"There's no place like home," says The Wizard of Oz's Dorothy Gale, and many seniors couldn't agree more. Some have lived in the same dwellings for decades and their homes have become their shields of independence. Even those older adults who live in small residences love their homes — and, with home adaptation technologies, more of them are empowered to do so each day. On a broader level, technological advances have helped cut overall and personal medical costs by improving efficiency and making full use of resources, reducing hospital readmissions, and facilitating health promotion efforts.
Meanwhile, demographic changes ensure greater numbers of older adults will be living at home, making the need for these technologies even more salient. According to the U.S. Administration on Aging, between 2000 and 2040 the number of adults over 65 will have doubled, while from 2012 to 2040 the number of seniors over 85 will triple. Compounding this issue is the increasing numbers of older adults living at home who are suffering from such chronic illnesses as cardiovascular disease, diabetes, and Alzheimer's.
The ability to adapt to the physical effects of aging at home is not limited to talking medication dispensers, sensors in shoes, or the myriad other technologies being developed and used to help seniors live safely at home. Continually evolving technologies that allow medical professionals to help seniors age in place can also be considered "home adaptation" technologies. Here is a sampling of technologies spanning multiple professional disciplines that work to help older adults age in place.
Doctors working to help elders remain at home need every technological advantage available to meet the needs of a flood of chronically ill baby boomers. Technologies that were unfathomable a few short decades ago can now be found in every medical field, and many more are coming. Some innovative companies lead the world in designing and marketing these technologies.
According to the U.S. Centers for Disease Control and Prevention, cardiovascular disease claims the lives of 600,000 people every year. In most cases a preventable problem, much of cardiovascular disease is well understood; today, for example, doctors understand that direct, minimally invasive surgical procedures significantly decrease the risks that stem from heart surgery, especially among older adults.
Being able to see the entirety of a patient's heart in real time allows for incredibly precise surgery. Though it may sound like a science-fiction story, 3-D holographic imaging is used at Schneider Children's Medical Center in Petach Tikva, Israel. Pediatric heart surgeons can peer at virtually at any area of the heart, can manipulate it any way they choose, and can slice it in any way they need, all through a real-time display. The virtual heart appears to be floating in midair. When the device comes to the United States, the greatest benefit of this holographic technology will be its function as a tool for geriatric interventional cardiology. Holographic medicine is on the threshold of explosive development, and the possibilities (even beyond their cardiovascular uses) seem endless. For example, imagine a mother sharing a perfect, real-time holographic rendering of her baby in the womb with a soon-to-be grandmother.
Orthopedic and Spine Surgery
Whether replacing hips and knees or bolstering and trimming spinal columns, orthopedic and neurosurgeons help countless seniors remain independent in their homes. From laser surgery to synthetic discs, technology has long been an important component of both orthopedic and neuroscience surgeons' work with spines. Printing in 3-D has been used for years to create models of vertebrae for educational purposes, but in August 2014 researchers in China announced the first successful 3-D–printed vertebrae implantations. The printed implants were made with the same material as has been used in implants for decades: titanium powder. Chinese interest in 3-D printing in the medical field began in 2002, long enough to appreciate and capitalize on the enormous design flexibility that allows for precisely customized joint replacements. Every spine is different, and that same design flexibility is what makes the prospect of printed vertebrae so promising for seniors with spine diseases.
According to the American Diabetes Association, nearly 26 percent of adults over 65 — 11.8 million — have diabetes. Prevention, early detection, and treatment compliance all minimize this disease's harmful effects, which can include autonomic neuropathy, the cause of such conditions as urinary incontinence, sweating disorders, erectile dysfunction, gastroparesis, and exercise intolerance.
Scientists in Taiwan have developed a pupilometer that appears to detect autonomic neuropathy early. Still in clinical trials, the pupilometer stimulates the pupil to change size when multicolored LED lights are shined into a patient's eye for 30 minutes. The pupil's size and reaction speed are measured to calculate the probability of autonomic neuropathy.
Alzheimer's is the sixth leading cause of death in the United States — the Alzheimer's Association reporting that more than 5 million Americans and one in nine seniors over 65 have the disease. There is no known cure for this disease yet, and no apparent way to stop its progression. Technology seems utterly thwarted by a dementia that still remains poorly understood.
However, that may be changing through the work of Dale E. Bredesen, MD, director of the Easton Center for Alzheimer's disease Research at UCLA; and John Q. Walker, PhD, chief technology officer of Muses Labs in the Research Triangle in Raleigh, North Carolina. Dr. Bredesen is a pioneer researcher in the role of combination therapy in treating Alzheimer's disease.
Dr. Bredesen discovered that combining different drugs in varying amounts among patients who make very specific dietary changes while increasing their physical activity appears to reverse the effects of dementia. While effective, the complexity of this treatment has been prohibitive for many — a major challenge that may be overcome, as Walker and software designers at Muses Labs are working on a program to manage these complexities. Though the technology is still in development, the potential benefit to Alzheimer's victims, their loved ones, and society at large is immeasurable.
