GeriTech

In Search of Technology that Improves Geriatric Care

innovation

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

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.

Connecting Health, Aging, Geriatrics, & Innovation

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.)

In Search of a PHR for Aging Adults & Their Families

[This post was first published on The Health Care Blog on 1/11/14, titled “In Search of a Really Usable PHR.” There are several interesting comments posted there.]

When it comes to the health care of a frail older person, families really need a good personal health record (PHR) system. So I am once again preparing to take a look at what’s available, in hopes of finding something that I can more confidently recommend to the families I work with. (To see what medical info I urge families to track, see this Geriatrics for Caregivers post.)

I have — yet again — met a family with reams of paper health records. On one hand, they’ve done very well: at our first visit they were able to show me labs, MRI results, and even some specialty consultations from last summer. They even had a hospital discharge summary, although unfortunately not the one from the most recent hospitalization.

And they’d taken steps to digitally organize, having scanned several key items, as well as created an online space providing shared access to their parent’s information.

So this is better than the situation I often encounter, which is that an elderly person has seen multiple outpatient doctors, has been hospitalized in a few different facilities, and no one has a copy of anything handy. (See why new elderly patients are a killer in primary care? If there is no data you fly blind, if there IS data it can take hours to review it.)

Still, there are clearly many ways a little well-designed technology could improve things for this family – and for the doctors trying to help them.

Here are the problems we have right now:

  • Hard to search the whole pile, whether on paper or via the family’s online repository of PDFs. These were not OCRed and searchable until I manually converted them with my own PDF editor, after which I had to upload them to the patient’s chart in my EMR. Now each file is text searchable (for me), but the pile still is not.
  • Cannot trend the labs. Figuring out what has happened to this patient’s key lab values over the past year has been very labor-intensive. This remains a problem once the lab data is uploaded to my EMR, because it’s still in PDFs which have to be looked at one at a time. Being the nerdy doc that I am, I’ve spent a fair bit of time creating a note that summarizes the key lab data over time. Ugh. Better than nothing but a far cry from being able to graph and trend the patient’s labs as needed.
  • Takes ongoing time and effort to get records from the hospitals and other involved doctors. Kudos to this family for being diligent and persistent in asking for copies of everything they can. But wow, it’s a lot of effort for them, and I can tell you that in my practice so far, I’ve generally had to expend a fair amount of energy repeatedly asking for information from other providers. (And then I’ve had to try to organize all this info which comes in as scanned images via fax. Oy!)

We have other challenges too, like how to coordinate care with the assisted living facility and home health agency (don’t get me started), or how to keep track of the elderly person’s pulse and blood pressure (not so easy unless the elderly person is living with highly motivated family members, or has a paid home aide who is good at communicating and at taking directions).

But for this post, let’s stick with the issue of a good personal health record, robust enough for the volume and complexity of records associated with a declining elderly parent.

Personal Health Record features I’m looking for

Here are some of the features I’m looking for in a secure online personal health record (PHR) to recommend to families of elders.

Note: Right now I’m prioritizing a tool that enables families to keep and organize medical information, so as to help clinicians effectively help their elderly loved ones. (Wasn’t this the original purpose of the VA’s Blue Button?) I’m not looking for something that will keep track of a person’s steps walked for the past 5 years.

