In my upcoming ebook about better digital health tools for aging adults, I share a case study — an older woman named Joan — and I write about her struggle to manage her health from three perspectives: Joan herself, her concerned daughter, and her busy primary care provider.
Joan has more chronic conditions than most seniors — eight diagnoses, plus she’s had falls recently — but they are a fairly common combination in people who smoked and were overweight in middle age.
In this post, I share part II of the case study: the perspective of Joan’s daughter Susie, who is understandably worried about her mother’s health and wellbeing. (See Part I of the case study for Joan’s perspective, plus a list of her conditions and medications.)
As you read this, consider the following:
- Do you know many people worried about the health of their older parents?
- What kinds of technologies, tools, and services have you come across that might help Susie and Joan?
Joan’s Health Story (According to Her Family Caregiver)
Susie is worried about her mother almost all the time.
She’s read up on her mother’s illnesses. She knows that atrial fibrillation can turn into heart failure, and diabetes can cause kidney failure, and that arthritis just keeps getting worse if you’re overweight. She’s worried that her mom’s not taking good care of herself, and if she doesn’t, all these illnesses will keep getting worse and her mom will get hospitalized, or become disabled.
Plus, her mom seems so miserable all the time. She tries to put on a good face, but she gets so short of breath, and her knees seem to be aching all the time. Suzie worries that she’ll wind up needing to quit her own job to give her mother full-time care.
From everything Suzie’s read, the magic cure for nearly everything her mother has is exercise. It improves diabetes and high blood pressure and cholesterol, it helps keep arthritis from getting worse, and it would even help with the COPD. But it’s nearly impossible to get her mother moving if she’s not there with her, and she can’t be there all the time – she has a family of her own.
“Get her a smartphone and an exercise app,” her husband Ben tells her. “There are apps for everything – I bet there’s even one to help her remember her medications and show her how to manage diabetes. There are apps now for all the major chronic diseases.”
Susie’s skeptical. Her mother has an iPhone but hardly uses any apps, and never learned to text. But maybe if the app is really good . . . Susie tries one out on her own phone, entering in a few of her mother’s nine prescription medications.
She gives up by the third entry. They take forever to enter, and her mother only takes half a dose of one of them, and there’s no option for that. Besides, the doctors change her mother’s prescriptions often. There’s no way she’d remember to enter the new medication on her own, and she might wind up accidentally double-dosing because the app confused her. The apps for chronic disease are no good either – her mother has a half a dozen chronic diseases, and she won’t use a different app for each.
Susie tries talking to the doctor at the next appointment. “Do you know of an app that would help her keep her health on track?” The doctor looks distracted and shrugs. “There are a lot of apps out there. It’s impossible to keep up with them all. Just make sure she takes her medications and make sure she gets her exercise, okay?” The doctor whisks out of the room before Susie can reply.
She hates the doctor a little bit for being so blasé. “Make sure she gets her exercise.” Like it’s that simple. Sure, Doc, have you ever tried to nag your mother every single day about getting a walk in? How’d that go for you? When Susie tries to gently remind her, Joan often gets annoyed, saying it’s bad enough having all these health problems without her daughter hassling her all the time. “Don’t forget who raised you, Missy.”
That evening on the news there’s a segment about something called “digital health.” A CEO is interviewed, and he explains how technology is helping people manage their wellness and taking responsibility for their own health.
Susie scowls at the screen. Sure, each of those apps might work for one person, with just that one health problem – a person who is otherwise healthy. But for her mother? There’s no one making technology for problems like that.
Rings very true. Getting access to current medication regimen, and the whole proxy caregiver / aide scenario seems to get harder even as the apps get more useful. Patients are what the telcos call “the last mile” in the system, and that mile is getting longer.
What’s an app you’ve found useful?
Yes, agree that patients and families are a key part of the system…and their ability to take action is often a key constraint.
possibly behavioural economics would work…the technique is to give someone a reward and take away some of it when they do not act as desired. The problem is what reward would work in this case.
Could Joan offer to visit/take her out to lunch/once a week and then refuse to do it when her mother fails to exercise? Could she offer her mother a reward of $100 and reduce the amount by $5 everyday that she fails to exercise? do you have any suggestionsfor an effective reward…it probably depends on the individuals involved.
Thanks for sharing your comment here. I assume you mean could Susie offer to visit or take her mom out to lunch?
Hm…I’ll admit I’m ambivalent about family members incentivizing each other with cash…somehow it feels different to have an adult child offer to pay for a tool or service to help an aging parent. Am ambivalent about penalties too. As per the previous post, Joan is not exercising in part because she is feeling overwhelmed, short of breath, in pain, and perhaps also depressed.