Aging brings its own challenges, but frequently this is compounded by increasing demands of failing health and a greater need to manage new diagnoses, understand new medications, negotiate limitations in function and all of this compounded by challenges to memory, concentration, adaptability, energy and mood. Polypharmacy sometimes creates problems of its own, rather than control the growing number of declining systems. Making changes to regimens that are poorly understood, instead of providing the rescues or positive outcomes that are hoped, just frustrates and frightens people already overwhelmed.
Changes in formulary that create unexpected copays at the pharmacy cause people to “leave” medications behind when they don’t have the readily available funds. Weather can deter or defer much needed and scheduled visits to the doctor, whether it is snow or freezing cold in the winter or allergies and heat in the summer. While the place people least want to be is the doctor’s office or the hospital the complexity of trying to “age well in place” seems to result in a constant flow of visits. Getting admitted to a hospital is disorienting and frequently leads to an unintended loss of functionality, hastening rather than forestalling decline. Not only do we have the most expensive dying of any country in the world, we have the most expensive, complex, fragmented and ill-designed care system for the elderly. What do people want? They want to have services that help them maintain their independence and to be valued as individuals not stereotyped because they are old, and they want to be at home, able to maintain their social relationships as best they can.
If we dare boldly we could deliver on this now. We could take their dream and turn it into a reality today. Two things are required; one an understanding of (and a willingness to embrace) what technology can do to assist us to remotely monitor, truly understand (at the individual level) and mange patients in their homes and two an alignment of the system to reimburse for “value” (clinical outcomes, financial outcomes, quality of life) beyond activity. The types of monitoring that can be done at home through simple readily available devices, blood pressure monitors, thermometers, scales, spirometers can not only give us insights to the situation when a patient “has an episode” but can more dynamically allow us to truly appreciate their individualized base-line, their normal variation and learn the unique exacerbants that are most critical in their life. When rescues are needed instead of bringing them to an emergency room to treat, then monitor and then reevaluate before sending home, rescue protocols that are ordered by their physician can be put in place and tracked and modified without taking the patient out of the house, giving them a greater sense of control of their own situation. All of this is powered by two way communication of data and messages both live and in text that let the patient know they are cared about, they are not alone, that their attempts to help themselves are being tracked for their safety. In addition new sensors that track the person as they go about their daily routine can give subtle and early cues as to changes in habits that signify pain, distress, or alterations in memory or mood. These create the deep insights that are truly personal, powered by machine learning algorithms that can help deliver on the promise of respecting the unique individuality of every patient and not just treating them as “yet another” diabetic or CHF patient.
This isn’t the future. For these patients who prefer this and are clamoring for it, this is here now, available, deployable, and affordable. So the question really is what does it take to turn hopes into reality – awareness and action. So if you are aware now, isn’t it time to act.
By David Whitehouse