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In Search of Technology that Improves Geriatric Care

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Pew Publishes Report on Family Caregivers

I’ve been a fan of Pew’s reports on health and the Internet for quite some time, but now I’m a superfan.

Just today, Pew has published a health report focusing on caregivers: Family Caregivers Are Wired for Health. Based on survey data collected in Aug-Sept of 2012 from 3014 adults, Pew found that 39% of respondents were caring for an adult or child with significant health issues.

The whole report is interesting, but here are some particular findings that caught my eye:

  • Pew’s survey found that 30% of adults were caregivers in 2010, compared to 39% now. 
    • This strikes me as a big jump; I’d love to eventually learn more about just what went into this increase. (Is an aging population and increased chronic disease burden enough to explain such a jump in 2 years?)
  • 86% of caregivers have Internet access; of those, 84% went online to research health topics. In comparison, 64% of non-caregivers with Internet access went online to research health topics.
    • I’m not surprised that caregivers are doing more research; families often seem more worried to me than patients do.
  • 39% of caregivers are helping to manage medications. 
    • The report doesn’t say how many medications they have to manage. But if you have someone else involved in your care, I’m guessing it’s a lot of medications. I’d love to eventually find out how many meds caregivers deal with on average.
  • Caregivers are more likely than non-caregivers to tap both online and offline information sources, such as clinicians, friends/family, or patient communities. Pew reports that “thirteen percent of caregivers were in contact with a clinician both online and offline, compared with 5% of non-caregivers.”
    • This is good, 13% of caregivers with access to clinical help online and offline. But we need to make it better.
  • One in three caregivers tracks a health indicator for a loved one. Of these, 44% track in their heads, 43% use paper, and 8% use an app.
    • As a clinician, I often rely on caregivers to give me the information I need to help address their loved one’s symptom. We definitely need to make it easier for them to track on paper or electronically, as this supports better clinical collaboration between patient, caregiver, and clinician. 
  • 41% of the caregivers who track end up sharing the tracked information with another person. More than half of the caregivers who track report sharing the data with a health professional.
    • This is good and I hope to see these numbers go up over the coming years. 

Unfortunately, although the demographics of the caregiver respondents are laid out, the main report doesn’t list the demographics of the care recipients. So, I don’t know just what proportion of these respondents are caring for elderly people, but presumably many respondents are caring for someone aged 65+.

All in all, this is a fascinating report and hopefully will generate some much needed attention to the need to educate and support caregivers.

If this topic is of interest to you, I’d also urge you to read Susannah Fox’s related blog post at e-patients.net, which is here. In it, she remarks

“Let’s stop there and consider: we have a large and growing group of people who are trying to conduct on-the-job training for themselves using the internet. They are more likely than other adults to have internet access and a mobile device. Many of them act like the kid who sits in the front row of every class, taking copious notes, clapping erasers for the teacher (anyone younger than 40, ask an older friend to explain). And yet if this report could be seen as a report card for how we as an online community are serving them, frankly it’s a D+.”

I myself am not sure just what grade I’d give the online community and digital health community when it comes to supporting caregivers…

But I think we can all agree that caregivers are very important, especially to those of who serve the elderly. Caregivers certainly need better support, education, and tools. This report should help spur additional attention to this essential issue.

Nice work, Pew!

GeriTech’s Top Picks from AARP’s 2nd Health Innovation@50+ LivePitch

On May 31st, AARP hosted its second annual Health Innovation@50+ LivePitch event. I wrote last fall about the ten companies that AARP had considered most promising for its first LivePitch event. In this post, I’ll present the second slate of 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. First, 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. The companies must be fairly small (less than $5 million in funding so far) and prepared to launch their product within one year of the event.

AARP’s list of this event’s ten finalists is here.

GeriTech’s quick take on the AARP LivePitch finalists

Here’s a short synopsis of the companies/products presented at the LivePitch event, along with my initial reactions.

