Tuesday, July 22, 2014

Thoughts on two tech innovation reports & a real family in need

From pg 4 of "Challenging Innovators"
Recently I read two reports on developing technology innovations to help us care for older adults:

"Challenging Innovators: Matching offerings to the needs of older adults" by Laurie Orlov, sponsored by AARP's Thought Leadership group, and

From pg 2 of "Catalyzing Technology"
 "Catalyzing Technology to Support Family Caregiving" by Richard Adler and Rajiv Mehta, sponsored by the National Alliance for Caregiving (NAC).

Both reports are based on expert opinion (as opposed to survey data), and seem to be primarily geared towards helping entrepreneurs develop better solutions related to the care of aging adults. (Note: the NAC report isn't specifically about caring for older adults, but acknowledges that much family caregiving activity is driven by the needs of older adults.)

Although these reports are worth reading, I'll admit that they both left me a bit perplexed and dissatisfied.

Undoubtedly this is partly because the authors -- and the primary intended audience -- are not "people like me."

Meaning they aren't practicing clinicians or academic experts embedded within geriatrics divisions, or even healthcare improvement circles.

The AARP report is very "business-y", and the NAC report seems to have purposefully excluded the perspective of healthcare professionals. (Perhaps to counter the way that healthcare professionals have historically dominated conversations about aging and caregiving?)

But let's set the needs of doctors and quality improvers aside for now. In the end, this is supposed to be about helping people, right? As in, helping patients, helping older adults, and helping the families and friends and many others -- like front-line clinicians -- who help them.

So, I tried to think of older adults and their caregivers as I read these reports. And I found myself still struggling to see just how these ideas and approaches were going to turn into materially better experiences for the patients and caregivers I work with.

Failure of my imagination? Or weakness of the proposed ideas and conceptual foundations?

Janny: A real boomer who could use tech help for aging and caregiving

Personally, when I find myself getting confused by concepts and improvement ideas, I resort to the concrete. 

As in, I think of people I know who have common problems, and need help. And then I try to follow a mental path from some entrepreneur's ideas to actual help for an older person, and/or the family.

This week I read about a family caregiver, whose problems are very common. Her handle is "Janny57" and I read about her situation on the AgingCare.com caregiver forum. (Now there is a GREAT way to learn about what family caregivers are struggling with: read the questions they post on active forums.)

Last week, Janny57 posted asking if anyone else had left husband and kids to care for a parent.

Friday, June 20, 2014

GeriTech's Take on AARP's 3rd Health Innovation@50+ LivePitch Finalists

Last month, AARP hosted its third annual Health Innovation@50+ LivePitch event. (You can see my thoughts re the first slate of finalists here, and the second group of finalists here.)

In this post, I'll list brief descriptions of the finalists, comment on how promising they seem to me -- in terms of improving the healthcare of older adults -- and tell you which products I'm most interested in.

For those clinicians and others who may not be familiar with the event, here's how it works. AARP invites companies with a new consumer-oriented health technology for the aged 50+ market to apply for one of ten spots at the LivePitch event. Submissions are screened by a "committee of technology experts" who decide which products or services are "the most innovative." (See the FAQ here for more info.) The ten chosen companies get to present two pitches at the LivePitch event: one for "investors and health technology experts," and one for AARP consumers. A winner is picked for each pitch session.

This year, AARP also added a SpeedPitch section for an additional 5 finalists. (Sorry but I'm not going to cover them here; even though the winner is for removing earwax -- an important issue in older adults! -- the product costs $1999, which would buy you a lot of Debrox and curettes.)

A neat addition to the FAQ this year is that AARP lists 11 categories of interest. (I'm always interested in how others frame the health needs of aging adults and their caregivers.) They are:
  1. Medication Management
  2. Aging with Vitality, e.g. increase daytime energy, maintain muscle strength, manage arthritis, improve or aid in memory/cognition , brain fitness improve/aid hearing, improve/aid vision
  3. Vital Sign Monitoring
  4. Care Navigation
  5. Emergency Detection & Response
  6. Physical Fitness
  7. Social Engagement
  8. Diet & Nutrition
  9. Behavioral & Emotional Health
  10. Aging in Place
  11. Other
AARP's list of this event's ten finalists is here.

GeriTech's quick take on the AARP LivePitch finalists

Here are the AARP descriptions of the companies/products presented at the LivePitch event, along with my initial reactions. I took a quick look at everyone's websites, but have not tried any of these products.

Friday, June 6, 2014

HCLDR Highlight: Barriers to Aging Adults Adopting e-Patient Approach

Wouldn't it be great if older adults -- and their families -- could leverage the Internet, and perhaps some technology tools, to better manage their health and wellbeing?

This idea has been of interest to me ever since 2008, when I discovered the world of Internet health information and online communities.

