Aging In Place Technology

'Aging in place technology' is a term that refers to technology that allows people to live in their own home regardless of age and ability level. These technologies include health monitors, reminder systems, and personal emergency response systems (PERS). Ethical implications of these technologies include but not limited to: privacy of patient being monitored, accessing protected healthcare information under the Health Insurance Portability and Accountability Act (HIPAA), and access/use of these technologies by non-healthcare professionals, many times without the patient’s knowledge.

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 and chronic diseases and need 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 technologies 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. 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.

Personal Emergency Response Systems

Personal Emergency Response Systems are usually wearable technology worn as a necklace or bracelet and 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 needs immediate medical attention they can simply press the button on their wearable technology and it alerts the response center to send someone. One of the most popular PERS is Philips Lifeline with AutoAlert, a wearable emergency button wirelessly connected to the 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 detects 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.

Ethical Implications

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.

Privacy

Many of these technologies are argued to be an invasion of privacy when keeping 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. Further, additional controversy stems from the surrounding professional liability for medical errors when these technologies are used by a non-licensed professional. 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 (or VPN). 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 measures in mind. Even with these extensive security measures in place, the caregiver is usually the one to set this system up and have access to all of this information. This can sometimes be done without the patient’s knowledge since many of those aging in place and in need of this technology are older adults that do 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. 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.