Caring for the geriatric population can be a challenging endeavor, especially when considering the numerous issues that they may have to cope with on a daily basis. This chapter reviews the topic of medication adherence and describes several promising technologies aimed at improving such within the larger scope of medication therapy management (MTM). These tools at our disposal today greatly benefit our elderly population in particular, by better equipping them to manage their chronic health conditions and addressing their unique challenges. As improvements in adherence monitoring technology become more affordable and available, the business of health care will evolve into a more integrated enterprise between patients and their health care providers. Although the future direction and successful impact of many of these adherence technologies looks promising, they will only be possible if both medical and nonmedical professionals find ways to safely and effectively adopt them.
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This chapter provides insight into the demographics of aging, and an overview of potential benefits and challenges of using technology to help older adults. It outlines four interconnected challenges of an aging population. With the expected increase in care needs that coincides with an aging population, the first challenge is the question of how to provide relevant high quality-care to older persons. Second, with fewer caregivers available in relation to the growing population in need, we can expect that the relative burden of care experienced by caregivers will increase. The third challenge is to increase the relative number of healthy and independent seniors by taking a more proactive approach with prevention and health maintenance strategies. The final challenge addressed concerns the development of health care systems and policy changes that are more inclusive of needed assistive technologies and medical devices.
Cognition itself is broken down into several domains including visuospatial reasoning, executive functioning, naming, memory, attention, language, abstraction, and orientation. The impairment of these domains of cognition is the strict definition of cognitive impairment, and when identified, must be explored to determine the underlying cause. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) helps clinicians in the process of diagnosing the cause of cognitive impairment. In the DSM-5, cognitive disorders are broken down into major neurocognitive disorders and minor neurocognitive disorders, as well as delirium. Technology is growing rapidly and can be considered an important aid in providing care for elderly people with dementia. Technology use among the elderly population is expected to increase over time, but even those seniors with extensive experience will find it difficult to keep up financially and skills wise owing to the rapid rate at which technology improves.
Pain management in the elderly remains a very complex and challenging issue to tackle. Much research is still required to assess the applicability and effectiveness of each of these described pain management modalities in our geriatric population. The advances in pharmacotherapy and drug delivery systems, while definitely promising, unfortunately do not bypass the uncertainty of drug pharmacokinetics and pharmacodynamics in the older population. This chapter briefly discusses the technological applications for pharmaceuticals and devices for pain management. It also describes the technological advancements in nonpharmacological management of pain, both acute and chronic. Nonpharmacological approaches include behavioral (cognitive behavioral therapy, biofeedback, and psychotherapy); physical or biomechanical (physical therapy, massage, chiropractic or osteopathic manipulations, exercise, thermal applications, such as heat and cold); interventional (e.g., surgery, acupuncture, injections such as botulin, nerve ablation, nerve blocks, epidural steroid injections); and finally neuromodulation approaches including the physical application of various electrical, ultrasound, and magnetic devices.
This chapter focuses on the concepts of personalized medicine in relationship to wearable technology. It begins by reviewing the technical foundations of wearable devices, including sensor technology, big data, and the Internet of things (IoT). Next, the chapter looks at the benefits, challenges, and limitations of wearables in health care. Finally, it presents specific case scenarios in which wearables have been, or could be, advantageous to an older population, applications in clinical research, the role of regulatory agencies, and the future direction of wearables in medicine. Wearable devices show great promise for aiding the development of personalized medicine, particularly home-based use case scenarios for the older adult. There are numerous requirements for creating successful wearable solutions including aesthetic design, mobility, connectivity, and data analysis. Obstacles and limitations are a reality, but technology companies, universities, and governments are working to surmount issues such as accuracy, security, and engineering.
There exist historical and current methods in which technology is used to improve transitions of care across the continuum. These programs include applications, software, and electronic tools that can improve transitions between providers in the inpatient and outpatient settings. This chapter provides the background, describes the many transitions of care that patients encounter, and identified some challenges created by the transitions. It focuses on the ways electronic health records (EHR) and cloud-based systems have thus far improved transitions and review any data related to read missions, patient safety, and patient quality of care. Additionally, it explores ways in which technology is expected to be integrated into transitions into the future. Technology will play a critical role in making transitions of care as safe and efficient as possible.