Ask a nurse what kinds of technologies would best help him heal his patients, and he will likely say, "Where do you want me to start?" The front line in the provision of healthcare services, nurses welcome technologies that help their patients adapt to aging in their own homes.
Whether they're helping patients recover in the hospital, rehabilitate in the nursing facility, or receive wound care at home, nursing and technology have been close partners for some time. From portable devices that measure and transmit vital signs to IV computers that continuously beep, some technologies seem designed by nurses for nurses, while others simply get in their way.
To meet the need for technologies to help nurses do their jobs safely, companies are stepping up with interesting and practical devices. Nursing is one of the occupations at greatest risk for musculoskeletal problems, says the American Nursing Association. Nurses' lower backs take a beating simply by monitoring vital signs, which is not as easy as some may think. Patients need to be turned, held down, or stood up, and they need a lot of help from nurses to do those things. A company called EarlySense has designed cushions that measure vital signs — all they have to do is sit on the cushion. Because of its portability and reliability, the safety implications for home health nurses are especially promising.
Hospitals, nursing homes, and home health have the potential to be dangerous to a nurse. Patients and their families are sometimes in emotionally volatile states; as a result, workplace violence frequently afflicts the nursing profession — and may prevent nurses from helping their senior patients. Given the risks, there is hope that wearable beacons will someday protect nurses. More than mere panic buttons, such beacons may be equipped with cameras and GPS-tracking chips, and be able to automatically lock down an area, limiting the breadth of a crisis.
Nurses are finding patient-worn wearables to be helpful, too. One example of patient wearable technologies is the Philips IntelliVue MX40 monitor, a wearable real-time monitor of vital signs and other clinical data that also acts as a programmed alarm system designed to prevent identification errors.
Pharmacists face the challenge of managing ever-increasing numbers of medications for a rapidly growing population. Many pharmacists are also playing active roles in the provision of such clinical services as IV antibiotic therapy. The range of technologies coming online is just as robust and exciting for pharmacists as with other professions. Hospitals only recently began sending discharge summaries to patients' pharmacies, primarily because technology has made it easier to do so. More retail pharmacies are providing Internet portals to patients. Bar-code and medication-dispensing technologies reduce errors, and important messages and reminders are texted to patients. Sensor-laden blister packs of pills track dosage compliance, while a "smart" pill reports dosage and other information. These and a multitude of other technological advancements profoundly affect the role of the pharmacist.
Physical and occupational therapy both play major roles in home adaptation. While physical therapists (PTs) restore or retrain the body, occupational therapists (OTs) assist seniors in relearning basic activities, such as brushing their teeth or driving after debilitating events such as strokes. The Microsoft Kinect is currently used by West Health Institute to implement its Reflexion Rehabilitative Measurement Tool. Programmable by the PT, a wearable monitor records the patient's movements during exercise at home. That information helps the therapist see where improvement is needed and whether a patient is complying with therapy. One example of emerging OT technology is a driving simulator developed at Clemson University. Specifically designed to rehabilitate injured members of the US Armed Services, it has obvious applications for seniors.
Social Work and Discharge Planning
Charged with developing realistic plans that meet the needs of patients while simultaneously honoring their rights, effective discharge planning strives to achieve good outcomes and reduce hospital readmissions. A variety of technologies help hospital social workers transmit referral information quickly and accurately. The single most important information tool, the discharge summary, can be made accessible to patients with ease electronically. This could be part of a patient portal that's used as a communication tool between providers and patients. Whether the patient is at her doctor's office or the hospital, an account is created, granting her instant online access to much of her medical records. Appointments, drug lists, labs, and much more are all at the patient's fingertips. More importantly, patients can communicate directly with healthcare professionals, including social workers, through such portals.
Healthcare's use of technologies that support home adaptation wouldn't be complete without improvement in informatics technologies, because the conceptual and operational hub of any healthcare endeavor depends on good informatics. Massive volumes of sometimes extraordinarily complex information compiled among providers, patients, and insurance companies are of little value if that data cannot be quickly accessed. Solutions specific to ICU, cardiology, acute care, and other critical care services include technologies that present exact data at the exact time it's required.
Technology bodes a promising future for healthcare professionals working to preserve senior independence, however indirectly — yet, technology is not always the answer, and the costs of the latest and greatest innovations can be well beyond the range of seniors and even some providers. Devices cannot replace the hunch of an experienced nurse, a family member's loving attention, or a caring, supportive community. It is when these disparate powers are combined that the true benefits of technology are realized.
Technological advancements are increasingly helping seniors to age in place. Would your patients benefit from a medical alert device? Refer them to a Lifeline service.