GeriTech

In Search of Technology that Improves Geriatric Care

Geriatrics Bound in Saskatchewan

[The following clinician guest post is by Dr. Magda Lenartowicz, an internal medicine resident in Saskatchewan, Canada. Thanks Magda!]


I am an internal medicine resident
interested in Geriatrics. No, scratch that, I am a resident GOING to be a
Geriatrician. In fact, I was an undergraduate student in Gerontology before
medical school, and I have had an interest in the care of older adults for as
long as I can remember.
I am also Canadian, and you will not find
one single “eh” in this entire diatribe. But I digress.
In the past year, I have had several people
question my resolve – “why would you possibly want to do Geriatrics?” And, I
have had my share of the not-so-subtle comments suggesting my interest in
“bowels and bladders” is not real medicine.
Ok, I am a big girl, I can take some
ribbing.
I choose to take this behaviour as an
opportunity to think about what my answer to this question really is.  Not just the off-the-cuff indignation I
sometimes feel, but the real reason I am so driven to do this.  The top two points that have come up so far are:
 a.)
I find Geriatric medicine to be complex, fulfilling, and one of the few
opportunities in modern medicine to practice a truly holistic type of medicine
(taking into consideration mental, physical AND social health),
and b.)… well, this is going to take a bit
more of an explanation.
I work in a province that has ONE, that’s
right, ONE board certified Geriatrician. There are several family practitioners
with additional training in the care of the elderly, but even they are not
enough. The province has a million people (yes, the entire province), of which
about 15% are over the age of 65, which means there is one Geriatrician for a
population of 150,000 – that’s not workable even if you only reduce this to a
subset of those over 80. This is farm country, and there are many very hale folks
over the age of 80 still living on farms. There are also many folks with
varying degrees of cognitive and functional impairment living independently on
farms. That is slightly more worrisome.
We do not have a Geriatric Assessment Unit
anymore – the 10-bed unit closed in 2009. Yes, you did read this right. In a province
with one Geriatrician and all those older people there is no place for older
adults to go. There were not enough doctors and others to sustainably staff the
unit. So now, our older folks stay in hospital, or if they are lucky, get moved
to the transitional care unit where they wait for long-term care. Those of my
patients who are elderly and cognitively impaired, but have no medical issues,
have absolutely nowhere to go. Those who DO have real medical issues have
nowhere to go once they have overcome their acute issues. Well, there is our
Geriatric Rehabilitation Unit, but it is very specific in what it offers and
again, does not have enough spots. So the worry becomes – will my older
patients succumb to a hospital-acquired ailment and die there, even though a
quick hospital discharge to an APPROPRIATE step down unit would have been
better? I think about this often.
As a cherry on top, our beautiful new
psychiatry unit has no acute beds for those with dementia. You are welcome to
figure out how this makes any sense. I still haven’t. I have had to assess
patients with dementia, deemed as “aggressive” and surrounded by guards, in our
ED’s psychiatry isolation room. When I talked to the patients, it turned out
the problem was being alone, disoriented, or overwhelmed. The frustration? I
had nowhere to send these people other than home or another tertiary care
hospital bed, a place where few people with dementia do well.
Yes, we do have Telehealth. We actually
have a very robust Telehealth network, and one of our neurologists and a team
of wonderful, dedicated folks puts on a very excellent Memory Clinic. Patients
love not having to travel hundreds of miles to their appointments, and when an
assessment occurs, everything is arranged for them in one day. The follow-up
takes place via Telehealth at regular intervals.
It’s so beautiful, it’s like poetry. Too
bad that funding is limited and not enough of those needing this service ever
get to use it. And I won’t mention home care at all because we don’t really
HAVE true home care visits by Geriatricians.
In one word, this is Geriatrics where I
work. Virtually non-existent. Yet we make it work, and the more I become
immersed in the minutiae of elder care, the more I WANT to take on that
challenge. I want to be a Geriatrician because there are so many things that I
can see myself changing.
So the b.) in my answer is: because there
is a need. Because when I took my oath I promised to be of service, not just self-service.
 My city is not the only place with a
dearth of Geriatricians, even large centers do not have enough physicians
interested in Geriatrics to meet the care demands of a growing 75+ demographic.
I’ll tell you what I do love about working
with older folks. I love the ability to make a real difference not just in the
office, but in their life in general. I love being able to take my time, and
really practice my art as well as my science. I especially enjoy working with
dementia patients and their partners in care, as hearing “This worked!” from a
caregiver or seeing a patient becoming less frustrated is one of the best
feelings in the world. And yes, I even love it for the bowelsJ Only fellow gastroenterologists will be able to share the rewarding
“I told you so!” when a delirium resolves simply because I prescribed some
Laxaday.
I have spent many years of my life being
embarrassed that my “talents” were in the social sciences, and not the “real”
science of physics, and math, and chemistry. I always loved the natural sciences,
but studying just those subjects felt empty unless I could combine them with
classes in medical anthropology, the humanities or linguistics. I hated rote
memorization and woke up when information lived for me, and you only get that
when you learn from people, not from books.
So now, that I am a little kinder to
myself, I see Geriatrics as that perfect canvas – being a poor visual artist,
Geriatric medicine allows me to join my patients in the creation of daily
masterpieces, one person at a time. 
[Magda Lenartowicz, MD is a second-year internal medicine resident in Saskatchewan, Canada. She divides her copious spare time between the Prairies and California, the home of her ever-patient better half. You can reach her at mlenartowicz[AT]gmail[dot]com.]

