AARP’s 6th Innovation@50+: GeriTech’s Take on the Caregiving Health Technology Finalists

On April 12 & 13, 2017, AARP hosted its sixth Innovation@50+ LivePitch event, an event that allows a group of chosen start-ups to pitch to a consumer audience and a panel of venture capitalists.

This year, the event had a “dual focus on Caregiving Health Technology and Financial Technology.”  AARP presented two slates of 10 start-ups,  one for each focus area, each with its own panel of judges.

In this post, I’ll list brief descriptions of the finalists for the Caregiving Health Technology group. I’ll comment on how promising they seem to me — in terms of improving the healthcare of older adults and the lives of family caregivers— and tell you which products I’m most interested in. [Read more…]

Omron home blood pressure monitor 786N: Good hardware, bad app design

omron home blood pressure monitorIf there is one device that I think most older people should have at home, it’s a home blood pressure monitor. So a few years ago, I wrote an article for the Geriatrics for Caregivers blog with tips on choosing and using a home BP monitor.

At the time, I didn’t recommend a specific device because I hadn’t tried any. But recently I decided it would be much better if I could suggest a specific device to patients and families.

So I looked on Amazon and looked for a home BP monitor that could meet my specifications:

  • Measures BP at the arm
  • Easy to store, review, and share BP readings, which means some type of wireless data transmission capability
  • Smartphone/tablet not mandatory to use the device

When I wrote a blog post in April 2014 about my specifications, Omron did not seem to offer a device with wireless data transmission.

But earlier this year I noticed a Bluetooth-enabled Omron monitor on Amazon.  So I bought an Omron 786N earlier this summer and have been trying it out.

Pros & Cons of the Omron 786N Home Blood Pressure Monitor with Bluetooth

Here are my thoughts so far: [Read more…]

GeriTech’s Take on AARP’s 5th Health Innovation @50+ LivePitch

On Wednesday April 27, 2016, AARP hosted its fifth Health Innovation@50+ LivePitch event, an event that allows 10 chosen start-ups to pitch to a consumer audience and a panel of venture capitalists.

This year the event’s description seemed a bit different than in prior years, with a new emphasis on caregiving: “Innovation@50+ is a one day pitch competition for emerging startups in the healthy living space with a focus on caregiving.”

As in prior years, there did not seem to be much judging or input from anyone whose primary work and expertise is to improve the health of people aged 50+, or to improve the lives of family caregivers for that matter.

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 the lives of family caregivers— and tell you which products I’m most interested in. To see what I’ve thought of past LivePitch finalists, here’s my coverage of the first, second, third, and fourth cohorts.

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, and for certain web-based products tried them out for a little bit, but have not tried any of these products in depth.

Cake: “Cake is the easiest way to do end-of-life planning. We break down a daunting and difficult task into simple, bite-size chunks, and provide experts who can answer your questions. Your online CAKE profile is a living document of your end-of-life preferences that is easy to access, update, and share.”

GeriTech’s comments: [Read more…]

New PCAST Report on Independence, Technology & Connection in Older Age

Yet another major report was released this month: “Report to the President: Independence, Technology, and Connection in Older Age,” from the President’s Council of Advisors on Science and Technology (PCAST).

PCAST convened a blue-ribbon working group for this report, which included several prominent experts who have done terrific work in improving the health and wellbeing of older adults.

So I was a bit surprised to find myself a bit disappointed by the report and the recommendations. Every now and then I read something that leaves me thinking “Wow, this really clarifies what’s happening, what’s important, and points towards solutions that are viable and likely to improve the problems we face.”

This report did not leave me with that feeling. But perhaps it will do more for you? In this post I’ll summarize some key highlights from the report, and then I’ll share a few thoughts on what I’m hoping to see in future expert reports.

How PCAST framed its report

PCAST identified four areas of change in aging, which offer opportunities for technology to help: [Read more…]

Still Waiting on A Personal Emergency Response System to Recommend

I’ve been interested in the PERS (personal emergency response system) offerings for quite some time, because families routinely ask me about these. The classic PERS device is a pendant device with a button to push, and often I see older adults in assisted-living facilities wearing these. (Do facilities offer residents a discount on these? Are facilities getting a commission? Or does it help facility staff do their work? I’ve never known.)

Residential facilities aside, in my work PERS devices come up especially for vulnerable older adults who live alone. I know many seniors who have fallen, fractured something or otherwise been injured, and have not been found for hours or even days. Needless to say, lying injured on the floor is often disastrous for health, and such falls often prompt a permanent relocation to a more supportive — and generally more expensive — living situation.

So I certainly understand why people are drawn to PERS devices, assuming an older adult is willing to wear it — but many forget or don’t want to. A PERS also has to activate when an emergency occurs, either by automatically detecting a fall or problem, or because the user triggers it.