  • Adhere Tech: Patented smart pill bottles that measure how many pills in bottle in real time, send the data into the cloud, and reminds patients to take meds via phone call or text. Works for liquid meds too. Info sent wirelessly via cellular radio signal.
    • I’m very interested! As a practicing doctor, I’m constantly struggling to find out just what medications my patients are taking (which is not always the same as what has been prescribed, although that info is very important too).
    • If this could provide clinicians — at the time of the visit/encounter — with an up-to-date list of meds being taken, this could really improve care for older adults.
    • This also sounds like it could address the issue of tracking PRN medication use; very important for pain medications, insulin, etc.
    • How do they send info to the clinicians? Their website doesn’t say.
  • Caremerge: Communication and care coordination platform for assisted-living facilities. Meant to improve communication within facility, with family of resident, and with external clinicians and providers.
    • Good concept, unclear how well they will be able to execute when it comes to real-world usability for external clinicians. Last fall I mentioned Caremerge in a post about the difficulties I have with care coordination for patients in assisted living; among other issues, these older patients often have SEVERAL other doctors and offsite providers (home health care agencies, private caregiving agencies) that I need to communicate with. I’m a bit skeptical that all will be willing to connect via the facility’s platform.
    • On their website’s section on clinical collaboration, Caremerge promises to “eliminate phone tags and faxes with offsite Providers (PCP’s, Specialists, Therapists, etc.).” Would be nice to see more specific information on how collaboration with the facility would work for the PCP. I’m guessing it involves inviting the clinician to log-in to the platform; unfortunately I doubt most doctors will be willing unless they have a lot of patients at the facility. It’s after all easier to just send a fax! As for sending messages, I might use an assisted living facility’s platform, but the busy neurologist I’m coordinating with probably won’t.
    • For specifics on what I regularly struggle to communicate with facilities about, see this recent post.
  • CoPatient, Inc: Service that identifies medical billing errors and sorts them out on behalf of the patient. Saves patient time, hassle, and reportedly money as well.
    • Sounds like it could be useful to patients, assuming it works as well as advertised. But not very relevant to helping geriatricians coordinate with older adults and caregivers.
    • The main insurance/financial issues I regularly run into relate to understanding how much a drug or assistive device will cost a patient. Having this information at point-of-care could help clinicians and patients better work out a feasible management plan.
  • HomeTeam Therapy: Service using online video and Microsoft Kinect to help patients with their home physical therapy exercises. Seems meant to be used in combination with (or as a follow-up to) in person PT sessions.
    • Could be useful, as I’m sure most patients have difficulty sticking to their home PT exercises.
    • Unclear how suited it will be to a frail older population. All the patients visible on the company’s website are young and athletic looking.
  • LabDoor: Service providing independent evaluation and grading of dietary supplements. Grades products based on safety and efficacy.
    • Not particularly of interest to me unless the service will also make it easy for patients to tell their clinicians what supplements they are taking.
    • In general, the biggest problems I face regarding supplements is 1) knowing what patients are taking, and how much of it; 2) spotting any interactions with their prescriptions, or dangers related to their health conditions; 3) getting some patients to stop taking mega-doses of certain vitamins. (Neat recent NYT op-ed summarizes some of the problems with vitamins.)
  • Life Vest Health: Service allows people to track health and create cash incentives related to following-up with health goals.
    • Hm. I can’t see my elderly patients using such a service, but perhaps this kind of gamification-incentivization of health will end up being more powerful than I realize.
    • Do we really want health to equal money? And will equating it to money result in lasting behavior changes?
  • Lively: “Activity-sharing” service, uses passive activity sensors in the senior’s home, and makes it easy for families to send pictures and news by snail-mail to their older loved one.
    • Hm. If one wants to keep an elder health, safe, and independent for longer, I don’t know that a passive physical activity monitor is the first thing I’d recommend. (I’d consider wiring up the medication box and arrange for daily social/physical activities instead.)
    • I recently wrote about whether passive activity monitors will help elders remain safe at home longer. It certainly seems that these devices might provide some reassurance to family caregivers, and there’s something to be said for this. Also, although there are lots of benefits to having a live person visit a senior regularly, it’s true that many seniors resist the idea. (Plus it can be expensive to pay someone, if there is no friend/family member available.) So a passive activity monitor might be seen as a cheaper and more acceptable alternative. I just don’t know that it will allow older people to remain safe at home for longer though.
  • SoundFest: Creator of RealClarity, which uses a smartphone app and a special bluetooth earpiece to provide hearing assistance. In other words, a hearing aid that doesn’t look like a hearing aid. Reportedly more affordable than conventional hearing aids.
    • Cool! If the product actually provides good hearing assistance, this will be a huge improvement over the current cumbersome process of referring patients for audiology and hearing aids.
  • Veristride: High-tech shoe insole which pairs with smartphone app to provide user with feedback on gait and mobility. “We seek to allow older adults to evaluate, track, and improve mobility and stability in the comfort of their own homes and communities.”
    • Hm. Obviously gait problems and mobility issues are very common in older adults, and primary care clinicians could use some help with evaluation and management. However, a high-tech insole can’t complete an evaluation on its own — it won’t identify problematic medications for instance, although clinicians often don’t identify these either. Also unclear to me how the assessment of the insole would compare with the assessment of a trained physical therapist.
    • What is this company’s strategy for relaying information from the insole back to clinicians?
    • Seems the product was originally developed to help people — presumably younger — after amputation. Remains to be seen how helpful this product is in the average elderly person, who often needs a multi-modal intervention in order to improve safe ambulation and reduce fall risk.
  • Wello: Online service allowing people to work with a fitness trainer via video, from the comfort of their home. Sessions can be one-on-one or small groups.
    • I have many older frail patients who no longer drive but need exercise. Unclear from Wello’s website if their trainers offer exercise programs tailored to the needs of the elderly. Could be useful for younger seniors however.
    • Would be interesting if some of these video-based trainers developed expertise in remotely helping on-site caregivers do an exercise program with an elderly person. Many elderly people have a family caregiver or paid caregiver present in the home, but this person doesn’t quite know how to help the older person with an exercise program.

