September/October 2023

Age Tech: The Next Frontier in Care
By Jennifer Lutz
Today’s Geriatric Medicine
Vol. 16 No. 5 P. 12

Technology is making it easier to age in place.

The number of Americans aged 65 and older is set to double in the next 40 years1 and expected to reach 80 million by 2040. Met with the ongoing shortage2 of home health care workers, increasing pressure on Medicare,3 and the prevailing burden of chronic illness,4 our aging population is facing a crisis in care and a potential collapse of the previous pillars to older adult care in America. As more older Americans require aid, the model will need to shift, replacing crises with innovative solutions. While this shift may come in many layers, technology is sure to play a major role—with new developments in virtual reality (VR), augmented reality, wearables, and Internet of Things (IoT) connected devices leading the way.

IoT Connected Devices
Many are most familiar with the IoT—devices like smartwatches and fitness trackers have become a common part of daily life. With or without intention, the 85% of US adults who own a smartphone5 can check their daily steps, hours spent in bed, and daily screen time. When it comes to monitoring health, there’s likely an app for that. Consumer comfort with those apps is growing, with two in five adults using health apps and at least 50%6 of those adults using them daily. Aging adults are no exception. “People assume that older people are dummies when it comes to smartphones and stuff, but most of my patients are very savvy when it comes to the internet,” says Imran Ali, MD, MS, MPH, an assistant professor in the department of medicine at the Icahn School of Medicine at Mount Sinai.

Monitoring Health to Stay Independent Longer
Apps that help people monitor their daily exercise, heart rate, and diet, for example, can help aging adults stay healthier longer, according to a recent study that examined whether health apps (mHealth technology) can improve health in measurable ways. For the study,7 researchers implemented a large-scale randomized field experiment based on detailed patient lifestyle activities (daily steps, exercise time, and calories expended; sleeping patterns; and food quality and quantity) and blood glucose values from chronic diabetes patients during a 15-month time frame. Patients were divided into three groups; the first had access to the mHealth app, the second had access to a web-based version of the app, and the third (control group) had access to neither. Patients with access to the mobile app showed improvements in both short-term health metrics (such as reductions in blood glucose levels) and longer-term metrics (such as reduced hospital visits and medical expenses). Those reductions in hospital visits and medical expenses are good news for patients and Medicare alike—90% of America’s $4.1 trillion8 in medical expenses are for people with chronic health conditions. Specifically concerning an aging population, Medicare per capita spending9 is projected to grow at an average annual rate of 5.1% between 2018 and 2028, and spending on beneficiaries with heart conditions averages $18,270, compared with $9,302 for those without.

IoT technology that helps people stay healthier longer not only lowers medical costs but also makes it more feasible for people to live independently, which makes it easier for the 77% of aging adults who want to remain in their homes10 as opposed to moving to a care facility or group living situation.

Smarter Homes for Greater Independence
Staying healthier longer isn’t the only way IoT devices can help older adults stay healthy at home longer. The Human/Activity/Space/Technology model11 pertains to the interdependence of aging adults, their built environment, and the performance of tasks. Importantly, each individual has different needs, abilities, and structures of care (both formal and informal), and when discussing health, there are multiple considerations: home safety, physical activity, mental acuity, and social interaction.

There are various ways IoT technology can make homes safer. For example, motion-detection lights can help individuals avoid falls—the second leading cause of accidental injuries or deaths worldwide.12 Of course, no matter how smart the home, falls can still happen, and getting care quickly can make all the difference. IoT devices like smartwatches can monitor falls and alert a central monitoring station (when paired with the appropriate app). Watches may be more suitable for older adults who don’t want to wear fall alert buttons; they can also share with emergency responders important medical information like blood type and medications and physical activity, including ECG stats. Smart speakers (think Alexa) are another option. Unlike a smartwatch, the speaker won’t automatically connect users to emergency services, but it will call any saved number and can also be used to alert multiple contacts simultaneously using third-party apps.