Should we be using PERS devices that require users to call for help? Studies generally find that most older adults do not trigger their call system after a fall. Here’s a quote (emphases added by me) from this very interesting study of older adults and falls: [Read more…]

Notes from the Institute on Aging’s Tech Conference

 

Last week I attended another one day aging & tech conference. But it was very different in feel compared to most events I go to, because this one was not hosted by an organization with an entrepreneurial background. Instead, the event was hosted by an aging services non-profit: the Institute on Aging (IOA). (Conference agenda is here.)

For those who aren’t familiar with the IOA,: it’s a terrific organization that has spearheaded a number of innovations related to better care of older adults over the past 30 years, including launching the first fellowships in geriatrics and creating the Friendship Line, the nation’s only crisis hotline to address isolation and suicide risk in seniors. (For more on the history of the IOA, see here.) The IOA has also often collaborated with the City and County of San Francisco on aging services.

This conference provided continuing education credits for nurses, social workers, therapists, attorneys, and residential facility providers. So the audience mainly seemed to be those individuals, rather than entrepreneurs and innovators.

This struck me as a bit of a pity, because the content of the talks seemed more focused on what aging people need — rather than how to make your entrepreneurial venture succeed — and I think the more entrepreneurs can hear about this, the better.

In truth, my overall impression was that this conference was “by the aging community, for the aging community” whereas most tech and innovation conferences are “by the innovation business community, for the innovation business community.”

Is there a way to merge these two groups more?? I don’t know the answer to that.

At the end of this post, I’ve embedded the Storify with all my tweets from the day, which hopefully will share a sense of the event, for those who weren’t able to attend.

A few particular talks that I really enjoyed

[Read more…]

Notes from the Aging 2.0 Global Innovation Summit

This past week, I attended the second Aging 2.0 Global Innovation Summit.

I wrote about the first one here. It’s now a year later, and I would say that the health and aging experience of the average older adult still hasn’t changed much.

But this perhaps isn’t so surprising. It’s been said that

“We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.”

So presumably we’re on track. The aging innovation community certainly seems to be growing and expanding its horizons, and this year again, I heard about many intriguing ideas and technologies.

I did live-tweet most of the summit, so for details on what was covered and what technologies were presented on stage, see the Storify here, or below. (Full disclosure: Aging 2.0 graciously extended a complimentary invitation to me.)

In the rest of this post, I’ll share some thoughts on what stood out to me during the conference.

Key Themes of the Aging 2.0 Innovation Summit

[Read more…]

Advance Care Planning Online: GeriTech takes a look at MyDirectives.com

A few weeks ago, a visitor to Geriatrics For Caregivers sent me a message via the contact form.

He explained that he is a hospital chaplain and that his workplace is considering using MyDirectives.com to help their patients with advance care planning.

“I would love to hear your opinion of the service,” he wrote.

I’d actually never heard of this service, but that’s not so surprising…new healthcare services for consumers emerge and evolve so quickly that even if I followed tech for aging adults full-time, I’d have difficulty keeping up.But I have a soft spot for advance care planning. So I decided to take a look at this website, in order to let the chaplain know what I thought.

And, as an experiment, I also decided to try recording myself visiting this advance care planning site.

So if you are wondering what I thought, or if you’d like to see what a practicing doc might do when a patient asks about some new-fangled web-based service, you can watch me explore MyDirectives below. (For audio-only, click here.) [Read more…]

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.
When another forum user asks her to share more details about her caregiving situation, Janny57 mentions that her 85 year-old widowed father

  • has memory problems,
  • isn’t taking his blood pressure meds (and was recently prescribed more BP meds to take, which sounds like sub-optimal healthcare management to me),
  • is having difficulty managing his finances,
  • is likely depressed,
  • drinks beer every night,
  • has been put on an antibiotic for high PSA,
  • has dental problems,
  • has a shoulder that is “killing him” due to bursitis/tendonitis,
  • has had some driving incidents,
  • is putting dirty dishes in cabinets and refusing to throw out rotten food,
  • is refusing to pay to have someone help him,
  • has not had a dementia evaluation and does not go to the doctor much, although he did go recently since his shoulder was killing him and the doctor noticed that his patient didn’t remember their conversation the day prior.

Other caregivers responded with a wealth of advice on helping a parent with dementia, on balancing family and work and marriage and caring for a parent, on surviving the experience, on moving a parent into your home, on moving into your parent’s home, and so forth.

This peer-to-peer caregiver support is good stuff, and I’ve actually been telling families to look for a suitable online forum.

But of course it’s not enough to tell someone like Janny to get help from a forum. She’s having serious problems, her dad is having serious problems, and as a society we need to get better at helping people like Janny and her dad.

