Aging In Place Technology

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'Aging in place technology' is a term that refers to technology that allows people to stay and live in their own home, regardless of age or ability level.[1] Examples of such technologies include health monitors, reminder systems, and personal emergency response systems. Due to the fact that many of these patients are either physically disabled or in cognitive decline, these technologies have the potential to be easily taken advantage of. These complicated situations give rise to a multitude of ethical implications including privacy, access to sensitive information, and use of these technologies by professionals who normally operate outside of the healthcare realm.

MedMinder pill dispensers are designed to remind patients to take their medication allotted for that day.

Health Monitors

Health monitoring devices and daily activity trackers are especially useful for patients that have general health issues or chronic diseases that need frequent biometric readings and tracking of their exercise. Health monitors usually involve wearable technology equipped with sensors that gather data about the user’s health in real-time. These sensors track glucose, blood pressure, oxygen levels, weight, and sleep patterns and upload this data wirelessly to an online systems interface that can be accessed remotely by anyone with a user account. Examples of these technologies include GrandCare Systems and BodyGaurdian Remote Monitoring System. Other systems track daily activity and exercise through video surveillance systems or motion sensors implemented throughout the home.

Reminder Systems

A need for reminder systems integrated into the homes of those aging in place is growing due to the cognitive decline and memory issues of many of those aging in place. Memory loss combined with the need to take multiple medications at various times throughout the day have made it difficult for patients to adhere to their medication schedules.

Companies like MedMinder and Reminder Rosie help try to remedy this problem. These technologies include pillboxes or other home devices that remind patients to take medications at the scheduled time. MedMinder is a pillbox that will lock and unlock on a programmed schedule, light up, and play pre-recorded messages to remind the patient to take their medications. MedMinder will even email, call, or text the patient if they still haven't taken their medications.[2] Reminder Rosie is a clock that can be programmed to remind the user to take medications, feed pets, take a walk, or anything else necessary. The user can either touch the clock or say ‘reminder off’ to turn it off.[3]

Personal Emergency Response Systems

Personal Emergency Response Systems (PERS) are usually wearable technologies worn as a necklace or bracelet and are wirelessly connected to either a base station in the patient’s home or a cellular network. They can also be equipped with GPS location trackers for more active patients or those prone to wandering. When a patient requires immediate medical attention, they can simply press the button on their PERS and it will send an emergency alert the response center. One of the most popular PERS is Philips Lifeline with AutoAlert, a wearable emergency button wirelessly connected to a base station plugged in somewhere around the house. Impressively, the sensors can tell the difference between a fall and other movement and will connect the user to a response center if it does detect a fall. Other PERS include AT&T’s EverThere Emergency Response System, which uses AT&T’s cellular network to contact a nearby emergency care center.


Benefits

Connecting Patients to Professionals

The 2018 National Healthcare Quality and Disparities report by the US Department of Health and Human Services found that 9 in 10 Americans found it difficult to find or comprehend basic information about health care and services in order to make informed and sensible choices for their own health [4]. Aging in place technologies allow patients, especially those living in rural or isolated areas, to access reliable information or obtain advice from trusted professionals from their own home, enabling them to better manage their own health.

Mental Health

One of the major challenges of aging in place is the emotional and mental wellbeing of patients. A study in 2020 found that 19% of Americans would feel alone and 17% would not be near any friends or family [5] However, this is not just an emotional barrier, as social isolation or loneliness has been found to lead to poorer cognitive function, as well as various other physical and mental health issues [6]. Many aging in place technologies now enable people living alone at home, who are not near friends or family, to not have to feel so lonely and still be able to interact with others without having to leave their home.

Caregivers

Often times, family members or close friends will step up to be a patient’s caregiver. A survey in 2011 found that more than one in six Americans who provided care to an elderly or disabled family member, relative, or friend worked at least a part-time [7]. However, having to juggle a job as well as assisting with the care of someone else is stressful and time-consuming, often leading to caregiver burnout. As such, aging in place technologies that allow caregivers to remotely monitor their patients and provide assistance relieves a lot of their burden, and helps to maintain the health and wellbeing of not only the patient, but the caregiver as well.


Ethical Implications

Privacy

Many of these technologies raise the concern of privacy when they keep tabs on a patient inside their home. Video surveillance systems are especially controversial because although they let caregivers and family members make sure patients are safe and not in need of medical assistance (such as in the case of a fall), some view them as an invasion of privacy since the cameras can be accessed remotely at any time without the patient knowing. The geriatric population struggle with these aging in place technologies due to cognitive problems, hearing or vision impairments, lack of experience with technology. Lack of ongoing support in the use of these technologies can make them further dependent on the support of caregivers and feedback from these remote health monitoring devices. Furthermore, additional controversy stems from the surrounding professional liability for medical errors when these technologies are used by a non-licensed professional.[8] With these technologies, it is unclear who is taking on the responsibility for interpreting the accuracy and transferring the data in order to care for a patient.

Access to Sensitive Information

Some systems that deal with sensitive patient health data have security measures in place that help to encrypt confidential health data. This data is stored on a home system and is displayed on a Virtual Private Network. Some systems may offer multiple access levels in order to keep personal and health information even more secure. However, not all are created with the same level of security in mind. Even with these extensive security measures in place, the caregiver is usually the one to set this system up and thus has access to all of this information. This can even be done without the patient’s knowledge since many of those aging in place and in need of this technology are older adults that may not have the technology literacy to understand these systems, their privacy concerns, or what personal data they are tracking and logging. Most caregivers have full control over these systems.

Use of Technologies by Non-Healthcare Professionals

Accessing data from health monitors by non-healthcare professionals has caused controversy as it is not the monitoring alone that improves patient outcomes; it is the monitoring, interpretation, and action regarding the data provided that may lead to improved outcomes for patients.[9] Non-healthcare professionals may not know what to do with this information or when appropriate action is needed; yet, these caregivers have full control over the systems and can change medication schedules and alerts without consulting a healthcare professional or the patient themselves.


References

  1. “CDC - Healthy Places Terminology”
  2. MedMinder Pill Dispensers
  3. ReminderRose: Personal Voice Reminder
  4. 2018 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Pub. No. 19-0070-EF.
  5. Fresenius Medical Care. Aging In Place In America. 2020, p. 9, https://eirochester.s3.amazonaws.com/Media/files/AgingInPlaceResearchReport_2020.pdf.
  6. "Social Isolation, Loneliness In Older People Pose Health Risks". National Institute On Aging, 2021, https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks.
  7. Gallup, Inc. "More Than One In Six American Workers Also Act As Caregivers". Gallup.Com, 2021, https://news.gallup.com/poll/148640/One-Six-American-Workers-Act-Caregivers.aspx.
  8. Inglis, Sally. “Telemonitoring in Heart Failure: Fact, Fiction, and Controversy.” Smart Homecare Technology and TeleHealth, 3:129-137. 30 April 2014.
  9. Inglis, Sally. “Telemonitoring in Heart Failure: Fact, Fiction, and Controversy.” Smart Homecare Technology and TeleHealth, 3:129-137. 30 April 2014.