One of the most discussed barriers to the adoption of mobile health technologies is the Digital Divide between the elderly and the rest of society. Technology may support initiatives encouraging aging at home. There are many reasons why older persons do not use technology. A recent report https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/PCAST/pcast_independence_tech__aging_report_final_0.pdf) by the President’s Council of Advisors on Science and Technology entitled “Independence, Technology, and Connection in Older Age” highlights many of these issues. I praise the report because it considers caregivers, socioeconomic, geographical and clinical aspects of older people both healthy and sick. It also provides clear recommendations to the President in the form of policy initiatives and actionable items (some of which require legislation which unfortunately might delay or prevent implementation). One can only hope that they can be enacted because of both their urgency and potential significant benefits. The report is divided into three sections and explores how technology can impact them: social engagement and connectivity, cognitive function, and physical ability. There were several common themes in the major areas of the study: heterogeneity of the older-adult population; the foundational role of Internet connectivity; monitoring within homes and communities; the need for more research; and technology standards. I will now discuss what I believe are the five most significant takeaways from the report.
- Socialization via technology. In its report, the Council clearly highlights the fundamental importance of social interactions in human well-being. Besides the most popular sources (Facebook, Twitter, Pinterest, Instagram), virtual communities (which might include medical peer support group sites), and real-time video conferencing, in-person facilitating websites (companionship/dating sites, Meetup). Examples of technologies which facilitate care. Honor is a technology in which older adults can participate in their own care in a convenient way. It includes a ratings feature which can help improve the experience over time via customization. Social media can also facilitate volunteer and employment opportunities.
- Technologies can address cognitive decline. The report addresses three opportunities in the area of cognitive function. It discusses how in-home and wearable sensor technology can identify changes in behavioral patterns of medication use and daily activities which may signal changes in cognitive function. Technology can assist in the prevention of economic fraud and exploitation, unfortunately commonly experienced by the elderly. The third opportunity lies in the potential for technologies to maintain or enhance cognitive health. Technologies available today can help monitor those with established cognitive impairment. An excellent example is a shoe inner sole geolocation which can track a potential wanderer. Simple digital music technology has been demonstrated to improve cognition. Not to be underestimated is the need for large scale educational efforts to increase awareness, healthcare and social community support, and adequate safeguards in the area of privacy and security of technologies.
- Technologies to address physical ability. The report appropriately cites the various definitions of mobility from a healthcare standpoint. It reviews the value proposition of telemedicine for those with physical problems limiting healthcare visits. This would result in increased access to care both in primary and specialty care. The encounters can be either synchronous or asynchronous. Much work remains to be done in increasing expanding payment for telemedicine. The authors accurately discuss the need for increasing broadband access for technologies like telemedicine. Other challenges include professional cross-state licensing, and both human and process implementation issues (none of which are insurmountable and supported by existing examples). Recommendations to improve functionality [(to have HHS work with the Department of Housing and Urban Development to improve functionality of home designs), product designs (medication and food packaging), wheelchair functionality] highlight social and other aspects of life necessary to optimize and accommodate physical ability.
- The report’s thread of aging at home. Older people have overwhelmingly stated that they want to age at home and not in institutions. The report’s theme supports a multidisciplinary approach which includes technology, public policy changes, support for caregivers, and consideration of environmental/social factors. AARP has established a $40M venture fund for technologies aimed at aging at home for its members. Aging at home must be a consideration in development of digital health technologies for older adults. Unobtrusive, secure, and wellness-focused tools will have the best chance of success.
- Significance of the report for digital health itself. The Council should be praised for giving weight to increasing awareness and education about digital technology in general. Complimenting this is its focus on increasing access to technology and physicians via expanding broadband and use of telehealth respectively. Decreasing the Digital Divide by getting older people utilizing the Internet and mobile devices is a challenge of widely varying geographical significance. Policy change recommendations by the Council in achieving this goal are to be supported by organizations like HIMSS, the AMA, and patient advocacy groups.
This report has implications for the digital health technology industry, for government agencies (who should look at aging at home as a national priority on many levels), and for the entire population who deserve the opportunity of doing all they can to age at home. Dignity is a universal value desired by the elderly. Technology has the ability to help people achieve this even in illness. I would like to thank the members of the Council for the contents of this report and look forward to seeing many of its recommendations implemented.