Key features wanted:
  • Easy to import information. The easier, the more likely families will do it. Which means, the more likely they will have useful information handy when the elderly person needs to see a new doctor.Can you email/fax into the PHR? This might make it easy for medical offices to send the info, as fax remains a very common communication mode in health offices.
    • Can it accept info via BlueButton, or BlueButton+? I have yet to meet a family that has retrieved information via Blue Button but can see this becoming more common. Although, having just looked at a Continuity of Care Document created by a PCP’s EMR, I can tell you that it felt nearly useless to me. No lab results. No listing of recent hospitalizations, or even recent clinic visits. No date on the meds or even the EKG listed. Sheesh.
    • Does it allow the patient/family to send a request to providers, and does it log those requests? Does it have any kind of features that facilitate the requesting? Requesting info from providers is a pain. Features that make this easier (by generating the HIPAA release, for instance, and making it easy to send) are sorely needed.
      • My own EMR, MD-HQ, has a nice feature that allows me to signal when I’ve received the results for a certain lab I’ve ordered. This is a way of closing the loop, and I’ve often wished for similar loop-closing support when I request records from other providers.
      • Example of bad usability: Just looked at Healthvault, and to enter lab results, you have to enter each result by hand. Argh. Shouldn’t there be software that will look at a PDF lab report, recognize the important fields, and convert it into the PHR’s structured lab data fields??
  • Easy to find information within the PHR. Once you’ve gotten the info into a PHR, you need to be able to find what you are looking for (or what a doctor is asking for) fairly easily.
    • Does it have good search functions? Note that many EMRs — in my own experience — have horrible search functions, so I am really hoping that PHRs will not be modeled on EMRs.
    • Does it have a sensible approach to organizing medical information? I’ll admit that what is “sensible” is open to interpretation. It may be reasonable to adopt an approach similar to a well-designed EMR, so that at least the clinicians can easily navigate, but there may be other good approaches to adopt. I liked many ideas that Graham Walker had in his Blue Button redesign submission.
  • Easy to import data from a BP machine or glucometer. Obviously there is a lot of other health data that I occasionally want to follow (e.g. sleep, continence, falls, pain; even steps walked could come in handy). But to begin with, I’d look for something that can capture the internal medicine basics: BP, pulse, weight, and for people with diabetes, blood glucose readings.
    • Can it import BP data from a Bluetooth enabled cuff, or otherwise easily inhale BP data?
    • Can it easily import blood sugar readings?
  • Easy to import pharmacy data. Medication management and medication reconciliation is hugely important in geriatrics. Although it’s not a substitute for reconciling a med list with the bottles an older person has (and what actually comes out of the bottles), importing prescriptions from a pharmacy website is much better than asking family caregivers to manually enter them all.
    • Can it import prescriptions from pharmacies?
    • How about importing a discharge medication list from the hospital?
  • Easy to export and share health information. Once an older person has a repository of health information, she’ll need the ability to easily send/share data with health providers.
    • Can it fax information to a doctor? It should be easy to send multiple items at once, if needed, and it should log which info was sent to whom, and when.
    • Can one give a health provider access to download/copy items? Although I think many doctors would prefer that info be pushed to them (less work than having to browse a patient’s online personal health record), I still think PHRs should allow patients and families to invite a clinician to access the info, especially if the lab data within the PHR can be trended.
    • Can one create and share useful summaries of vitals data? It is hard to review a long string of BP values. A well-designed summary, perhaps graphical, would be better.
    • Is it easy to create a printed summary of selected info? For in-the-moment clinical use of information, it’s hard to beat a good printed summary, and that’s what I’d suggest a family take to the ED. Of course, it’s also nice if in the ED a family is able to help the doctor access the PHR, in order to query for other needed info.
  • Easy to maintain a list of all healthcare encounters. I am always trying to figure which clinicians and facilities have seen a patient, in order to know what’s been going on, and who I might need to get information from.
There are of course other features that one might want in a PHR product. In a perfect world, the PHR would integrate with some kind of communication and care coordination system, so that all the different providers could stay in touch with the patient/family and with each other. It would also be terrific to have some kind of task/project management support built into such a system, to help everyone keep track of what needs doing next, and prevent problems from falling off the radar.

But in my own experience, it’s very hard for a product to do multiple things well. Heck, it’s hard to find a product that does just one moderately complicated thing well. So for now, I am prioritizing the functions of obtaining, organizing, maintaining, and sharing of personal health information.

In Search of Real Feedback on Existing PHRs

Now that I’ve told you what I’m hoping to find, who can give me some useful information and feedback regarding the now available personal health records.

I would really like to have something that I can recommend to families. To date, I’ve not worked with any families using a digital personal health record. Even the geriatric care managers I work with seem to not be using a modern PHR. (Surprising in a way, but when you consider the overall tech-conservatism of healthcare, not so surprising.)

So far, the main candidates I’m aware of are Healthvault and CareSync. I also know ofMyKinergy, which combines a health data repository with a care coordination platform.

I have briefly tinkered with Healthvault, and it seems labor-intensive to enter data, unless you are using one of the many apps/devices that it’s compatible with.

Does anyone have personal experience to share on using a personal health record for an older adult? Has anyone put any of the products above through its paces?

Any suggestions on what I can recommend to the families I work with?

Aging 2.0: On Engaging Innovators & 11 Startups

[This post was first published on GeriPal on 11/25/13.]

If you are interested in the intersection between aging and innovation, these certainly are intriguing times.

