment algorithms, and “clinician alerts” by remotely located health care professionals.  These are especially important in rural and medically underserved communities. 

4.            Assistive Technologies and Home Modifications

Videophone products, for example, offer family caregivers the advantage of being able to see and hear their relatives.  Observing an elder performing basic tasks, such as sitting down and getting into bed, can provide important information about strength and balance.  Additionally, if an individual has changed or stopped routine grooming and self-care habits, it will be more apparent via video.  

5.            Remote Training and Supervision

For family caregivers who have to learn how to perform long-term care tasks and who also feel isolated, remote training has become increasingly beneficial, e.g., online tutorials, coaching sessions, and family support groups.

6.            Cognitive Fitness: Training and Assessment

Designed for working with cognitively impaired older adults with chronic illness, some of the available tools include counseling support instruments, electronic health records, and point-of-care computers.

7.            Social Networking and Loneliness:  Social Connectedness

Although not typically categorized as an illness, loneliness is a problem faced by many older adults in poor health who may live alone.  As research indicates, they have a very different experience of aging than those with family and social supports.

In such cases, technology can help elders feel more connected to those outside their homes.  As just mentioned, videophones can be a tremendous asset.  In addition, computer networks, such as the Internet, offer many opportunities for communicating with others.  Some services are designed specifically for people aged 65+.  They may offer social activities as well as host a variety of online discussion and enrichment topics, such as book clubs and virtual travel excursions.

8.            Social Media

Most health experts agree that the future of medicine will incorporate social media – Internet-based tools used for sharing and discussing information.  Such social media might include social networking sites, news and bookmarking, blogs, video sharing, photo sharing, and virtual reality.

For example, according to nation-wide survey findings of The Pew Social Research Center,  once someone is online, living with a chronic disease is associated with a greater likelihood of accessing user-generated health content, such as blog posts, hospital and physician reviews, and podcasts.  In general, it seems that older adults believe that others with the same condition are more likely to understand, be supportive, and offer wise advice (Pew Research Center, 2010).

An aging population and a growing number of individuals living with chronic conditions mean, in turn, an increased reliance upon family caregivers to provide front-line health care. Recent national reports indicate that these caregivers are becoming health information specialists – thanks to the internet, used in researching health conditions and treatments.  (Pew Research Center, 2013). 

Health Technologies in Nursing Facility Settings
          While this discussion has primarily focused on home-based care, I also want to add a few    comments about those technologies that are being implemented within nursing home settings.

·               Advanced Total Quality Systems – integrate several basic components such as nurse calls, wandering management, fall prevention, resident tracking, resident assessment, and electronic medication administration.

·               Advanced Bedding Systems – have embedded sensors for monitoring vital signs and sleep quality.

·               Comprehensive, Interoperable Electronic Health Records (EHRs) – allow security in sharing health information across various settings. 

As noted by many nursing home administrators, resistance to change remains one of the biggest obstacles to technology integration within a facility’s environment.  Having a long history of being manual and paper-based, it will require a cultural shift to a technology base. Education and communication are essential in addressing this challenge (Eldercare, 2015).  

The Future of GeroTechnology

While it is clear that future cohorts of older adults will have more options in health care, much will depend upon their financial resources. It seems clear that consumers who do not have adequate income will have fewer choices in the type or quality of services received.  It must also be recognized that use of these technologies (low-tech and high-tech) assumes a level of health literacy, as well as a willingness to embrace the required new learning.  Others caution us to be mindful of potential negatives, such as patients’ privacy / confidentiality issues and dissemination/access to personal information. 

Most agree that those health technologies that connect elders (in a long-term care facility or home) and their respective families will continue to experience increased demand.   However, among the challenges we face will be the ability to make these innovations seamless, easy to use, respectful, and affordable. 
Health Technologies & Elder Care

  • Eldercare (2015). Assistive Technology, Eldercare: Connecting you to Community Services. 

  • Georgia Institute of Technology.  Human Factors & Aging Laboratory (2016).     

  • The American Elder Care Research Organization (2014). Technologies to reduce care costs and allow safe aging at home.  Paying for Senior Care.

Blog Author:  Dr. Donnelle Eargle

With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College. Standish, Maine. 

No comments: