GeriTech

In Search of Technology that Improves Geriatric Care

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

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

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

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

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

How PCAST framed its report

PCAST identified four areas of change in aging, which offer opportunities for technology to help: [Read more…] about New PCAST Report on Independence, Technology & Connection in Older Age

Aging in Place: What are the problems to solve?

I came across a thought-provoking report recently, titled “Technology for Aging in Place 2016,” by Laurie Orlov, a market analyst for aging technology. The report seems to be an update to her 2014 report on aging and technology, which I commented on in this post.

As always, I’m interested in how business people conceive of needs and approaches to solutions, and how that compares to our view of the needs and issues as aging health professionals.

A striking fact which I hadn’t previously appreciated is that many older adults remain in their homes while aging because they can’t afford to move elsewhere. Per Orlov:

Median net worth of the 75+ age range is now $156,000, inclusive of home equity (see Figure 1). This is deferring moves to assisted living – its move-in age now a mid-80’s and frailer demographic. But boomers are right behind them – and even less able to move in. They have simply not saved enough – holding an average retirement savings portfolio of only $136,000 – enough for just two years of a private assisted living community like Brookdale.

Orlov also cites this AoA data summary, which reports that

  • About 28% (12.5 million) of noninstitutionalized older persons live alone (8.8 million women, 3.8 million men).
  • Almost half of older women (46%) age 75+ live alone.

In short, we have a growing population of older adults, many of whom have limited financial resources, and many of whom live alone in the community.

What percentage of older adults are living in their own homes was unclear to me; Orlov states “Eighty percent of older adults today live in their own homes,” however the reference provided does not address this particular statistic.

To me, “living in your own home” means you own the home. I did find a very good report on aging and housing from Harvard’s Joint Center on Housing Studies, which notes:

Among those aged 80 and older in 2011, fully 60 percent had lived in the same residence for 20 or more years. Another 18 percent had occupied their homes between 10 and 20 years.

However this data is from the American Housing Survey, so presumably it is referring to older adults who are already in community housing, as opposed to all older adults.

The NIA report “Growing Older in America” does provide data on living situations and says 79% of older Americans live in their own homes, however this report is based on Health and Retirement Study data from 2002, and 2002 is starting to feel like a long time ago. Hence, I am still left wondering just where older adults are living, and it would be nice to see updated data addressing this issue.

The most important questions to ask, to address aging-in-place

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The geriatrician & social media: On goals & motivations

Social media

Patricia Bach, a geriatric psychology colleague who is active in social media, recently emailed me a question: how to encourage more clinicians in geriatrics and long-term care to use social media?

In particular, she asked me “What do you feel is the ROI for geriatricians to use social media/networking in their professional roles?”

This is an interesting question to consider. After all, we have a limited number of geriatricians available for a growing older population. We also each have only so much time and energy in every day.

So how should each of us be spending our time? How much should be on social media, and do we all need to be using it?

I myself really like blogging — obviously — but was a reluctant adopter of shorter-form social media. To this day, I have a minimal personal social media presence. I only got going on Twitter because I started this blog in the fall of 2012. For me, Twitter was a good way to learn about digital health and connect with others interested in tech and aging.

Then I started using Facebook in 2014, mainly because I was focusing more on my geriatrics content for the public, and at that time Facebook seemed to be a better platform for interacting with the general public, compared to LinkedIn or Twitter. (I would say this is still true.)

In adopting social media for these reasons, I was manifesting something that is very important to consider when it comes to physician behavior — or really any person’s behavior — with a respect to engaging in a certain activity:

  • What are the most important motivators and interests for the person? What are they most eager to accomplish? How does the activity address those?
  • What are the demotivators? What are the downsides to engaging in the activity?
  • How much friction or difficulty is involved in engaging in the activity?

You can also consider an activity in terms of “Return on Investment” (ROI), however, this term doesn’t usually take into account how soon the return is going to arrive. And we know that people are much more motivated by concrete returns that happen fast — and are related to something currently of great interest/appeal/fear to them — whereas they discount returns that are coming way off in the future.