Last Thursday I attended the kickoff event for Aging 2.0’s brand new GENerator program. This is “a new founders program that supports the most promising entrepreneurs working to enhance the lives of older adults and improve long-term care.” (Which I think means this is a business accelerator, but after only a year blogging about digital health innovations, I can’t promise to have mastered all the business lingo.) 
Despite the whopping size of the boomer market (see this terrific Bloomberg article on how business has so far struggled to tap it), this seems to be the first accelerator focused on serving the 50+ demographic.
I found myself impressed both by the growth of Aging 2.0 — an organization co-founded by a gerontologist only 18 months ago — and by the offerings of the eleven companies chosen. It’s encouraging to see the power of innovation and technology really focusing on the problems affecting older Americans, and those who serve them.
Of course, I also find myself with some reservations. I think of myself as a public-health geriatrician, and as such, my primary interest in these new innovations is less about whether there’s a good business market, and more about whether or not these offer good, practical solutions to the more important health and social problems affecting aging adults.
There is no question that entrepreneurs are great at innovation. But to succeed they also need to be great at selling their product. Businesses involved in healthcare or other socially-minded arenas always proclaim that they are doing good things for individuals and for society. Which sometimes is true but often it’s not quite as true as the business says it is, or as the business would like it to be. In the end, a startup must satisfy its investors. And an accelerator must satisfy its startups and investors.
So what does this mean for those of us professionals with expertise assessing social value and healthcare value? It means we should get in there and plan to constructively engage with two crucial groups. One group is the the innovators themselves, who will be interested in our expertise and feedback (although once they have a product at market they’ll probably be ambivalent when we raise concerns). 
The other group is the public to whom these products are being marketed. We can and should equip ourselves to help the public assess and understand the real health and social value (or at least, likely value) of these innovations that they are being invited to purchase. 
This public, needless to say, is quite a large group. It encompasses the 50+ demographic, as well as those offering services to this group, including long-term care and senior housing providers. And the sheer size and diversity of the 50+ age group is really something: the US Census data shows that in 2011, the 50+ population (civilian, non-institutionalized) was 98 million people. 
Of those people, many are family caregivers worried about an aging adult. Others are themselves in need of products and services to help cope with chronic illness, cognitive problems, or physical frailties. And of course, a large group of boomers is eager to maintain health and wellbeing for as long as possible. 

11 Startups chosen by Aging 2.0

For its inaugural GENerator program, Aging 2.0 chose eleven companies. I heard each give a short talk last week. Here are capsule summaries, based on what I heard, along with a few extra thoughts. 
  • BrainAid: smartphone or tablet app with patented software meant to help people compensate for executive dysfunction. Originally designed to help people with brain injury or stroke, the company believes its software can help people with early Alzheimer’s or other neurodegenerative cognitive impairment as well. Company has been working with the VA.
  • CareLinx: online marketplace allowing families to find, screen, hire, and pay in-home caregivers without going through an agency. (I wrote about CareLinx last year; still think it’s a promising idea although I have no idea how well it’s actually working out for the families and paid caregivers involved.)
  • CareSolver: a free online platform that provides customized tools to help family caregivers manage the needs of aging parents or other loved ones. This is right up my alley given my long interest in caregiver education, so I will probably try this soon. Of note, they apparently offer a Beer’s criteria med checker (something I’ve said we need in previous GeriTech posts).
  • Life2: predictive analytics company focusing on aging. From the short presentation provided, seems to me they might focus on helping LTC providers identify residents at increased risk, along with offering support in mitigating the risk. Suspect mitigating risk will end up being harder than identifying those at risk.
  • Lift Hero: “Medical Trips Made Easy,” says the website. Connects seniors who need rides with off-duty EMTs who provide door-through-door service to appointments. (Having seen elderly patients struggle to get to and from the curb, that “through” could be important.) This could be a very useful service although if the passengers are on average frail enough to benefit from EMT drivers, or have cognitive impairment, I certainly hope clinicians will have a way to connect with the care circle regarding the visit. (Often the person accompanying the older patient is instrumental in providing extra history, or in helping relay instructions to the care circle.)
  • MyGrove: This one flummoxed me a bit so I’ll just quote the blurb passed out at the event: “a multimedia marketplace and social engagement platform tailored for Active Adults and their communities.” If you, like me, aren’t sure what an Active Adult is, it’s apparently a term used to refer to people aged 55+. (What to call Active Adults when age and illness render them less active? I don’t know.) Whatever this product is, it sounds like they are targeting the “young old” who aren’t yet close to needing geriatric expertise.
  • OpenPlacement: platform designed to help seniors, families, and discharge planners find and choose among rehab or residential placements more easily. I assume this is modeled on OpenTable, although obviously placing seniors is more complicated than making a restaurant reservation. Should be helpful to families and discharge planners facing transitions in care, since right now families often find it’s a nightmare to figure out who accepts their insurance, has beds available, offers certain features, etc.
  • Sabi: Per Google, the “pill box and walking cane company.” Per Sabi, a creator of products that improve day-to-day life with “superior functionality and design.” The website reminds me of the dilemma many companies face: how to sell products to older adults without reminding them that they are older? Still, the products really are attractive and look quite functional too.
  • Tapestry: App for web and mobile which simplifies social media for older adults. Meant to help families stay connected, by creating an easy interface for seniors to view Facebook photos, email, photos, etc. Currently has a free basic plan or for $5/month offers unlimited messages and photo storage. In general I think this kind of service will ultimately very useful to many older adults. Almost every older person loves to get messages and pictures from family, but navigating a standard tablet can be overwhelming to some, either because they are not tech-savvy or because they are cognitively impaired.
  • True Link: A caregiver-managed debit card allowing personalized spending controls and with fraud-protection features. The founder said that every year seniors lose $52 billion to scams and fraud (!); True Link is meant to offer vulnerable seniors a way to spend without putting themselves at excess financial risk. Caregivers can block spending on certain merchants or types of merchants (i.e. sweepstakes.) I could see this being a great option for seniors with cognitive impairment, and wonder if it will be of interest to financial trustees and fiduciaries. For families, the hard part will be bringing up their concerns re finances to an older loved one; proposing this option likely will be dicey. 
So there you have it: eleven ideas meant to make life better for older adults and their caregivers. Will they take off? Will people use them? Will people like them? (And how will we know if people like them? Hopefully users will have some way of posting reviews.)
Last but not least, will these improve outcomes in terms of wellbeing, function, avoiding morbidity, and reduction of caregiver stress?
We should find out the answers to at least a few of these questions over the next year or two.