Now below are two ideas I have, which maybe could enhance future reports of this type.

Idea #1: More challenging personas

What if these reports were to include a persona similar to Janny, or to her dad? (Not sure what I mean by “persona”? Try this resource for information on how personas help in design.)

Personas are actually featured early on in Laurie Orlov’s report; right at the beginning it says “Age Doesn’t Matter — Personas Help Shape Scenarios that Inspire.”

And on page 4 of the report, there is even a nifty graphic, which she says are “three personas reflected throughout its publications that represent the AARP cohort of age 50+.” Here it is:

But I found myself rather dissatisfied by this graphic.

Obviously, when you are a hammer everything looks like a nail. So, since I’m a physician, I’m oriented towards health problems. And since I’m a geriatrician, I’m especially prone to think about how almost every problem an older person has tracks back to an underlying problem with health, or healthcare.

So I admit I am biased to thinking of health and healthcare. Still, I wonder if many non-clinicians out there might not agree with me, and find it a flaw that this graphic says exactly zero about the role of health problems in each personas life.

After all, what do you suppose it is that moves people from one stage to the next? (Er…health problems, no?)

What is a major cause of caregiver involvement in an older person’s life? Health problems. What do caregivers spend a significant portion of time doing? Helping an older person interface with the healthcare system, and helping an older person with his or her “self-healthcare.”

Why is Janny about to leave her husband and kids behind, to help her father? Because of his health problems.

Speaking of Janny’s father, which persona represents him??

Maybe someone can answer that in the comments below. Suffice to say that I have come across many, many people like Janny’s dad, and as the population ages, more and more families will be in this position.

And Janny herself, if she gets more involved in caring for her father, is at high risk for developing or exacerbating her own health problems. (We should care just on moral/ethical reasons, but her employer and health insurer should also be very concerned about this.)

So, I think we need to expand the persona selection. Designers for caregivers and aging adults: consider following the caregiving forums. You might get some good ideas there.

Idea #2: Make sure you always consider the role of health problems and healthcare

As I said above, I realize my geriatrician background means I’m likely to be biased in favor of attention to health and healthcare.

Still, when it comes to caring for aging adults, I don’t see how you can create truly useful — and usable — solutions without giving serious consideration to health, and healthcare issues.

And I mean solutions that are useful to older adults and their caregivers, not just solutions that are useful to doctors. (Although really, our fates are intertwined! Healthcare is a partnership!)

At a minimum, I think some bar representing “health & healthcare problems” needs to be added to the Personas graphic.

For instance, among the “Independent Persona” people who are highly functioning, a fair proportion of them have chronic health problems that they need help managing. They need this help in order to maximize their current quality of life, and they need this help in order to reduce the chance of progressing to “Transitioner” or “Struggler.”

Their health problems usually can’t be managed without interfacing with the healthcare system. Supporting an effective partnership with the system is important. (Which means to some extent helping people compensate for the system’s deficiencies and dysfunctions, but that’s a topic for another post.)

Those who are “Transitioners” are presumably even more likely to have health problems. They are also more likely to have others — whether family, friends, or residential facility staff — concerned about these health problems.

Furthermore, the status of — and approach to managing — health problems often affects how much daily help an older person needs. (For example, it’s often possible to streamline or simplify a medical care plan.) This is especially true for the “Strugglers,” and the NAC report quite correctly cites Carole Levine and the 2012 AARP/United Hospital Fund survey which found that over half of caregivers are “‘performing medical/nursing tasks for care recipients with multiple chronic physical and cognitive conditions,’ which involved such tasks as managing multiple medications, wound care, giving injections or intravenous therapy, incontinence support, and/or serving as care coordinators.”

So, if you are trying to design solutions to meet the care needs of aging adults — whether you are trying to help older adults or whether you are focusing on helping caregivers — it would seem that health and healthcare are important factors to consider.

But if you take a closer look at Frog Design’s “Aging by Design Innovation Map,” which is where the 3 Persona graphic comes from, you’ll note that there is precious little about health and healthcare concerns.

Shouldn’t “Help me feel well” be a core need?

Yes, it should.

Summing it up

Many of the challenges that older adults — and their family caregivers — face are heavily influenced by issues related to ongoing health problems, as well as healthcare encounters.

To develop and offer effective solutions that help us care for aging adults, innovators should consider the relevant health and healthcare issues. Although specialists are obviously very useful, innovators should also seek out good generalists, whose job it is to help patients develop an overall comprehensive plan for their care. (Examples: Dr. Allan “Chip” Teel has developed a tech-enhanced approach to help his older patients in Maine remain independent. OnLok and other PACE clinics have found ways to effectively work with family caregivers, to keep nursing-home eligible seniors in their homes. Figure out what they are doing right and build on it.)