[Brief bit of backstory: my long-standing interest is in improving the quality of primary care for older adults. When I discovered the potential of the Internet to educate, support, and connect people, I stopped studying quality measures and started working on e-health resources, mainly via writing geriatric health information for family caregivers and older adults.]

Last month I wrote a blog post for the HCLDR Tweetchat on this topic, and then was featured as the guest while the group addressed 3 topics:
  • T1: What are the barriers to older adults and family caregivers adopting a more “e-patient” approach?
  • T2: How can we foster more online communities where aging adults and/or family caregivers learn practical geriatrics?
  • T3: What can we do to bring more attention to geriatric medicine / healthcare for older adults?

I posted the collection of tweeted responses a few weeks ago. In this post, I want to share a few particular insights and ideas that I gained from the tweets related to Topic 1.

What exactly do we mean when we say e-patient?

The first thing that struck me during the tweetchat was that the term e-patient is a bit broad and fuzzy to many. This meant that either people were unsure of what it meant, or people had varying definitions. Eventually someone posted a tweet to tackle this head-on:
"Does e-patient mean "engaged" or "electronic"? Help :-)"
Of course, a problem is that the term "engaged" is also vague, fuzzy, and being used to refer to all kinds of different behaviors. But in general, many in the group agreed that e-patient should refer mainly to an attitude and approach, rather than specifically to use of electronic tools:
"Seems the definition of is varied, w/ many thinking it's electronic, vs engaged. Let's focus on tool independent def."
 " is an approach, a frame of mind not just the tech"
"For the 80-100 yo,start w/ letting the e stand for engaged, empowered.Don't worry about electronic.1rst step-get buy in 4 process"

My own working definition of e-patient is that adopting the e-patient approach is fundamentally about 2 key behaviors:

Wednesday, May 21, 2014

Notes from Aging 2.0's Global Innovation Summit

Well, even though the health and life experience for most aging adults hasn't changed much these past few years (as best I can tell), things certainly are zooming along when it comes to aging, digital health, and other hotbeds of innovative entrepreneurship.

Last week, I attended the first ever Aging 2.0 Global Innovation Summit, and spent much of the day live-tweeting. (See the tweets here, or below.)

Aging 2.0, which was founded in 2012, has grown a lot over the past two years. The founders, Katy Fike (a PhD gerontologist) and Stephen Johnson, have seeded Aging 2.0 chapters around the world, partnered with Stanford to sponsor a design challenge related to cognitive impairment, created a business accelerator related to aging, and now are launching an "early-stage fund focused on aging and long-term care."

I've especially admired the way they've encouraged entrepreneurs to talk to older adults, and they've hosted a number of events in Bay Area residential facilities. They even have a Chief Elder Executive, June Fisher, an 81-year old retired physician and product design lecturer. (This PBS story is nice.)

The Innovation Summit featured mainly entrepreneurs, as well as executives in senior living (who pointed out that they are involved in healthcare because they facilitate a lot of it for their residents).

There were a lot of thought-provoking innovations to consider, and I wish I could find the time to write thoughtfully about them all. It's also interesting to consider the obstacles and challenges, such as reimbursement issues, a rapidly changing healthcare landscape, the challenge of designing for an aging population with diverse & complex needs, and how will we know which products really improve outcomes.

But alas, my time is limited. So I will share what I can, which is my tweetstream from the event. It includes notes from a very interesting talk by Cynthia Breazeal (from MIT's Personal Robots Group) on how robots can form emotional bonds with people, and even provide supportive coaching (!). You'll also see a list of the 29 featured start-ups, developing products to help aging adults.

Can you envision using any of these technologies to help older adults, caregivers, and/or front-line clinicians? Let me know which ones you find most promising!

Monday, May 12, 2014

Wisdom of Crowds: The HCLDR ideas for aging & e-patients

Last week, it was my great honor to be featured on the Healthcare Leaders (#HCLDR) tweetchat, where we discussed the issues I raised in recent blog post titled "Aging & e-Patients: Challenges & Opportunities in Geriatrics."

In this post, I'll share a list of key tweets from the session. If this is a topic of interest to you, I really hope you'll take a look! It was fun to see what came out of a diverse group's brainstorming on how we might leverage new approaches, and new technologies, to improve healthcare for aging adults & their families.

To seed the conversation, I wrote last week's blog post for HCLDR, which was specifically about how we might adapt the e-patient approach, in order to empower and inform older adults and their care circle.

Now, please note that by e-patient approach, I don't necessarily mean tech-enhanced health activity.

Instead, I'm thinking of the approach by which people use the internet -- and often online communities -- to become more proactive about their health and healthcare. Among other things, this can allow people to be more participatory and involved during encounters with clinicians and the healthcare system. (This Wikipedia entry on e-patients is useful to those new to the term, even though it may not "reflect the encyclopedic tone" desired.)