And we should think about giving the innovators, as well as the public, constructive feedback on these products. They surely aren’t perfect, but they are a step in the right direction and most of them are trying to meet real needs of aging Americans.

In the meantime, if you’re a clinician or work on healthcare for older adults, which of these ideas do you find most promising?

[Disclosure: I have no financial ties to any of these companies, or to Aging 2.0.]

Knocking on Health 2.0’s Door

[This post was first published on The Health Care Blog on 10/16/13. See comments here, including one from Katy Butler, calling for a grassroots movement to demand changes in Medicare that would support more high-touch services and Slow Medicine. Hear hear!]

I recently attended the flagship Health 2.0 conference for the first time.
To avoid driving in traffic, I commuted via Caltrain, and while commuting, I read Katy Butler’s book “Knocking on Heaven’s Door.”
Brief synopsis: healthy active well-educated older parents, father suddenly suffers serious stroke, goes on to live another six years of progressive decline and dementia, life likely extended by cardiologist putting in pacemaker, spouse and daughter struggle with caregiving and perversities of healthcare system, how can we do better? See original NYT magazine article here.
(Although the book is subtitled “The Path to a Better Way of Death,” it’s definitely not just about dying. It’s about the fuzzy years leading up to dying, which generally don’t feel like a definite end-of-life situation to the families and clinicians involved.)
The contrast between the world in the book — an eloquent description of the health, life, and healthcare struggles that most older adults eventually endure — and the world of Health 2.0′s innovations and solutions was a bit striking.
I found myself walking around the conference, thinking “How would this help a family like the Butlers? How would this help their clinicians better meet their needs?”
The answer, generally, was unclear. At Health 2.0, as at many digital health events, there is a strong bias toward things like wellness, healthy lifestyles, prevention, big data analytics, and making patients the CEOs of their own health.
Oh and, there was also the Nokia XPrize Sensing Challenge, because making biochemical diagnostics cheap, mobile, and available to consumers is not only going to change the world, but according to the XPrize rep I spoke to, it will solve many of the problems I currently have in caring for frail elders and their families.
(In truth it would be nice if I could check certain labs easily during a housecall, and the global health implications are huge. But enabling more biochemical measurements on my aging patients is not super high on my priority list.)
Don’t get me wrong. There was a lot of cool stuff to see at Health 2.0; a lot of very smart people are creating remarkable technologies and tools related to healthcare. The energy, creativity, and sense of exciting possibility at a gathering like this is truly impressive.
And yet, most of the time I couldn’t shake the feeling that all this innovation seemed unlikely to result in what our country desperately needs, which is more compassionate and effective healthcare for Medicare patients and their caregivers.
The need to improve healthcare is particularly urgent for those seniors who have 3+ chronic diseases, or have developed cognitive and/or physical disabilities, since health issues seriously impact the daily lives of these patients and their caregivers. And of course, these patients are where most of the healthcare spending goes.
So here we have a group that uses healthcare a lot, and their problems are the ones who challenge front-line clinicians, healthcare administrators, and payors the most. And we love these people: they are our parents, grandparents, and older loved ones. Many of us are even taking care of them, sometimes to the detriment of our own health.
Knock knock. Who is listening? Where is the disruptive innovation we need to help elders, caregivers, and their clinicians?