“Help me feel well” is a core need that often requires attention, when it comes to older adults. That need, and what it takes to address that need, should be on the innovators’ radar.

It would probably help to develop personas that factor in some key health issues, and I hope Frog Design will consider revising their Aging by Design Innovation Action Map.

I recommend innovators consider how their conceptual frameworks might help them with the story of Janny57 and her father. Consider the problems she needs to solve, for herself and for her dad. How will your solution help? What else needs to happen for it to help? I’d also encourage innovators and designers to read many other real caregiving stories in online caregiving forums.

If you’re part of that frontline of care for older adults — an older patient, a family caregiver, or a practicing clinician — what do you think of these latest reports? I hope you’ll post a comment below.

ISO a tech-enhanced blood pressure cuff for older adults

As I mentioned in my last post, having a record of home blood pressure (BP) measurements is often extremely useful for internal medicine and geriatrics.

I’ve been recommending that older patients have a good home blood pressure monitor for quite some time, but which monitor to recommend?
This is a question that’s been stumping me for quite a while. You’d think we’d have lots of options, when it comes to suggesting a BP monitor that makes it easy to collect, share, and make use of an older person’s BP data. But so far I haven’t come across much.
Here’s what I’m looking for specifically, in a home BP monitor for older adults:
  • Does not require a smartphone or tablet in order to view the BP readings. I think it’s hard enough to get people to strap on a cuff regularly. They should not need to connect an additional device as well. And, they should be able to see what their BP and pulse is, right away, without attaching anything else.
  • Easily transfers BP & pulse data to a place where it can be reviewed, queried, and shared. In this day and age, easy means wirelessly. And the data should be easy to share with family, and with multiple providers.
  • Available for iOS and Android. I’m not persuaded that requiring BP data to transfer via mobile device is the best solution. (I think BP cuffs that transmit to the cloud via wi-fi might be a simpler for many older adults.) But for those solutions that do this, I am looking for devices that can be used with either iOS or Android.
  • Arm cuff. Arm cuffs are the standard in medicine; if we are collecting data for clinicians to take action, we should offer clinicians something they trust. Wrist cuffs are much more sensitive to position, so it’s tricker to get a valid reading. And don’t even mention Wello & the other devices which measure BP by touching the fingers; this technology is intriguing but the BP measurements will need a lot of validation before clinicians will be comfortable with this. (The tech press somehow never explains just how these new smartphone cases are going to check your blood pressure.)
  • Easily purchased by a regular person. I’m looking for something that people can buy on their own, for themselves or for an older person. Maybe their primary care doc — or geriatrician consultant– suggested it, maybe not. This means that the purchasing interface has to be consumer-friendly. Enterprise-style devices that are meant to be sold to hospitals or big primary care clinics are not ideal.
It would also be nice for the device to have enough consumer reviews for us all to have a sense of quality and usability. Barring that, a good warranty/customer service reputation could go a long way in reassuring families that this new-fangled device isn’t going to be a risky purchase.

A brief survey of the tech-enhanced BP monitors I’ve considered:

I haven’t done an in-depth survey, I’ve just asked around and done a little Googling. (In other words, I’ve looked in the way that the average doc is likely to look, if they bother to look at all.) Here’s what I’ve come across:
  • Withings BP monitor: Withings seems to have released a new version of its BP monitor this year. It now works wirelessly via Bluetooth, and is compatible with iOS and Android. The data can be reviewed via app and desktop. However, it doesn’t show BP results without mobile device. Unclear how many BP readings it can store on its own.
  • iHealth BP monitor: Wireless BP cuff. Seems to use Bluetooth, compatible with iOS, not super clear if compatible with Android. Unclear just how data gets shared with doctors, and whether this can be done outside of mobile app. Like Withings, doesn’t seem to show BP results without mobile device.
  • Blipcare BP monitor: Wireless BP cuff that uses wi-fi rather than Bluetooth. Data can be viewed via smartphone apps, or can be viewed online. This monitor does show BP results directly.
Of note, the well-established company Omron does not seem to currently offer a BP monitor with wireless capabilities. They do offer a monitor that connects to PC via USB cable, which sounds like the tech of 5 years ago to me and I wouldn’t recommend it to patients today.
After browsing for options this past month, I’ve decided to try the Blipcare monitor, for an older patient who is in assisted-living. This patient does not have a smartphone or tablet, but does have active issues related to hypertension and atrial fibrillation.
Of note, Blipcare does mention on its website that its monitor is simple and suitable for older people. I also found this review on iMedicalApps.com, in which the author seems to successfully use this device for his father.
If it works well, I’ll try to report back.In the meantime, if you can recommend a home BP monitor for older adults, please let me know.