GeriTech

ISO a tech-enhanced blood pressure cuff for older adults

April 4, 2014

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.

Example of Bad Design: This app’s interface for entering blood pressure

March 20, 2014

Here’s a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps:

I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at hand in sensible increments.)

You may think I’m being too picky, but I really think our ability to leverage technology will hinge in part on these apps and devices being very usable.

And that usability has to be considered for everyone involved: patients, caregivers, and clinicians.

Why am I looking at an app to enter blood pressure?

Let me start by saying that ideally nobody should be entering vitals data manually. (Not me, not the patient, not the caregivers, not the assisted-living facility staff.)

Instead, we should all be surrounded by BP machines that easily send their data to some computerized system, and said system should then be able to display and share the data without too much hassle.

But, we don’t yet live in this world, to my frequent mild sorrow. This means that it’s still a major hassle to have regular people track what is probably the number one most useful data for us in internal medicine and geriatrics: blood pressure (BP) & pulse.

Why is BP and pulse data so useful, so often?

To begin with, we need this data when people are feeling unwell, as it helps us assess how serious things might be.

And of course, even when people aren’t acutely ill, we often need this data. That’s because most of our patients are either:

Taking medication that affects BP and pulse (like cardiovascular meds, but many others affect as well)
Living with a chronic condition that can affect BP and pulse (such as a-fib)
All the above

As we know, the occasional office-based measurement is a lousy way to ascertain usual BP (which is relevant for chronic meds), and may not capture episodic disturbances.

So clearly, giving people the tools to measure at home is the way to go. And along with that measurement, we need to make it easy for them to record and share the data. Preferably in forms that allow graphical views. (I get hand-written BP logs all the time. They are a major pain.)

For a while now, I’ve been looking for a good BP monitor — one that facilitates data tracking and sharing –to recommend to my older patients…and I haven’t yet found it. (This is a problem I’ve been meaning to blog about and I will try to do so soon, as I’d like to explain why I consider options such as the Withings blood pressure monitor and the iHealth monitor unsuitable.)

The next best thing would be an app that makes it easy to enter and then share data. Now, I don’t like to use apps to solve this problem, because many of my frail older patients are not comfortable with smartphones and tablets.

Still, for those who can easily use a smartphone or tablet, using an app to track BP data could be easier than entering it into a spreadsheet in a computer.

Provided, of course, that one finds the right app. Because I can tell you, if I were faced with the scrolling wheel every time I was supposed to log my BP (or my mother’s BP), I’d give up pretty quickly.

Maybe that’s why people keep sending me handwritten logs?

Have you found a blood pressure tracker you like?

Ok, if you’ve found an app — or better yet, a tech-enhanced BP machine — that you like for easy tracking and sharing of BP and pulse, let me know in the comments please.

Bonus points if you’ve actually used, or witnessed someone using, your recommendation on a daily basis for at least a week.

Triple bonus points if that user was older and not terribly tech-savvy…I am looking for “universal” design here, as opposed to tools designed for the quantified-selfers and wellness junkies. Thanks!

Data on the Eldercare Workforce (including Family Caregivers) in California, & what it means

March 8, 2014

If you’re interested in how we care for aging people in California (or in the U.S., for that matter), you should definitely take a look at the latest set of briefs from the Eldercare Workforce Alliance.

I especially like that these reports have a whole section devoted to family caregivers, including an estimate of how many per state, and how many hours of unpaid care they are providing.

Must-see Data on Family Caregiving in California

Below are my favorite statistics from the California issue brief, which can be viewed here. (Emphasis is added by me.)

“Family caregivers in California— all 4,020,000 of them—provided more than 3,850 million hours of unpaid care in 2009. The estimated economic value of California family caregivers’ unpaid contributions in 2009 was approximately $47 billion.”

“Nationally, 46% of family caregivers performed medical/nursing tasks for care recipients with multiple chronic physical and cognitive conditions.”

Yes, you read that right. 4 million Californians are providing unpaid care worth $47 billion. And many family caregivers are performing medical/nursing tasks. (This is why I have a Geriatrics for Caregivers blog over at drkernisan.net.)

Other highlights from this California eldercare workforce brief:

Population aged 65+ expected to be 8,288,241 by 2030.

Compare this to a population aged 65+ of 4,246,514 in 2010, so we are talking about a 95% increase (!)

“Direct-care workers” provide 70-80% of the paid hands on care to older adults or those with chronic disabilities.

This kind of work is a quickly-growing occupation, however a shortage of direct-care workers is anticipated.

California projected to need an additional 2813 geriatricians between now and 2030.

We had 739 certified geriatricians in 2011. Our current shortfall is estimated at 1081. (However, this brief doesn’t explain how the right ratio of geriatricians to older adults is calculated.)

By 2030, the ratio of “potential family caregivers aged 45-64 for every person aged 80+” is likely to decline to 4.4 to 1

In 2010 this ratio was 7.7 to 1.

What this all means

The Eldercare Workforce Alliance’s press release states that “New issue briefs show need for investments in workforce specially trained to care for older adults and support for family caregivers.”

As far as I can tell, the press coverage so far has largely focused on the paid workforce, and less on how we might support family caregivers.

Building up the workforce — by supporting direct-care workers and by training healthcare professionals in geriatrics — is certainly very important.

