Geriatrics Goes High Tech

How many times have you heard the story of a patient who had fallen and was “found down”—with no witnesses to the fall? The patient has no recollection of the fall. Who knows what happened?

One day last spring, a proactive caregiver showed me how easily a caring family can follow what is happening in the day-to-day life of an elder alone at home. Right in my office as the patient was saying, “Next thing I knew, I was on the ground,” her daughter turned her iPhone screen my way and showed me exactly what had happened. The fall occurred when the patient got tangled up in her bed’s comforter and fell right next to the bed, narrowly missing the chest of drawers but hitting her head soundly on the floor.

The video footage came courtesy of Dropcam. It represents just one of a wide range of technological products and services that are enhancing care for aging loved ones. Certainly there are costs for some families, and in some cases you may question whether a technology impinges on an individual’s privacy or dignity. But in most cases, these devices and services provide added security for elders who value independence and caregivers who value dignified support.

Below are some of my favorite technologies your patients and caregivers may find valuable.

Personal Medical Response

Think of this as a Fitbit for safety. For an elder with physiological reserves stretched thin, time is of the essence if injury or illness sets in. Getting immediate assistance can truly mean life or death. We all know there’s a bit of a stigma attached to the “I’ve fallen and can’t get up” button of your grandmother’s era. But those one-trick ponies are gone. Personal medical response systems are more sophisticated than ever. But buyer beware: There are also more service providers than ever before, so some of the key attributes patients should look for include the following:

• operator-assisted services that offer a monthly check on whether the unit is functioning properly;
• active/mobile patients’ GPS embedded devices that provide protection anywhere;
• fall detection that protects patients unable to activate a call button; and
• systems that do not require landline phones.

Every area has a variety of providers so you may want to contact your local hospital or Area Agency on Aging for a listing. Consumer Reports recently published an article about these devices. It provides a good overview and is available online.

And specific to veterans is Blue Star Veterans Network, which offers products and services for vets only. Its products are detailed on their website at www.bluestarvets.us.

Home Video Monitoring

With today’s technology there are a number of systems that allow a caregiver to stay connected with a loved one for relatively low cost. And while it’s important to respect an individual’s privacy, there are times when video monitoring can allow necessary peace of mind for concerned caregivers. Think of caregivers who are at work during the day or live in a distant city or country. The world of Wi-Fi and home video now allows for the ultimate in real-time video, and in some cases, audio connectivity.

The options related to the necessary hardware and software are numerous. There are do-it-yourself systems for which users can buy separate pieces as well as fully loaded packages available in home improvement stores and electronic sections of major department stores and online. Caregivers have shared with me some of the features they found valuable, including the following:

• Wi-Fi enabled;
• cameras controlled by a smartphone or tablet;
• available cloud storage of 12 to 24 hours of footage for later viewing in the case of a fall or onset of illness;
• alerts for activity or people;
• night or low-light capability; and
• two-way audio.

ID Bracelets/Necklaces

Until we all have microchips with medical history and key medical facts subcutaneously implanted, the good old-fashioned MedicAlert bracelet retains an important function for many patients.

Consider them must-have accessories for patients with diabetes, patients with epilepsy/seizures, patients on anticoagulation (blood thinner) medications, cardiac patients who use nitroglycerine, and patients allergic to penicillin, latex, shellfish, or bee stings.

I advise patients with Alzheimer’s disease and their caregivers to wear ID bracelets. With the high risk for Alzheimer’s disease patients’ wandering (see GPS tracking devices below), a caregiver of a similarly aged spouse can utilize the ID bracelet to alert emergency/first responder personnel of the caregiver’s role in caring for a vulnerable patient. Typically a patient’s bracelet identifies the caregiver, while the caregiver’s bracelet identifies the next relative who knows of the patient’s needs and would care for the patient in the case of emergency.

I favor a bracelet that is connected to a monitored call center. A choice in which you can have confidence is MedicAlert.

A 50-plus-year-old not-for-profit foundation provides the identification and call center, and electronically stores health information, which is then forwarded to medical personnel when necessary. While the standard dog tag or iconic medical alert tag remains available, there are numerous options for various styles and price ranges.

Medication Dispensers

Medication mishaps are some of the most dangerous medical mistakes that occur. Forgetting medications, skipping doses, and/or doubling up on doses can all lead to exacerbated medical conditions, dangerous medication interactions, and distressing or dangerous side effects. Because older adults average about eight drugs per day to manage, the challenges involved in taking medications accurately cannot be ignored.

Medication reminder systems can be low-tech plastic pill organizers or high-tech electronic medication dispensers with connectivity for alarms and alerts. Electronic systems are plentiful and range from complete stand-alone systems for which families fill medication dispensing devices that have connectivity to call centers that notify caregivers if doses are missed.

From the low-tech category, one of my favorites is the 31-Day Pill Organizer by MedCenter Systems.

For patients with dementia who may be unable to keep track of the date, the automated systems are likely best. One of my favorites in this category is MedMinder.

Is There an App for That?

More and more the answer will be yes. Some caregiver-recommended apps include the following:

• Alzheimer’s Caregiver Buddy;
• Best Alzheimer’s Products; and
• Words With Friends (I am told this one is very good in physicians’ waiting rooms.)

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.