Subscription services can be used to augment smart home technology. For example, Alexa Together allows family members to check in on their loved ones. It also has an emergency feature that allows caregivers to call for help and connects to professional monitoring. Third-party sensors can also include activity feeds that allow users to monitor a person’s interaction with IoT home technology. A caregiver can keep tabs on when someone turns lights on, plays music, or moves about the house, making activity feeds important early detectors in emergency situations.

Staying Connected to Stay Sharp and Well
Social connectivity13 is an important consideration for aging in place, particularly for mental acuity and well-being. And while too much screen time has been linked to poorer mental health in young people, video calls and even voice-activated assistance can help aging adults stay connected. Despite old-school ideas of the “digital divide,” research shows that many older adults use technology to stay connected,14 some even as much as their younger counterparts. The Health and Retirement Study14 surveyed a subsample of adults older than 50 (with a mean age of 68) to assess their attitudes toward technology as well as its impact on health and social wellbeing. The results showed a willingness to use technology as well as to learn new technology. The social technology included in the survey included email, social networks, video calling services, online chatting, and smartphones. Technology use was associated with less loneliness, better health, fewer chronic illnesses, and lower rates of depression. Limits of the study include a predominantly white, partnered, and financially stable population sample. Within those limitations, when controlling for age, gender, and education, technology use remained a significant predictor of life satisfaction.

The International Telecommunications Union acknowledges and supports ways in which information and communications technologies can help people overcome age-related barriers. For example, screen readers/text-to-voice and voice-to-text virtual assistants can help older adults stay informed and connected. These accessibility tools help them stay engaged longer (which can prolong acuity and independence). Beyond just staying safe and connected, these accessibility tools could help adults work longer (if they’d like to).

The Role of VR
VR15 immerses users in an environment and can be used to educate, motivate physical activity, and delay cognitive decline. VR learning can rely on gamification techniques to help older adults stay sharp and learn new tasks while including elements of socialization. VR intervention has been used to intervene in older adults with mild cognitive impairment, helping improve learning and retention. VR also can be used with physical rehabilitation in the home that allows aging individuals to interact and consistently partake in exercises without the risks and hassles of commuting. And VR experiences can transport people to cultural experiences, whether museums, concerts, or travel to the Amazon. “There are certain memory units that are trying to use VR to provide experiences that can stimulate the brain. We know that music can stimulate certain parts of the brain, and we’re using headphones to try to bring people back to a place where they were happy, and these can reduce the feelings of agitation, confusion, and fear. I want the Apple Vision Pro to come to centers for seniors so they can travel to other places,” Ali says.

VR may have a special place in reminiscence therapy, a decades-old practice used to help cognitive decline by engaging people with reminders of their youth, like photographs, music, and videos. VR can sort of supercharge that by “placing” the person in their past. Studies16 have shown VR technology to reduce anxiety in people with cognitive decline (with a preference for live images rather than computer generated). The use of VR can aid in the reduction of medicines, such as antipsychotics that are used to treat anxiety with far-reaching side effects. Another study17 showed that VR is well-tolerated by elderly participants and can be used to improve autobiographical memory. While generating rendered images of a person’s past can be costly and out of reach for many people, taking 360° footage of someone’s childhood home from the internet can be both accessible and effective.

VR can also help older adults feel included. While distance can be a hurdle to attending family events, such as weddings, births, and graduations, 360° footage and a headset can allow someone to attend virtually. While it’s certainly not the same as hugging a grandchild, virtual attendance can improve morale and spark greater feelings of socialization.