What I’m most interested in

Definitely AdhereTech, provided the technology is affordably priced. Keeping track of whether a patient is taking medication, and how much he/she has taken, is a *huge* issue in primary care of older adults.

Blood pressure too high? Well, is he taking his prescribed diuretic? (Often no, because older people are already struggling with frequent urination issues). Still complaining of pain? Well, has she been taking the acetaminophen 500mg three times a day as I suggested last time? Hm, let’s look at the bottles. Ma’am, show me what you take. Oh wait, you’ve been taking aspirin three times a day for pain? (This actually happened to me the other day.)

And if AdhereTech can figure out how to track how much insulin a patient has been taking, that would be hugely helpful. I have come across so many patients who have been told to give themselves a little extra insulin when their sugar is high, and then when they come to the visit and we discover occasional hypoglycemia (or chronic hyperglycemia), they are unable to relay just how much insulin they’ve been taking and how often. A dangerous and difficult situation that we sorely need technology to help us with!

Next most promising to me is SoundFest’s RealClarity hearing product. Many older adults struggle with their hearing, and historically getting them an audiology evaluation and possible hearing aids has been a considerable hassle. So it would be terrific if a smartphone-based product made it easier for patients to have their hearing evaluated and assisted.

And which companies won at LivePitch?

The same company won the judges award and the audience award: LabDoor.

The judges, one should note, have experience in healthcare tech entrepreneurship and business investment. (See here for the list of judges and their bios.) As with the first LivePitch event, there were no clinicians, geriatric care managers, or other front-line health and aging problem-solvers invited to judge these innovations in healthcare technology.

This is a little disappointing to me, but not surprising as no start-up can succeed unless it’s promising from a business perspective. Although older people — and those of us who serve them — face lots of important health problems that tech could solve, the business case is often very difficult.

As for LabDoor, what can I say. Supplements are very popular, so a good service helping people with supplements should be appealing to consumers and to investors, who care more about whether people buy than whether something is objectively helpful to their health.

Maybe LabDoor will eventually consider helping consumers and clinicians connect over what supplements a patient is taking? Even enabling patients to bring in a printout of what supplements they are taking would be helpful to clinicians, and could improve healthcare for the patients.

In the meantime, I’ll be keeping an eye out for AdhereTech and SoundFest in particular, and look forward to seeing how all these companies’ products evolve over the coming year.