The three topic questions were:
  • T1: What are the barriers to older adults and family caregivers adopting a more “e-patient” approach?
  • T2: How can we foster more online communities where aging adults and/or family caregivers learn practical geriatrics?
  • T3: What can we do to bring more attention to geriatric medicine / healthcare for older adults?
This was my first tweetchat -- as a featured guest, that is -- and wow, what a ride. Over an hour, 108 participants posted 1519 tweets.

As you can imagine, I did not manage to read 1519 tweets in real-time, esp as I was trying to respond to at least a few of them during the event. But what I did do is try to use Storify afterwards, in order to create a list of people's answers to the three questions above. (Apologies to anyone whose insightful tweet was left out; I tried to focus on answers to the three topic questions and minimized the retweets.)

Below is the Storify. Reading it gave me lots of ideas, some of which I hope to blog about very soon. 

What ideas does this Storify bring to your mind? Please share in the comments below, or send me an email.
You can also read the complete transcript of the tweetchat here.

[Interested in this topic? See my follow-up post about barriers to older adults being e-patients.]

Friday, May 2, 2014

Aging & e-Patients: Challenges & Opportunies in Geriatrics

[The following post is cross-posted to the HealthCare Leader Blog. I'm very honored to be the featured guest on the #HCLDR Tweetchat next Tuesday, May 6, at 5:30p PST (8:30p EST). We'll be talking about how we might bring more geriatrics health information to older adults & their caregivers, and other aspects of adapting the e-patient approach for an aging population. Hope you can join!]

How can we, as a society, as healthcare providers and as healthcare leaders, provide good care to vulnerable older adults? Consider this person:
Mrs. A is an 86 year old widow who lives in assisted living. She’s been diagnosed with diabetes, hypertension, atrial fibrillation, COPD, osteoarthritis in her back and knees, stage III chronic kidney disease, osteoporosis, depression, and urinary frequency. Her daughter Ruth lives about an hour away. She’s been worried about her mother’s mood and memory.
You don’t have to be a geriatrician – as I am — to find yourself taking care of someone like this. Many of us have an elderly relative whose multiplying health problems cause us to worry.
And worry we certainly should, because people like Mrs. A often struggle with health, and with healthcare.
To begin with, the ideal management of most of her chronic conditions requires her to take on a certain amount of “self-healthcare.” This includes things like monitoring for symptoms, taking medication, and trying to stick with certain “lifestyle changes.” When people suffer from multiple conditions, as Mrs. A. does, the list of things to do for one’s health can become a lot of work.
This can be a big challenge for people of any age. But at some point most older adults will experience declines in their physical abilities, and sometimes mental abilities. Just as they have more and more to do healthwise, they may find themselves less and less able to manage it successfully on their own. And so, worried family members begin to step in, either with health-related tasks or with life tasks such as shopping, transportation, or finances.
Mrs. A is a fairly classic “geriatric” patient, in that she’s older and is experiencing many health/life problems that tend to happen as people age:
  • Physiologically vulnerable body and mind
  • Multiple chronic conditions
  • Chronic physical and cognitive impairments
  • Chronic caregiver involvement

Friday, April 25, 2014

Less is More: On Being Careful About BP in the Elderly

[The following post was first published on The Health Care Blog, on 2/28/14. I also wrote a related post for family caregivers here.]

When it comes to high blood pressure treatment in the elderly, the plot continues to thicken.

Last December, a minor controversy erupted when the JNC hypertension guidelines proposed a higher blood pressure (BP) treatment target (150/90) for adults aged 60+.

And this month, a study in JAMA Internal Medicine reports that over 3 years, among a cohort of 4961 community-dwelling Medicare patients aged 70+ and diagnosed with hypertension, those on blood pressure medication had more serious falls.

Serious falls as in: emergency room visits or hospitalizations for fall-related fracture, brain injury, or dislocation of the hip, knee, shoulder, or jaw. In other words, we are talking about real injuries and real human suffering, as well as real healthcare utilization.

How many more serious falls are we talking? The study cohort was divided into three groups: no antihypertensive medication (14.1%), moderate intensity treatment (54.6%), and high-intensity treatment (31.3%).

Over the three year follow-up period, a serious fall injury happened to 7.5% of those in the no-antihypertensive group, 9.8% of the moderate-intensity group, and 8.2% of the high-intensity group. In a propensity-matched subcohort, serious falls occurred in 7.1% of the no-treatment group, 8.6% of the moderate-intensity group, and 8.5% of the high-intensity group. (Propensity-matching is a technique meant to adjust for confounding differences – such as comorbidities -- between the three groups.)