Dr Kirstyn James saw firsthand the benefits of telemedicine while doing her geriatric fellowship at Harvard Medical School in Boston.
Working in the Veteran Affairs Healthcare System, she’d find herself doing a remote medical consult with a veteran in Cape Cod, who found the three-hour drive to the clinic too onerous. Or with a veteran who had a problem with memory or mobility, making it difficult for them to leave home.
“We had a hub-and-spoke team in Boston – we could see patients from all over Massachusetts remotely in one morning,” says Dr James, now a consultant in geriatric medicine at CUH.
Such digital solutions to elderly healthcare are set to come into their own as the world’s population ages. The number of people aged 80+ will triple globally in just under 30 years. By 2030, over 60s will comprise one-quarter of Europe’s population.
With such demographic shifts, costs of elderly healthcare are set to rise – but with less people working for every retiree, how is this sustainable?
New digital technologies – some current, some in the pipeline – will very likely be part of the solution. The 2019 EPTA (European Parliamentary Technology Assessment) report highlights the potential of digital technologies – like e-health and robotics – to ‘contribute to active ageing in a cost-effective manner’.
Working in CUH since last August, Dr James has seen – with the pandemic – big progress in HSE rollout of telemedicine facilities. Between August and the end of December 2020, the geriatric medicine tele-health clinic in CUH did 46 consultations. Patients hailed from as close by as Cork City to remote areas of the county, such as Castletownbere, and the wider parts of Munster.
Based predominantly in the emergency department, Dr James offers telemedicine to older people who need follow-up visits. She can do memory tests, inspect skin and feet or notice shortness of breath. “If a patient’s familiar with checking their own weight or blood pressure, I’ll often ask them to do these measurements.”
She reviews mobility and assesses triggers for falls, for example, dizzy symptoms. “Seeing someone’s mobility in their own home is very useful. When they stand up or turn around I might see a coffee table that they could potentially fall over. If someone calls to their door and it takes the patient a long time to get to the door, or they seem unsteady on their feet, I’d be prompted to do certain tests.”
With a patient who has poorly-controlled blood pressure, Dr James might ask to see on video how they organise their medicine. “I might see it’d be easy for them to miss doses or make mistakes. I’d then work with the pharmacy to put in place a medication organisation pack.”
A survey of mobile technology use among 119 older people at CUH found 55% own a smartphone – but just over half didn’t intend to use technology for healthcare. Many in Dr James’s care have now seen the benefits of telemedicine. “A doctor doesn’t have to wear a mask on a video visit – a great help for patients with hearing impairment. In their own home environment, patients are potentially more at ease – there’s no waiting in a waiting room or dealing with stress of car-parking. And family members can join the telemedicine visit – we’ve had them join from the US.”
Consultant geriatrician at CUH Dr Denis Curtin previously worked on a research project around creating a digital health record for people with dementia. The model, he says, could be used for different chronic diseases, and it’s around keeping all stakeholders involved in the patient’s care – the patient, caregiver, GP, hospital specialist – in the loop about what has been happening in the patient’s life health-wise.
“At the moment, we have a disconnected healthcare system. Between clinic visits, a patient of mine may have attended their GP several times, been diagnosed with something new and had their medications changed. But very often I won’t have access to this information because the patient’s GP and hospital records aren’t connected. So I’m relying on the patient to give me this, often very complicated, information,” explains Dr Curtin.
He illustrates the potential benefits of having a private personal health record, held on a secure internet portal. “If a person were to become unwell while on holiday in Donegal and the local hospital wants to know about their past medical history, they’d be able to open up their health record on the secure portal. The patient – and all stakeholders in their care – can access that same information.”
He believes the technology could take 10 years to come on stream – navigating privacy/GDPR issues will present a challenge.
With robotic technology an emerging approach to assisting older adults, the 2019 EPTA report gives the example of socially assistive robots, which they said can enhance older people’s wellbeing. The robot seal Paro has been used in therapies for older people having problems with emotional contact and sleeping in Germany, Japan, Netherlands and Britain.
In 2018, the Alzheimer Society of Ireland (ASI) brought Paro to Ireland to help with delivery of person-centred care at ASI’s Orchard Day Care Centre in Blackrock, Dublin. An advanced interactive therapeutic robot, Paro – says an ASI spokesperson – is proven to reduce stress, increase socialisation, stimulate interaction and improve relaxation and motivation for people with dementia.
Challenges to implementing health/social care technologies among older people include lack of broadband and limited digital skills. And a Swiss study cautioned that using robots to replace human interaction could increase the user’s sense of isolation. The EPTA report says it’s obvious care of elderly people and their participation in society requires far more than a simple technological fix.
They point to research that shows when developers of technological solutions put the needs of older people first and foremost – rather than focusing on their frailty – elderly people are more likely to accept and use innovative technology.
- Generation Tech, free service, Monday-Friday, 8am-8pm, for 65s and over needing help with accessing technology. Phone 01-9633288; email email@example.com.
- ALONE offers free technology supports through BConnect programme. Phone 01 679 1032; email BConnect@alone.ie