Designing for Caregivers of Elders

[This post was first published on The Health Care Blog on 5/25/13. See the comments for a short response from Microsoft Healthvault’s Sean Nolan. (Thanks Sean!)]

What user personas do healthcare technology designers and entrepreneurs have in mind as they create their products? And how often is it the family caregiver of an elderly person?
This is the question I found myself mulling over as I wandered around the Health Refactored conference recently, surrounded by developers, designers, and entrepreneurs.
The issue particularly popped into my head when I decided to try Microsoft Healthvault after listening to Microsoft’s Sean Nolan give a very good keynote on the perils of pilots and the praises of platforms (such as HealthVault).
As some know, I’ve been in search of apps and services that can help older adults and their families keep track of lengthy and frequently-changing medication lists. For years now I’ve been urging family caregivers to maintain some kind of online list of medications, but so far I haven’t found a specific app or service to recommend.
Why? Because they all require way too much effort to enter long medication lists. Which means they are hardly usable for my patients’ families.
Could HealthVault do better? Having heard generally promising things about the service these past several months, I signed up and decided to pretend I was the daughter of one of my elderly patients, who had finally decided to take Dr. Kernisan’s advice and find some online way to keep track of Mom’s 15 medications.
Sigh. It’s nice and easy to sign up for HealthVault. However, it’s not so easy to add 15 medications into the system. When I click the “+” sign next to current medications, I am offered a pop-up box with several fields to complete.
I can’t help but think that when HealthVault’s UX team worked on this, they must not have considered the case of the 58 year old woman trying to enter the lengthy med list for her 85 year old mother.
This is too bad, because if they had considered the caregiver of an older adult, they surely could’ve come up with some better options. For example, consider what happens when one signs up for a new social media platform these days. Usually, the service offers to connect to one’s email account or contact list to conveniently import useful information.
Similarly, if HealthVault had designed with lengthy medication lists in mind, they might have immediately offered the option to import medications from one of their major pharmacy partners, like CVS or Walgreens. (Oh wait. Looks like Walgreens and HealthVault broke up recently. Bummer.)
Unfortunately, as far as I can tell, most companies don’t seem to have considered usability with the needs of an older medically complex patient in mind, unless they are specifically focused on the aging/caregiving market. (And even then, I’m not always sure the design can stand up to the medical complexity of these patients.)

How to help healthcare tech companies design for the older medically complex patient

The number one health services problem facing the nation is how to provide compassionate effective healthcare to the growing Medicare population, at a cost we can sustain.
Healthcare technologies companies often gravitate towards wellness, prevention, and serving a relatively young, tech-savvy population. But if they really want to serve the needs of society, they need to help those patients who are the chronic high utilizers: the elderly.
How to design for these older patients, and the family caregivers who are often their proxies in healthcare?
Developers and designers would need to start by better understanding how usable their product feels when used on behalf of someone with multiple conditions and multiple medications.
(Of course, in an ideal world the product would be designed to be usable by the elderly themselves, but let’s start with the simpler scenario – and currently relatively common scenario – in which young and middle-aged adults use healthcare technology on behalf of an older loved one.)
Here are three things that designers of healthcare tech tools should do:
  • Create a “family caregiver for a medically complex older adult” user persona. In my experience, family caregivers are pretty stressed and overwhelmed by the substantial job of managing an older person’s healthcare. They need help, and that help needs to be easy to use. Hence, I’d be surprised to see them adopt any product that requires labor-intensive data entry.
  • Involve caregivers of medically complex elders in the user testing of your product. See what happens when caregivers try to use the product on behalf of an elderly person.
Of the three ideas above, the second will probably be the most difficult for companies to implement. That’s because a realistic sample data set for a medically complex patient is hard to generate from scratch.
One possible way to tackle this would be for some larger entity governmental or non-profit entity to create this, and then distribute to designers and developers so as to help them serve this critical user demographic.
Can anyone think of a way to encourage medically complex patients to volunteer their de-identified data?
Other ideas on how to encourage developers and designers to create products that work for the caregivers of the elderly?

Medicine in Denial: What Larry Weed Can Teach Us About Patient Empowerment

[This post, which was first published on The Health Care Blog on 5/22/13, is the third and final part of a commentary on “Medicine in Denial,”(2011) by Dr. Lawrence Weed and Lincoln Weed. You can read Part 1 here and Part 2 here.]

