December 27, 2013

At first thought, seniors and digital health technology don’t exactly seem to go hand-in-hand. For some of the 65+ population, just learning to use a computer can be like learning a foreign language, and less than 20 percent of U.S. seniors use a smartphone.

But Dr. Wen Dombrowski, CMIO and vice president for connected health at VNA Health Group, thinks that just because someone is older doesn’t mean they can’t use the Internet or mobile technology. It just means that what they’re using needs to be better designed to accommodate their needs.

A geriatrics physician by training, Dombrowski now works with VNA Health Group on collaborating with industry partners and technology companies to identify new tools that could improve care delivery and promote better outcomes for the group’s patients. VNA Health Group is the largest nonprofit visiting nurse association in New Jersey that provides home care, hospice and community health services.

Broadly speaking, she sees two worlds of technology coming into play here. The first is information sharing and analytics — the kind of behind-the-scenes technologies that hospitals are using to store and analyze electronic data and coordinate care between facilities. Long-term care and home care are lagging dramatically here because they were left out of the meaningful use program and aren’t eligible for federal incentives for using EHRs.


“It’s pretty sad because if you look at (the costliest) Medicare patients, they’re elderly, disabled patients often requiring home care or long-term care,” she said. “We recognize that there’s a lot of opportunity to innovate care for these patients. I think a combination of technology on the healthcare side and on the consumer side could help manage these high-risk populations.”

As baby boomers age, there simply won’t be enough people, money or ways to take care of all of them effectively, she said. That’s where the consumer technology –telemedicine, sensors and apps – could really make a difference.

Much of the innovation here will likely come from the consumer market, in terms of miniaturizing sensors and creating a great user experience, she said. Then it will be up to healthcare companies to adapt those technologies to be used by seniors.

The problem she’s seen with that so far is that some sensors and apps try to address the senior population as one homogenous market, when really it comprises endless sub-populations of people with varying literacy levels, functional statuses and cognitive abilities.

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“With medication management, for example, there are generic all-in-one apps for someone with memory problems, but they don’t segment the population well,” Dombrowski explained. Someone with mild dementia would likely have different needs for reminders than someone with full-blown Alzheimer’s.

Then there are a few universal design principles that should always be, but aren’t always, considered when designing a product for seniors. For example, an app or website that uses 8-point fonts would be just too hard to read. And, a lot of older adults might have arthritis or inflammation in their fingers, so their ability to touch or manipulate things is different than the average cell phone user’s. They might need to use two or three fingers or different motions to complete a task.

“Sometimes entrepreneurs are designing things with a theoretic customer in mind; I encourage people to actually spend some time with those users,” she said.

The good news is, the startup community seems to be catching onto the need to connect technology companies with seniors. StartUp Health struck a collaboration with AARP earlier this year to support entrepreneurs in realizing what seniors really want in new products. And a new Bay Area accelerator called GENerator provides funding and support for startups developing solutions to improve long-term care or enhance the lives of older adults.

In the future, Dombrowski sees uses for more sophisticated gadgets in senior care — for example, robots that could automate some of the more basic duties of a nurse assistant and allow her to work more at the top of her skill level.

“The concept of internet of things is also very exciting — combining sensors with computing,” she said. “I think there’s a lot of very interesting use cases for pairing a motion sensor with gesture and voice, and to really make monitoring less intrusive. Right now to many people it’s kind of science fiction, but there are some very interesting IOT technologies that I think will become more widely available.”

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