In Situ Monitoring of Health in Older Adults: Technologies and Issues

Hyun Gu Kang, PhD; Diane F. Mahoney, PhD, GNP; Helen Hoenig, MD; Victor A. Hirth, MD; Paolo Bonato, PhD; Ihab Hajjar, MD, MS; Lewis A. Lipsitz, MD

Disclosures

J Am Geriatr Soc. 2010;58(8):1579–1586 

In This Article

Abstract and Introduction

Abstract

With the upcoming reform of the healthcare system and the greater emphasis on care in the home and other living environments, geriatric providers will need alternate ways of monitoring disease, activity, response to therapy, and patient safety. Current understanding of the dynamic nature of chronic illnesses, their effects on health over time, and the ability to manage them in the community are limited to measuring a set of variables at discrete points in time, which does not account for the dynamic interactions between physiological systems and the environments of daily life. Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurements of physiological and sociological data for use in geriatrics care. This article identifies and discusses the important issues regarding the use of monitoring technologies in elderly patients. The goals are fourfold. First, some emerging technology that may improve the lives of older adults and improve care are highlighted. Second, the possible applications of technology in geriatrics settings are discussed, with a focus on acute falls, dementia, and cardiac conditions. Third, real and perceived concerns in using monitoring technology are identified and addressed, including technology adoption by elderly people; stigma; and the reduction in social contact; ethical concerns of privacy, autonomy, and consent; concerns of clinicians, including information overload, licensure, and liability; current reimbursement schemes for using technology; and the reliability and infrastructure needed for monitoring technology. Fourth, future approaches to make monitoring technology useful and available in geriatrics are recommended.

Introduction

Older adults will soon constitute 20% of the population, yet little is known about how they will experience the onset of disease and disability or how to treat and prevent these conditions. With the anticipated reform of the healthcare system and the greater emphasis on care in the home and other living environments, geriatric providers will need alternate ways of monitoring disease, activity, response to therapy, and patient safety. The advent and requirements of electronic medical records provide an opportunity to link in situ monitoring with the medical record and the algorithms to respond to critical values. Current understanding of the dynamic nature of chronic illnesses and the ability to manage them in the community setting are often limited to measuring a set of variables at a few discrete points in time, which does not account for the dynamic interactions over time between physiological systems and the environments of daily life. Such detailed data may be available in a hospital but not in the community. Management of diseases, particularly in the community setting, often depends on limited contact times and self-reports.

Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurement of physiological and sociological data. Monitoring physiological markers and patient behaviors could lead to better understanding of aging and disease. Monitoring technology in situ can also greatly assist in chronic disease management to maximize health, prevent complications, and conserve healthcare resources. Monitoring technology can also allow older adults to live independently for longer and age in place. It can also provide opportunities for extending healthcare resources to more people who currently have little or no access to care.

Monitoring technology can also provide new avenues and approaches to studying aging. The dynamics of social engagement are important determinants of health and disease, which can be assessed using modern monitoring technologies.[1–3] Continuous physiological data may lead to a better understanding of the dynamic nature of risk factors for disease[4,5] and lead to better prediction of the onset of disease than a set of measurements at a few points in time.

Despite the interest in these technologies for clinical use, many hurdles exist in bringing monitoring technology into clinical care. Technology is often developed without proper understanding of specific needs of older adults or what would be useful to clinicians. Patients, particularly older adults, are concerned about privacy, unfamiliarity with technology, and potential decrease in social contact. Many providers are concerned about potential information overload, with irrelevant information and technology detracting from interpersonal care. The lack of funding for instrumentation, data collection, and interpretation of data can also be prohibitive.

This article has four goals: first, to highlight emerging technology that may be used to improve the health and care of older adults; second, to discuss the possible applications of technology in geriatrics settings; third, to identify and address real and perceived problems in using monitoring technology; and fourth, to provide recommendations for future clinical and research to help make monitoring technology useful and available.

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