How to Help Families Assess Quality of Care

[This post was first published on The Health Care Blog on 6/27/13, titled How Patients Can Assess the Quality of Their Outpatient Care.]

Even before I launched my geriatric consultation practice, I found myself often poring over another doctor’s outpatient notes, trying to explain to a patient what the other doctor was doing.

Sometimes these other doctors were specialists to whom I’d referred the patient. But often they were simply clinicians – either previous PCPs or currently involved specialists — whose involvement with the patient predated my own.

Not every patient had questions and concerns about what their other healthcare providers were saying, and doing, but a fair number of them did. And family caregivers, in particular, were often concerned that perhaps their older loved one hadn’t been getting the “right” medical care.

These are, in truth, legitimate concerns patients have. In a busy outpatient setting, doctors often don’t have the time to explain the assessment and plan to a patient and family. And in many cases, the care that clinicians provide may not correspond to best practice guidelines – if applicable to the situation – or to the patient’s preferences and values.

So if you are a concerned patient or family member, and you’re not entirely sure about the medical care you’re getting, what to do?

Should you:
  1. Look up the provider’s quality ratings online, through a government, non-profit, or other website?
  2. Figure that the ACO or payer is on top of it, now that we are moving to pay-for-quality and fee-for-value?
  3. See what other patients have said about the provider’s care?
  4. See how many doctors are referring to the provider in question, and assume that if many doctors refer to this clinician, the clinician must be good?
  5. Look up your medical problems online, and try to determine for yourself whether you’d been getting the right medical care?
  6. Get a second opinion from another doctor?

My guess is that most patients and families end up trying one – or both – of the last options. In this post, I’ll explain why I’ve come to believe that facilitating second opinions is integral to empowering patients, and to improving the quality of outpatient care.

Why seek a second opinion

I don’t know about you, but when I’ve found myself trying to solve a problem in which I lacked adequate expertise, I’ve turned to a professional for help. (I haven’t had to do this for medical reasons in the past decade, but have done it for issues such as home renovation and website design.)

And in many cases, after meeting with an expert for a while, I’ve then turned to yet another expert to get an additional perspective on the issue at hand.

Why? Well, how else am I supposed to determine whether expert #1 is providing me with suitable expertise, especially if after seeing expert #1 I’m left with a nagging feeling that maybe this isn’t quite the help I wanted. In my case, the stakes have been my time, money, and satisfaction with the end product. But if it were a question of health and wellbeing, I’d probably be even more diligent about getting a second opinion.

Incidentally, this is how many patients and families now find me. They have been getting care, but they are either dissatisfied, or they’re worried that perhaps not all the right things are being done.

And so even though I’m happy to be a consultant to other doctors, I’m now mainly a consultant to elders and families. And just as I did when I was a PCP, I find myself spending a lot of time explaining to families what other doctors are doing.