But I would also argue that these reports support the following ideas which I’ve mentioned before in my blogs:

We should be teaching geriatrics to family caregivers. They are providing a lot of medical and nursing care, so they need training in how to adapt healthcare to “what happens as people get older.”

Just as we teach patients about their health condition, and how to care for themselves, we can and should teach family caregivers about geriatrics.
The goal is not to turn them into geriatricians or clinicians. The goal is to give them the knowledge and tools so that they can effectively help an aging adult with all the “self-healthcare” that is usually required. Also, if they know where to focus their energies, this might relieve a little bit of stress and anxiety for them.

We really need tech tools to help us implement geriatric care. These reports highlight just how many people are involved in health and healthcare for an older adult. They also note that much of this care is delivered to people with multiple chronic conditions.

We have historically relied on family caregivers to provide a lot of care to aging adults. Since fewer family caregivers will be available for each older person, we really need tools that allow everyone involved to do more with a given amount of time or energy.
We also need tools that address family caregivers’ needs for support and relief.

Innovators should be careful about developing a tech tool that is not usable by people with “the things that come up as people age.” I started this blog in large part because so many tech tools I come across seem not designed for people who have:

multiple chronic conditions
chronic physical impairments
chronic cognitive impairments
a caregiver often involved.

But in the future, many of us will urgently need tools that work for people with these issues. Hence it’s important that as many tech tools be “geriatrics-compatible” as possible.

So. I hope you’ll agree that the data demands tech solutions to make geriatric care more doable.

Now, let’s go bring the best of what we know in geriatrics to the tech & innovation community. And also to the family caregivers, who are likely to remain quite involved in eldercare for decades to come.

ISO A More Practical Way to Define Geriatrics

February 21, 2014

As I mentioned in my last post about health and aging, I’ve found over the past few years that many people aren’t quite sure of what geriatrics is, or how a geriatric approach might be relevant to their work in health or in aging.

This is understandable. After all, the term “geriatrics” is not widely used outside of healthcare. And even within healthcare, many doctors believe they are practicing geriatrics…when in fact they are just taking care of the elderly, in much the same way as they would take care of any adult.

And herein lies the rub. Geriatrics is not just about taking care of the health of aging people, it’s about how you provide such care.

The problem with explaining geriatrics as the health care of aging adults — or older adults — is that this definition is vague about what is different about this form of health care, and why it needs to be different.

So, I’ve been trying to find a way to be more specific about what geriatrics is, as I write for family caregivers and for the tech community.

Here’s how I explained geriatrics to an audience at the recent Health Technology Forum event about older adults.

A More Specific Definition of Geriatrics

I then presented a list of “issues that come up as people age.” This list emerged as I thought through two questions:

What kinds of problems are very common when it comes to the healthcare of aging adults?

What kinds of things trigger the need for a “geriatric approach”? By which I mean, what kinds of issues require healthcare professionals to provide care that is different from what we provided to people when they were younger?

Connecting Health, Aging, Geriatrics, & Innovation

February 7, 2014

What exactly does geriatrics have to do with the buzzing areas of innovation in aging, and in health care?

Several months ago, at a Bay Area gathering related to innovation and aging, I remarked to one of the organizers that these events generally didn’t seem to include much conversation about the health needs of older adults.

“Oh, we’re not doing health. We’re doing aging,” was the reply.

Ah. I see.

I was a little surprised by this statement, but not very. Obviously, if you are a hammer, everything tends to look like a nail. I’m a physician specialized in the care of aging adults, so when I look at an elderly person, I see the underlying health concerns and age-related vulnerabilities.

But over the past several years that I’ve been talking with people interested in “aging” (e.g. in public health school, at the caregiving website where I used to write, and now with the entrepreneurs and innovators wanting to serve the “aging market”), I’ve noticed two recurring issues:

People often think of aging issues and health issues as different topic areas. Because of this, people offering to help with life problems in aging adults often don’t make as many connections to health issues as they could.

Consider an older person who is having trouble with shopping and cooking. Sure, you can arrange Meals on Wheels, or get a care circle to start helping with the groceries, or you can might even consider assisted-living. (And if you are a worried family caregiver losing sleep over this situation, you should definitely seek out support.)

But what about the health problems contributing to this functional decline? Is there cognitive impairment? Poorly treated arthritis pain? Fear of falling?

The ideal way to help such an aging adult is to integrate the social and life interventions with the right type of medical evaluation and interventions.

People don’t understand what geriatrics is. Ergo, they don’t understand how what we know and do might be relevant — and useful — to what they are trying to do.

Oh sure, some people know that geriatrics has something to do with taking care of the elderly; a well-informed minority even know that geriatrics is the health care of older adults.

But, really, what does “health care of older adults” mean? This definition is vague about who’s an older adult, what makes aging adults need changes in health care, and what constitutes said health care.

Connecting Life, Health, and Aging

Recently I was invited to be on a panel about aging, health, and technology. The event was titled “Challenges & Opportunities in Developing Products for Older Adults,” hosted by the Bay Area Health Technology Forum.

I decided to see if I might be able to address these two issues during my ten minute talk to the group.

Here is one of my slides from my talk:

Thoughts? Feedback? Please post in the comments below!

(PS: I also experimented with a different definition of what is geriatrics in the talk. I’ll write about that in an upcoming post.)