It seems that Dr. Larry Weed is commonly referred to as the father of the SOAP note and of the problem list.

Having read his book, I’d say he should also be known as the father of orderly patient-centered care, and I’d encourage all those interested in patient empowerment and personalized care to learn more about his ideas. (Digital health enthusiasts, this means you too.)

Skeptical of this paternity claim? Consider this:

“The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.”

“Our job is to give the patient the tools and responsibility to organize the knowledge and slowly learn to integrate it. This can be done with modern guidance tools.”

These quotes of Dr. Weed’s were published in 1975, in a book titled “Your Health Care and How to Manage It.” The introduction to this older book is conveniently included as an appendix within “Medicine in Denial.” I highlighted it this section intensely, astounded at how forward-thinking and pragmatically patient-centered Dr. Weed’s ideas were back in 1975.

Thirty-eight years ago, Dr. Weed was encouraging patients to self-track and to participate in identifying the best course of medical management for themselves. Plus he thought they should have access to their records.

Fast forward to today. The Weeds’ book, appendix aside, contains many of the best ideas I’ve encountered regarding empowering patients and engaging patients.

This is because in the Weeds’ ideal world, healthcare would provide an orderly, consistent, dependable, and transparent infrastructure through which patients would move through as required by their medical needs, their preferences, and their goals.

The Weeds compare this vision of healthcare system to our existing transportation system. It’s an interesting analogy. They point out that travelers rely on expert service providers (i.e. pilots, travel agents, mechanics) as needed, but that the primary decision makers are travelers themselves, who are able to choose the destination, the route, and the mode of travel for a journey.

The Weeds use their transportation analogy to make a strong case for individualizing medical care according to patient preferences. They point out that two people driving across the country might choose completely different routes, depending on their preferences and needs, and that no one would expect travelers to conform to an “evidence-based” best route determined by experts.

They observe that similarly, no one should expect that two different people labeled with the “same” disease have comparable medical needs. They correctly note that “effectiveness is context-specific,” and that the patient really should be the one best positioned to determine effectiveness.

Hence the Weeds describe high quality, efficient care as emerging “case-by-case, each person finding a different pathway in a progression of many small steps, with each step carefully chosen, reliably executed, and accurately documented.” They also critique evidence-based medicine, which they feel interferes with the process of thoughtfully tailoring care to fit a patient’s uniqueness.

They propose that health care not be an “esoteric domain for specialized experts” but rather be seen as a “universal human pursuit.” They state that the health care system should be usable by ordinary consumers when feasible.

This is a very robust and well-articulated vision of healthcare that serves the needs and well-being of patients, rather than of providers. I especially liked the emphasis on patients learning to take an active part in individualizing the medical care so that it can best meet their needs, and would say this approach is essential if primary care doctors are to serve the role of expert consultants helping patients meet their health goals.

In fact, an entire chapter of “Medicine in Denial” is devoted to the need to develop a system of educating patients and helping them gain the skills to be more autonomous in healthcare. Particular good in this chapter is the Weeds’ explanation of why patient involvement is essential in two common medical situations: cases of medical uncertainty, and cases of chronic disease.

“In situations of uncertainty, the patient faces a set of choices, with substantial evidence for and against each choice based on the details specific to his or her own case. The physician cannot be relied upon to identify the individually relevant options and evidence without the right informational infrastructure. Once that infrastructure is available, reliance on the physician radically diminishes. The patient’s private judgment should control, as trade-offs are recognized, ambiguities assessed, and choices made. The choices are inherently personal.”

“[Chronic disease] cases start with great uncertainty, but often what needs to be done becomes reasonably clear from careful investigation and planning. Then the issue is execution, feedback and adjustment…It is the patient, not the physician, who must live with the risks, the pain, the trade-offs, the effort and time that decisions may entail…The patient is the one who must summon the resolve to make the behavior changes that so often are involved in coping with chronic disease. If the patient does not feel responsible for deciding what has to be done and is not heavily involved in developing the informational basis of that decision, then very often the result is “noncompliance” with doctors’ decisions.”