Treating illness at home is a tradition that has recently been revitalized by a number of factors. Specifically, telecommunication tools, financial imperatives, quality initiatives, staffing constraints, and patient preference are among the leading drivers for this transition. Successful telehealth program outcomes depend on a number of issues, with knowledge, leadership, and management being paramount. Home telehealth programs hold the potential to improve patient outcomes with cost-effective, patient-centered care. Home telehealth programs offer an appealing cost-effective alternative or extension to acute, subacute, and long-term care centers, or nursing home facilities. Developing effective, cost-effective, value-based, patient-centered alternatives requires a redesign of many fundamental aspects of health care delivery. Home telehealth programs hold great promise in facilitating this critical paradigm shift in health care, and success depends on interrelated factors, which are well illustrated in the context of the Triple Aim. The Triple Aim is a framework developed for improved population health.
Frailty has been defined as either a physical phenotype, or as an index that quantifies the accumulation of a large number of deficits across multiple systems, and is reported as a ratio of abnormal systems to total systems measured. This chapter examines technologies that can assist with screening, assessment, and delay or prevention of the physical, cognitive, nutritional, and psychosocial aspects of frailty. A minority of these technologies have strong evidence for use in frailty. Consequently, the chapter also explores technologies that are in use or have potential applications to frailty, but have not been rigorously evaluated for this purpose. Improved technology geared toward the elderly, plus research to support its use, is desperately needed, for now the provider, pre-frail and frail elderly populations, and their caretakers will have to continue to improvise with the resources currently available to them.
This book is part of the Critical Topics in an Aging Society series. It serves as a catalyst in the technological transformation of aging services through organized presentation and evaluation of tools for a broad health care audience. Geriatrics interprofessional care is a fundamental part of older adult clinical practice modeled on a team approach inclusive of various fields, among them social work, pharmacy, nursing, rehabilitation, administration, and medicine. All clinicians who treat older adults, from the independent to the frail, are engaged in geriatrics team care which is continually adapting and evolving for individuals based on functional status changes, new treatment paradigms, and different settings of care. The need for advanced technology is clearly evident as one enters a hospital, nursing home, or geriatric care setting, including the patient’s home. Older adults have limited abilities to adapt to changes across these care locations, and thoughtfully implemented technology may eliminate these obstacles while providing safer, more enjoyable, and cost-effective care. The book presents some of the latest medical technological innovations and discusses options to help improve not only transitions of care, but also independence and quality of life for older adults. It is organized into four sections. The first section discusses current major challenges in aging and targets for technology, and promoting technology adoption and engagement in aging. The second section focuses on transitions of care and technology integration, home telehealth, and telemedicine and its effects on elder care in rural areas. Section three explores technology design for frailty, technology and cognitive impairment, advances in medication adherence technology, and technological advancements in pain management in elderly population. The final section describes personalized medicine and wearable devices, social robots and other relational agents to improve patient care, artificial intelligence and its potential to improve health, and advances in health education technology.
Clinicians, health providers, and others have always tried to use the latest and most advanced telecommunication and information technologies to improve health care. Historically, concerns about distance and availability of medical expertise in remote regions was the driving force for use of telecommunication devices; technology costs were the prohibitive factor. Telemedicine has the potential to significantly reshape health care, and fundamentally change medical care. Proponents of telemedicine claim that with advances in technology, telemedicine will continue to increase access to physicians, decrease health care costs, and generate revenue. Virtual learning, electronic consultations, and telemedicine are three modalities that have shown promising results in improving quality of care provided to rural residents. Telemedicine can provide teleradiology, telepsychiatry, teleophthalmology, teledermatology, teledentistry, and telepharmacy services at remote areas and improve health care for millions.