This, I think, is good work to be doing. By looking over records and discussing a family’s medical concerns, here are the specific things I’ve found myself doing:

  • Reassuring families that the current medical treatment plan is reasonable. Often, in looking over the care, I find that the medical care so far corresponds to guidelines and common standards of practice. However, in many cases clinicians have not had time to explain their approach in depth to the patient and family. Families are often relieved to hear this, and appreciate developing a better understanding of their usual clinician’s plan.
  • Pointing out which aspects of the care plan are worrisome. Worrisome, as in really not concordant with guidelines or best practice. These include benzodiazepines for sleep in the elderly (with no discussion of the risks, or plan to avoid indefinite benzo use), or failure to initiate workup for an alarm symptoms such as significant weight loss. This also includes failure to follow-through on a plan; I’ve come across some charts in which the PCP repeats the same plan to get labs or pursue a study, at every follow-up visit. (In one case, the patient’s family had no idea that this was the plan.)
  • Pointing out medications, procedures, or other medical interventions that are likely to be of marginal benefit. This comes up quite a lot in frail elderly patients, because many common approaches in general medicine require time to benefit (i.e. statins, tight glucose control). In other cases, clinicians have developed the habit of referring patients for tests that research has shown to not be so helpful, such as screening for asymptomatic carotid stenosis.
  • Pointing out which aspects of the care plan could be considered choice and preference sensitive. There are some things in medicine that definitely should be done. For example, if an older person has a loud murmur and shortness of breath on exertion, he or she should almost certainly be sent for an echo, to evaluate for symptomatic valve disease. But for many other things, especially when it comes to elderly patients – or patients of any age, in truth – there are many possible ways to proceed, all of which could be considered reasonable. Back pain without alarm symptoms? One could refer for physical therapy, or prescribe analgesics. Or do both. Ideally this would depend on the patient’s preferences and particular circumstances. But in common practice it seems to depend more on the style of the clinician.

 

Why we should make it easier for patients to get second opinions

The main reason to do it relates to last point above: we should enable patients to get a second opinion because often there is no definite right way to proceed medically, and so how to proceed is essentially a judgement call.

And without access to second opinions, it will be very difficult for patients and families to determine which aspects of their medical care involve judgments calls.

Now, in an ideal world, this wouldn’t be an issue because clinicians would be able to consistently let patients know which aspects of the treatment plan consist of judgment calls, and would always offer patients the option of shared decision-making for these situations.

But the real world is different. Most clinicians are not used to presenting patients with options, and then tailoring the care plan to meet the patients’ preferences rather than a clinician’s habits. If nothing else, doing so takes time, and no clinician has much time these days. So judgment calls proceed according to the clinician’s judgment and preferences, in accordance with our time-honored habits of letting doctors decide because presumably they know what’s best for the patient.

Except, they often really don’t know what’s best, or even better. Among other issues, in many cases clinicians have not had the time or inclination to develop a good understanding of the patient’s experience. To quote from Dr. Larry Weed’s “Medicine in Denial”

“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.”

On their own, patients experience pain and effort. But they may not be aware of trade-offs, risks, and alternative options. For that, they need more information, and although some of it can be found through diligent searching online, they should also be able to access an expert who can synthesize information and tailor it to the situation at hand.

In this way, patients and families can be empowered to check on the quality of their care, and can identify other courses of medical treatment may be a better fit for them.

Barriers to second opinions and how to overcome them

There are, of course, some barriers to making high-quality second opinions more easily available to patients. They include:

  • Difficulty accessing patient data and bringing it to another clinician. My own work is often held up by the effort of obtaining records and information from other clinicians. Patients should be able to access and collect their own healthcare data, as this will facilitate care coordination and empower patients to participate more in their own healthcare. (Give ‘em their damn data!) But until this is widespread, the challenges of health information exchange make it hard to have another clinician weigh in on one’s care.
  • Inadequate clinical documentation. Even when one manages to get information from another clinician, it’s usually quite hard to tell what the clinician was really thinking or planning to do. Before templated EHR notes, the problem was that notes were very short and uninformative. (See Larry Weed’s 1971 grand rounds for a hilarious and biting critique of clinical documentation. Sad to say that things have not yet improved much.) Now that EHRs provide templates, I receive notes with lots of text and still have no idea what is going on. Plus some of the information is quite frankly wrong, presumably because the clinician has checked too many boxes in a hurry.
  • Difficulty accessing and identifying a suitable expert. Even when patients have gathered the right medical information, they may often find it difficult to access someone for a second opinion. Academic clinics often have long waits for an appointment. Clinicians who are not subsidized by a larger institution may not offer appointments that are long enough to allow for review of a complicated medical situation.