Given that in geriatrics, we are constantly trying to help patients navigate medical uncertainty as well as chronic disease, the above paragraphs really resonated with me.

Psst! Pass it on: patient empowerment is the underlying driver of “Medicine in Denial”

It’s this extremely patient-centered and person-centered vision of what healthcare should be that underpins the Weeds’ multiple detailed critiques of healthcare as we practice it now, and their proposals for how healthcare should be changed.

But it seems that “Medicine in Denial” has generally not been perceived as a book about transforming healthcare to support participatory medicine. For instance, Dr. Weed is not mentioned by name in e-Patient Dave’s recently published book “Let Patients Help,” nor is he mentioned in Eric Topol’s “Creative Destruction of Medicine,” two recently published books that emphasize the need for healthcare to provide more information and autonomy to patients.

This is too bad. Many people are currently in support of changing healthcare to better meet patients’ needs. But few have been as thorough, articulate, and perceptive about the obstacles to such changes. I’d also say that only a minority of writers seem to understand, as the Weeds do, the real challenges of managing multiple chronic illnesses over years.

Today we have a growing e-patient movement pushing for substantial changes in the patient-provider power dynamic. We also have the Internet making information widely available, as well as digital health technologies that can finally offer patients unprecedented assistance in accessing and organizing their own health data. Larry Weed was surely ahead of his time in 1975, but what about now?

Well, now it seems that Larry Weed is mainly thought of as someone who criticizes the way physicians approach diagnosis, or wants to reform the way they maintain medical information, or proclaims that all of medicine is in denial. This, I think, is in large part due to “Medicine in Denial” itself (starting with its title).

It’s a good book, but it is long, and feels somewhat sprawling. Who exactly is the intended audience? I found it a bit unclear. And what are the authors asking of the reader, other than to understand their analysis and agree that the profession of medicine is, in fact, in denial? The Weeds do describe how they believe medicine should be practiced, but the book lacks specific suggestions on how we might get there from here.

I found myself wishing the Weeds had worked more closely with an editor and – don’t laugh – some kind of a marketing or strategy consultant.

Because I think there is a market for their ideas, and that market is essentially the patients themselves, along with the patient engagement movement. It would be patients, after all, who have the most to gain from medicine adopting a more orderly and transparent approach to diagnosis and documentation. Likewise, it is the patients who have the greatest interest in chronic medical care being tailored to their individual needs, rather than proceeding according to evidence-based guidelines which may or may not be well-suited to their medical uniqueness.

So I found myself wishing that the Weeds would’ve addressed their book more directly to patients, and to those who are rooting for “disruptive innovation” in healthcare and hoping it will usher in a shiny new future of patient empowerment.

Summarizing my impressions of Medicine in Denial

My takeaway in assessing the contents of Medicine in Denial was this:

  • The Weeds’ vision of what healthcare should be is very sound, compelling, and in line with what many people – patients and healthcare experts – say healthcare should become. This book can and should be considered a manifesto for participatory medicine, especially since the Weeds do a particularly good job of emphasizing how we can individualize care according to the goals and preferences of patients.
  • The Weeds’ analysis of how the common practices of physicians – both in terms of cognitive work and of documentation — interfere with ideal healthcare is robust, detailed, and compelling. The flaws they identify in current practice are undeniably present and adversely affecting care. This should not really be a subject for debate (although it probably will be). The debate should be about what we can and should do to address these problems.
  • The Weeds’ proposals for alternative methods of delivering healthcare are intriguing, and deserve serious consideration. In this commentary I’ve touched on their proposals for how patients should be initially assessed (via standardized inputs and knowledge couplers, followed by clinical judgment and patient-provider collaboration), and how medical charting should be reformed to support comprehensive individualized care over time. Can these proposals really be implemented and operationalized at scale? I’m not sure, we would have to pilot the approaches, or better understand what happened in those smaller practices that Dr. Weed says adopted his methods several years ago.

In short, I believe Larry Weed and his son Lincoln are completely right about what healthcare should offer to patients, and what’s wrong with the way doctors practice now. Their analysis of what’s wrong touches on issues related to quality, outcomes, patient-centeredness, patient empowerment, medical education, the training of the healthcare workforce, and the personalization of medicine.