Another option is creating shared 3D spaces (think games) that don’t mimic a person’s life but rather allow an escape from the difficulties of aging—and they can be shared with a social network. One study18 examined the use of a shared metaverse for older people during COVID. Participants could select an avatar and engage with other users by performing group activities. Scenes were designed for real life (like a park) so older participants could better identify included rest areas (such as benches) where they could interact with each other casually and take a break from planned activities. The study’s main success was showing the potential for the interaction of rehabilitation and social activities with the metaverse to improve mood, well-being, and cognitive functioning. This sort of VR could offer community for many, but Ali warns that when dealing with patients with dementia, it’s best to stay away from avatars and focus on images that are as realistic as possible—bringing people back to their reality.

It’s not just cognitive functioning where VR shines; it’s also being used in balance training19—helping lower the risk of falling. When users perform VR training, the prefrontal, parietal cortical areas and other motor cortical networks are activated, which may be involved in the reconstruction of neurons in the cerebral cortex. Clinical studies have shown improved neurological functioning in patients utilizing VR in rehabilitation for spinal cord injury, cerebral palsy, and neurological impairments. The user doesn’t have to physically navigate a jungle or perform complex balancing tricks; the VR training works by generating visual, audio, and haptic feedback.

When we first think of balance, we may have images of standing on one leg, but the importance of balance (especially as we age) is preventing or quickly recovering from the loss of balance. Three major systems are involved in this: visual, vestibular, and proprioceptive sensation. When one of these systems is impaired (such as in the case of cognitive decline), another system can be trained to compensate; this is where VR can be beneficial by creating virtual tasks that help the systems compensate.

The Role of Augmented Reality
Whereas VR transports the individual to an immersive world, augmented reality creates elements of a 3D reality in the individual’s physical space. Remember the research showing the positive impact of video calling on mental wellbeing? Imagine the value of bringing that person into the room—using augmented reality. “If I can get the family of my patients to do FaceTime, but rather than a face in a box, it’s augmented reality, the person becomes more relatable; it makes a world of difference,” Ali says.

Augmented reality can also be a useful tool for older adults who are experiencing mild cognitive decline by helping them navigate an augmented version of their home. And it can be useful for those returning home after rehabilitation, allowing them to acclimate themselves to their environment in an augmented way (free from sharp corners and hard surfaces).

Augmented reality may also be a useful training tool for aging adults to learn new skills, thereby increasing cognitive function and creating daily habits that improve mood. By creating 3D images that people can walk around and interact with, augmented reality interacts with more brain regions than do 2D learning tools and offers users a range of objects to work with.

Augmented reality, like VR, can be a tool in an expanding variety of digital interventions that help older adults live fuller lives, adapting to a world with increasing physical limitations.

What Comes Next?
The many opportunities launched with technology come with challenges, some of which are the usual suspects—accessibility, equity in care, and insurance coverage. Other challenges are more nascent, such as privacy issues and scalability. For example, regarding the use of VR in reminiscence therapy, Ali says, “It should be guided and episodic. For other recreational treatments (such as music therapy), we have a recreational therapist. I’m constantly referring clients to our recreational therapist.” This works great for people who live in a care center or who are mobile enough for outpatient care, but what can we offer to patients who want to age in place and have limited mobility?

Technology like VR is becoming more common and more affordable; it’s a great moment for providers and care teams to get involved and be part of the conversation. Imagine a world where Apple creates modules for older adults, or creating personal renderings is formulated and more readily available.

“We’re trying to move away from medications as quickly as possible and toward using more recreational therapies. It’s such an exciting time, and I think geriatric medicine is really going to harness what technology has to offer,” Ali says.

Too often, we assume that aging adults are technophobic, but often the opposite is true; technology may be the new frontier in caring for our aging population.

— Jennifer Lutz is a freelance journalist who covers health, politics, and travel. She’s written for both consumer and professional medical magazines as well as popular newspapers. Her writing can be found in Practical Pain Management, Endocrine Web, Psycom Pro, The Guardian, New York Daily News, Thrive Global, BuzzFeed, and The Local Spain. In addition to journalism, Lutz works as a strategies and communication consultant for nonprofits focused on improving community health.

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