Social media is about communication and networking

Back to social media itself. It is fundamentally about communicating and networking. So to use it sensibly, I recommend individuals — or larger entities — consider the following: [Read more…] about The geriatrician & social media: On goals & motivations

How many phone calls & faxes does it take to evaluate a common complaint in assisted living?

If we are going to provide compassionate and effective care to an aging population, at a cost we can all afford, we are going to have to get better at dealing with health concerns that come up often.

I am perpetually struck by how much effort and friction is involved, when I have to address certain common health issues.

Today I’m going to share a recent example: new confusion in a 90-year-old elderly woman who lives in assisted-living. Goals of medical care are to avoid hospitalization, and to focus on optimizing function and comfort.

Brief backstory: this elderly woman has Parkinson’s disease, but generally has very good cognition. She has private 24-hour caregivers because she can’t get up out of chairs on her own, needs stand-by supervision when she gets around her apartment with a walker, and needs to be taken by wheelchair to the dining hall and other locations within the facility. She also needs help with continence care. And, she’s been getting home health services for the past few months, for a sacral pressure sore.

As you can see, lots of people involved in her health and care: private home aides, home health agency RN, assisted-living facility staff (which includes their own RN), and an attentive adult child who visits often. This lady is essentially home-bound but very occasionally gets out to see her neurologist or another healthcare provider.

And now for what happened with confusion. For me the story started when the woman’s son sent me a message, saying his mother was now having delusions and crazy thoughts, and that her paid caregiver said she hasn’t been herself for the past 36 hours.

So this sounds like delirium: worse than usual mental functioning, generally brought on by an illness, stress on the body, or sometimes by a medication side-effect.

In other words, this is a common concern that comes up for many older adults, especially if they have a chronic condition that can cause cognitive impairment, such as Parkinson’s.

And cognitive impairment is apparently very common among assisted-living residents. Here’s what a 2014 Health Affairs paper says:

Estimates derived from national data indicate that seven out of ten residents in these residences have some form of cognitive impairment, with 29 percent having mild impairment, 23 percent moderate impairment, and 19 percent severe impairment. More than one-third of residents display behavioral symptoms, and of these, 57 percent have a medication prescribed for their symptoms. Only a minority of cognitively impaired residents reside in a dementia special care unit, where admission and discharge policies are more supportive of their needs.

Given this data, delirium must be very common in assisted-living, and you’d hope that a clinician would be able to evaluate and manage without too much hassle. But let’s see what happened in my case.

Evaluating a worsened confusion complaint in the real world

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As the Population Ages, How to Make Geriatrics More Widely Available?

This headline above is the one I’ve been waiting for. But the one this past week in the NY Times was more in line with the usual narrative: “As Population Ages, Where Are the Geriatricians?”

Now, I’m always glad to see geriatrics in the news, because this helps people know/remember that geriatrics exists.

But this article was like many: heart-warming stories of how we take better care of frail older adults, gloomy statistics on how few geriatricians we have, the requisite comments about how few doctors are signing up to train as geriatricians and how it might be because the pay is less than other doctors.

There was also the usual conflating of geriatrics with geriatricians — there’s mention of the efforts to train other clinicians in geriatrics but it’s brief. Overwhelmingly, the message seems to be that you need one of these special docs to be your PCP (or your mom’s PCP) if you want better health while aging. But these docs are scarce and getting scarcer, so disaster looms for an aging population.

My concern: this feels like a discouraging message.

Given the very definite shortage of geriatricians, I want to see headlines how we might improve healthcare for older adults even though we are short on geriatricians.

In other words, how can we leverage what we know and do in geriatrics?

Ideas on Making Geriatrics Care More Widely Available

What we need are some well-researched magazine articles on the topic, but in the meantime, here are a few ideas I’ve been thinking about:

“Virtual Geriatrics” for information and consultations

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