Real impediments to the Health 2.0 Revolution

“Ready to Revolutionize Healthcare?” asks the Health 2.0 homepage.
Yes, I’m ready. But we’ve got a ways to go before these revolutionary tools can actually revolutionize the average older person’s experience with healthcare.
Why? Two key reasons come to mind.
1. Most solutions not designed with the Butlers in mind. As best I can tell, most innovators don’t have the situation of the Butlers in mind when they design their healthcare solutions. They neither understand the situation from the point of view of the Butlers themselves, nor do they understand the situation from the perspective of the front-line clinicians who could and should do better.
For instance, did the Butlers need games to maintain healthy behaviors and keep Mr. Butler walking and exercising after his stroke? Did they need for all interventions to be considered in light of “Healthspan” rather than “lifespan”?
(What is Healthspan for a slowly declining person with dementia and incontinence anyway? We geriatricians think of improving function, wellbeing, quality of life. And most importantly, of prioritizing the issues because you can’t possibly address them all so go with a combination of what matters most to the patient and what seems most feasible.)
And did the clinicians involved need predictive analytics to help them identify when Mr. Butler was at risk getting worse on some axis that the population health management gurus are worried about?
Which of these innovations will help patients, caregivers, and front-line clinicians establish an effective collaboration on mutually agreed-upon goals, and tailor healthcare to the patient’s situation and needs? How to convert population level processes regarding outcomes and cost-containment into real improvements in the healthcare experience of most elderly patients?
Finally, Medicare is the 600 pound gorilla in healthcare, both as a payer and as what most healthcare providers spend most of their time serving. You want to change healthcare? Change how we care for seniors. (And I don’t mean the healthy ones over-represented at AARP.)
2. Too many solutions to choose from. If you are a patient or caregiver, and decide to consider a new approach to weight loss, or timed toileting, or tracking a symptom: the number of approaches you could try – whether tech enhanced or no — is overwhelming. Especially if you research online.
If you are an individual clinician — or a smaller practice — and would like to consider a new and improved way of doing things: the choices are overwhelming. (A lot of primary care is provided by small practices; there’s obviously a trend towards consolidating but also some backlash.)
Now of course, big organizations have more resources with which to choose solutions for their providers, and big payers can choose solutions for individual patients and families. But unfortunately, when tools aren’t chosen by those who use them, users tend to end up with crummy user experiences.
There is probably an innovative way to work around this and make it possible for end-users to more easily find tools that are a good fit for them. But until those innovations become widely available, I think many in the trenches — patients, caregivers, and clinicians — may find that supposedly helpful innovations are actually not so helpful…a frustrating state of affairs when one is overwhelmed with the challenges of helping an aging adult in declining health.

Islands of relevance at Health 2.0

At an event as big as Health 2.0, there are of course pockets of activity relevant to the care of geriatric patients. There was a session on tools to help family caregivers (which covered two care coordination tools and two sensor/alert type tools) and another on nifty tech to help patients take their meds.
And of course, there was the justifiably popular Unmentionables panel, led by Eliza Corporation’s Alex Drane, which highlighted pervasive issues that affect health but that we tend to not talk about much. These include financial stress, relationship stress, and caregiving. (Good recap of the panel at Healthpopuli.com, and I LOVE that caregiving is high up on this list.)

Words to keep in mind

Alex reminded the Health 2.0 crowd that when it comes to helping with health, we must meet people where they are at. “Health is life; care, completely; empathy absolutely.”
As for me, I found myself thinking of a quote from Larry Weed and “Medicine in Denial.”

“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.”

Similarly, for those who evangelize digital health, and believe that new technologies will revolutionize healthcare, I would say:

The religion of healthcare should not be feats of technology. The religion of healthcare should be to help solve the problems of patients and caregivers, and the compassion involved in the very act of care.

And I’d also recommend they read “Knocking on Heaven’s Door,” or something similar, while attending exciting conferences and planning to revolutionize healthcare.