As a practicing outpatient geriatrician, I generally embrace the principle that less is often more. But is this the approach we should take towards technology and the health care of older adults?
Consider the situation we are in:
- An aging population is creating unprecedented need and demand for assistance in maintaining health, well-being, dignity, and independence. The number of adults 65 and older will double by 2040, and the population of people age 85 and older will almost triple.
- Increasing demands are being made on family and caregivers and others; an estimated 30 to 40 million people are currently stepping in to support older loved ones.
- There is a shortage of health care workers trained to meet the unique needs of older adults and their families. Today, there is one board-certified geriatrician for every 2,600 Americans aged 75 or older; that ratio is expected to worsen to 1:3,800 by 2030.
This situation constitutes a national emergency and we need to mobilize on multiple fronts to find ways to provide our seniors with the effective compassionate health care they deserve at a financial cost that the nation can sustain.
Technology is one of those fronts.
Now, I’ll admit that I do consider myself a bit of a techno skeptic. That’s because so far, I’ve generally found that the technologies applied to my patients have been more of a hindrance than help. (Example: Not-really-needed chest CTs that uncover random pulmonary nodules in frail seniors, or any senior for that matter. Do we really need to find these random nodules?)
But I’m also a techno optimist, and here’s why: because I believe that the right kind of technological innovations will be instrumental in helping us help older Americans and their families with their healthcare needs.
For example, on the outpatient provider side, we struggle to address innumerable patient needs, from smaller tasks, such as reconciling medications, to more substantial ones, such as maintaining effective communication with other providers and colleagues to provide coordinated care.
Meanwhile seniors and families are similarly asked to step up to a variety of health-related tasks, from managing medications and keeping up with wellness programs to monitoring symptoms and sometimes self-managing substantial medical care in the home.
Already many of us – providers, patients, and caregivers alike – feel that the tasks at hand are more than we can sustainably do, with the time and resources we have available. But we are not going to get more time, and probably not significantly more in the way of financial resources.
And something must be done soon. A recent survey of physicians found that more than 50% of doctors practicing in general medicine and family practice (the main providers of primary care to seniors) are reporting symptoms of burnout.
I can’t say that this data surprised me. I made the difficult decision to leave my primary care practice last May. I’d found myself unable to provide care to my satisfaction and that of my patients with the time and resources available. I was burned out by the strain of trying to serve geriatric patients in a setting that demanded that I see 20 patients per day.
The only answer I see to this problem is technology: technology to allow us to do some parts of our work faster, more thoroughly, and more effectively.
This will give us all a little breathing room to focus on the things that technology can’t do. As providers, we’ll have more mental and emotional reserves to direct to thoughtful and attentive patient-centered care. Seniors will be better able to focus on articulating their needs and goals in order to constructively engage in managing their own wellness. And families may find themselves better able to appreciate the unique relationship opportunities presented by caregiving.
Or that’s that the theory, in any case. In reality, more technology will only help us if it’s the right kind of technology: easy to use, tailored to our needs, and likely to bring us outcomes we value, rather than snow us under more information or bring on more complications.
How to find this technology? I’m not entirely sure, but I’ve decided we must start looking and sharing ideas. For instance, at this point most of us in health care are adopting electronic health records and other technology systems meant to improve communication and care coordination. For clinicians this has often felt like an additional strain rather than a boost, as Abigail Zuger recently observed in the New York Times. But EHRs will improve, especially if we develop our ability to provide constructive information to those responsible for bringing us this technology. And some aspects of the new EHRs offer exciting possibilities for improving care, such as “integrated patient portals,” which enable patients to communicate with medical offices online and will surely become an important means of coordinating care with seniors and caregivers.
On the consumer side, there is a vibrant entrepreneurial world developing health tech innovations for the “mature market.” Among others, these include home-based technologies to support aging-in-place, and online platforms to support collaboration among a person’s circle of care.
Do any of these technologies currently improve outcomes? It’s of course too soon to know for most of them. We should also note that our traditional academic methods of investigating what works (e.g., peer-reviewed research) will have difficulty keeping up with the rapidly evolving options.
So as we continue to pursue high-quality research on these emerging technologies, I propose we also create forums for learning, sharing, and conversing about these technologies. (You can read my thoughts on AARP’s recent list of innovations for folks over 50 here.) After all, seniors and caregivers will be asking clinicians for our opinions on these technologies, and will also ask clinicians to interface with them. Furthermore, those of us with expertise in senior health need to make sure the innovators understand what we need technology to do for us, as well as hear our reservations when we come across technologies that may not serve us well.
To return to my original question: do we need more or less technology?
I say we need more of the right kind of technology. This will enable us to provide more care, when people need us the most.
Have you come across a technology that has helped you manage some aspect of senior health care, or shows great promise for doing so? If so, I would love to hear about it. I invite you to consider writing about it here, at www.GeriTech.org, or in another forum where we can all learn from each other.
Leslie Kernisan, M.D. M.P.H., 36, is a practicing outpatient geriatrician in San Francisco. She blogs about geriatrics and technology at www.GeriTech.org.