Summing it up

Second opinions can help patients and families check on the quality of their care, in real-time. This can reduce a family’s anxiety about ongoing medical care, and can help patients better understand the care they’ve been receiving.

Although occasionally real gaps in care are uncovered, in my own experience I’ve found that second opinions mainly help patients and families identify other management approaches which their previous clinician may not have discussed with them. For older patients in particular, care should be individualized and tailored to the patient’s – and caregivers’ — needs and preferences. Historically clinicians have tended to dictate care according to their own habits and preferences, in part because shared decision-making takes more time. Second opinions can help educate patients, and empower them to better individualize their care.

Barriers to faciliating second opinions include difficulty accessing clinical information in the possession of other providers, as well as inadequate information within the progress notes. Last but not least, patients may currently find it difficult to find a provider willing and qualified to provide a second opinion.

Thoughts in response to the NYT post

This past week, the NYT New Old Age Blog featured a post about me and my practice. Titled “Walking Away from Medicare,” it describes my decision to opt-out of Medicare and create a different kind of geriatric practice.

It has generated quite a lot of comments: 163 at my latest count. Most of them judge me pretty harshly. It seems that many people feel that I’m doing this for the money. And that I don’t care about society or older people.

Of course, if you know me or if you’ve been reading this blog, then you’ll know that nothing could be further from the truth. My practice is fairly small, in part because my goal in having this practice was to have a way to keep working with patients and families, while having the flexibility to pursue my other professional interests. Since I started the practice, I’ve spent most of my time writing for this blog, learning about the worlds of digital health and healthcare innovation, and thinking about how we can teach geriatrics directly to caregivers.

Although I’ve phased out working with Caring.com, I’m thinking about how I can build on what I learned there, and keep connecting caregivers to resources that leverage geriatrics expertise.

This morning, I gave a talk to a group of family caregivers, at a retreat sponsored by Family Caregiver Alliance. We talked about what caregivers should know about the geriatric approach to care, and how they can learn more about medical care that is tailored to the needs of aging adults. We talked about delirium, and how caregivers can recognize it and get better help from clinicians.

We talked about participatory medicine — they were all savvy, experienced caregivers but none had heard of the e-patient movement — and the Beer’s criteria, and then we got into how tech tools might help caregiving feel more manageable. (More on those in future posts!)

I loved every minute of it, doing this session with family caregivers. I can’t wait to participate in more events with caregivers.

So why am I writing all this? Mainly because I hope to illustrate in a time of geriatrician shortage, there many ways we can be of service to society, even if we make the decision to leave Medicare, or otherwise aren’t as available to serve patients in a one-on-one fashion.

The Future of Geriatrics 

Just for the record, I don’t think the future of geriatrics should be that geriatricians leave Medicare en masse and require that patients pay them an hourly rate, out-of-pocket, for services.

Instead, I hope my own story and struggles will foster more conversation on the following topics:

  • How should we — as a society — best deploy a very limited supply of geriatricians, given an aging population and inadequately prepared healthcare workforce? The projections are sobering. 
  • How can we make practicing geriatrics attractive and sustainable for geriatricians? Most geriatricians I know love caring for older adults, but many complain of stress and burnout. (Some have emailed me this past year, having heard of my practice.)
    • What changes to reimbursement or work structure would attract more clinicians to geriatrics? 
    • How can we make practicing geriatrics within Medicare feel more sustainable? (Answer: we may need to think beyond debt relief and 10% salary increases.)
  • How can we make geriatric care doable for ALL front-line clinicians? As people age, they benefit from a geriatric approach to their care. And for the foreseeable future, that approach will have to be delivered by non-geriatricians: the primary care clinicians who will hopefully have had some geriatric training, but didn’t do a fellowship.
    • With front-line clinicians already suffering from high levels of burnout and dissatisfaction, how can we support them in effectively caring for a growing number of older patients? 
    • Earlier this year I proposed that the job of PCP for complex Medicare patients be doable within 35 hours, which could help retain all those empathetic clinicians with young children. Other ideas?

Food for thought and future conversations, I hope.

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.