What to do about all that’s wrong about healthcare? These are the difficult questions that we are all wrestling with. I don’t know that implementing all of the Weeds’ ideas is the way to go, but I’d like to see their ideas being given more serious consideration.

“The religion of medicine is not feats of intellect. The religion of medicine is helping to solve the problems of patients, and the compassion involved in the very act of care.”

Words to change medicine by.

Will Activity Sensors in the Home Help Mom?

Lots of people are worried about aging parents who live at home, often alone. Could activity sensors in the home help?

Patients’ families have occasionally asked me about home sensors in the past, but I’m guessing this question will become much more common. After all, sensor technology is becoming much more affordable and easily available. And of course, many people want to help older adults remain safely in their homes. So there seems to be a market out there, and yesterday evening, at an Aging 2.0 event, I heard brief presentations by two companies developing home-based activity sensors targeting the aging market: Lively and Evermind.

With both services, sensors provide passive monitoring of an older person’s activity. Evermind uses sensors that are plugged into commonly used appliances. These track use of the appliances, and presumably would generate alerts if the use pattern were to change. Lively uses motion sensors in the home, which relay information to a nicely designed small base station with a cellular connection.

Both products seem to require minimal set-up or alteration to a person’s living environment. Evermind is still in development, so pricing and details are TBA. Lively is launching this summer, and will cost $149 for the equipment, plus a monthly subscription fee of $19.95. (Along with the passive activity monitoring, Lively’s service includes postal delivery of Livelygrams, which allow families to share news and pictures with their older loved ones.)

So, if you have an aging parent living home alone, should you get one of these activity monitors? Will it help?

The answer, of course, depends on how you define help, and just what problem you are hoping to solve.

What problems will activity monitors help solve?

As far as I can tell, these types of activity monitors mainly address the following problems:

  • Families feeling anxious about how an older person is doing. 
    • Activity monitors will let families know if the person is not moving around the home — or using applicances — as usual.
  • Older adults don’t like having to frequently tell their families that they are ok, or mind calls to check on how they are doing.
    • If activity monitors can be relied on to flag a change in status, then phone conversations can instead focus on telling stories, or other conversations that don’t highlight anyone’s anxieties about aging, safety, and possible decline/disability.

It’s also possible that these devices might help older adults feel more secure, knowing that someone will be alerted if they significantly change their activity pattern.

Is there clinical data on how activity sensors in the home actually affect outcomes and quality of life? I took a quick look in the literature and did not find much on outcomes, although I did come across this nice article in The Gerontologist which reviews some issues that clinicians should consider when advising families re smart home technologies. (The author mentions assisting with information gathering, ensuring comprehension, and ensuring voluntariness.)

Back to the original question: will activity sensors in the home be helpful to older adults as they age? Hard to say. The idea of smart homes and connected independence is compelling. And there is something to be said for products that provide some peace of mind.

But presumably everyone is also assuming that when these monitors flag a change in activity, someone, somehow, will intervene in such a way that allows the older person to live a better and more independent life.
In other words, along with reassurance, it seems to me that these products are implying greater safety for our older loved ones. (Kind of the way that those infant sleep monitors imply reduced risk of SIDS when in fact there is no evidence to support this.)

Here, I have to say that I’m a bit skeptical, and if a family asked me for ways to help keep their older loved one safer at home, I might first suggest things like assistance with medication (so many elders are on unnecessary and dangerous medications! and so many elders need to take certain medications daily in order to feel their best), optimizing physical function, reducing fall risk, social activities, and arranging for proper support of ADLs and IADLs. Come to think of it, if you want to monitor activity, why not wire up a medication dispenser, so that you can follow the activity pattern while still helping an older person and her clinical team manage the medication plan?

Bottom line: If an activity monitor isn’t too expensive, it seems reasonable to give it a try and see if it feels helpful. Family caregivers are often quite anxious to know how a loved one is doing, and anything that helps them cope with worry and the other challenges of caregiving should be taken seriously. However, I hope families won’t have overly inflated expectations of safety benefits, unless research demonstrates that outcomes other than anxiety are improved.