Question

Utilizing consumer healthcare technology and network sensors for general health assessment for elderly and vulnerable patients is another major area that assists with a physician’s duty. Telemedicine can integrate IT and the bedside. Identify two potential wireless applications for elderly and vulnerable patents.

Answer 1

Answer - A majority of older adults are challenged by chronic and acute illnesses and/or injuries. Eight out of ten older Americans are living with the health challenges of one or more chronic diseases.1 In addition, falls are the most common cause of nonfatal injuries and of hospital admissions for trauma among older adults. Remote patient monitoring (RPM) technologies have been shown to be effective in helping to manage chronic disease, postacute care, and monitoring the safety of the older adult population. RPM technologies can help older adults slow the progression of chronic disease and ensure continued recovery after being discharged from an acute care setting. RPM technologies also can alert caregivers and prompt intervention when a vulnerable older adult is injured or in harm’s way.

A number of RPM technology-enabled innovations can improve the health and independence of older adults. Here we discuss two areas of opportunity for remote patient monitoring in this population:

1) chronic disease management and post-acute care management and

2) patient safety.

In alignment with the mission of the Center for Technology and Aging, we are focusing on technologyenabled innovations aimed predominantly at improving the health of older adults and promoting independent living in communitybased, home, and long-term care settings. Such technologies are used by patients and caregivers principally to improve self-management of care and enhance communication of patient information to clinicians.

Overview of Remote Patient Monitoring

Remote patient monitoring refers to a wide variety of technologies designed to manage and monitor a range of health conditions. Pointof-care monitoring devices — such as weight scales, glucometers, implantable cardioverterdefibrillators, and blood pressure monitors — may individually collect and report health data. They also may become part of a fully integrated health data collection, analysis, and reporting system that communicates to multiple nodes of the health system. Such integrated systems provide alerts when health conditions decline, allowing patients, caregivers, and clinicians to intervene quickly and modify treatment plans as needed.

To promote safety and prevent injuries among older adults, many technology developers are focusing their attention on RPM technologies that detect and ultimately prevent falls and wandering. The incidence of falls among older adults is high, as are the associated health care costs. Additionally, older adults with dementia are at increased risk of both falling and wandering. The primary goals of fall detection technologies are to distinguish falls from activities of daily living (ADL) and then contact authorities who can quickly assist the individual. Fall detection systems can be active, passive or a combination. Active systems, such as PERS, are devices that users must activate to obtain assistance, most commonly by pushing a button or pulling a cord. Passive systems involve the use of sensors to continuously monitor movement, while utilizing specific algorithms and alert systems to inform caregivers and others of potential falls. Users do not need to activate passive systems as they automatically detect a fall and contact help. Motion and pressure sensors can be placed around the living facility on walls, ceilings, and floorboards, and furniture while location and position sensors, like accelerometers and gyroscopes, can be placed on older adults themselves. Some passive systems contain a back-up active system where users can activate the device for assistance.

• Alarm with fixed or portable receiver and transmitter - Personal Emergency Response systems require older adults to activate a call button, which can either be stationary in a room or portable worn by the user. Some devices activate third party audio communication with the patient to address the situation and can contact the appropriate parties for further assistance.
• Location and position sensors with algorithms -Sensors, like accelerometers and gyroscopes, are connected to the user and detect user’s location and position in relation to the ground. Preset algorithms determine if movement is out of the scope of activities of daily living and is considered a fall. Software alerts third party or caregiver to potential fall.
• Gait and balance monitors with algorithms - Pressure and motion sensors, accelerometers, and gyroscopes are used in devices attached to users or assistive technologies to monitor gait and balance. Sensors detect patterns in movement, establishing threshold based fall risk algorithms. Software alerts third party or caregiver to fall risk potential.

Most of the discussed technologies are potentially beneficial to a significant population of older adults who are at-risk for moving to a higher level of care. Technologies may also be instrumental in enabling people with high-burden disabilities and chronic illnesses to better self-manage their health conditions and thereby prevent complications and injuries.

In the medium to long term, some technologies may reduce demands on the ever-stretched workforce that cares for older adults — by encouraging greater selfmanagement and other efficiencies. Expanding use of such technologies in the short term, however, may place extra burdens on this home care and health care workforce as well as caregivers.