How Virtual Care Uptake Can Support Seniors Aging in Place

WHY SENIORS WANT THE OPTION TO AGE IN PLACE

The global geriatric population is proliferating, with the World Health Organization estimating that one in six people will be aged 60 years or older by 2030. In the US, for the first time ever, adults 65 and over are projected to outnumber children under 18 by 2034, according to the US Census Bureau.

With the drastic rise in seniors worldwide, certain concepts that define aging, like retirement, have become somewhat anachronistic, according to Dave Ryan, strategic advisor of the ATA.

"There's much that needs to be, just fundamentally, re-thought," said Ryan, who is also the former general manager of Health and Life Sciences at Intel Corp. "[We] should retire the concept of retiring. Because [of] the demographics we have, I think, now [we can] allow people and afford people the opportunity to have multiple chapters."

As the process of aging evolves, biological age may ultimately have little to do with what type of care seniors need. Healthcare needs may begin to vary widely within older age groups.

"I'm fascinated by my patients and the differences [in] how we age," said Anita Szerszen, DO, vice president of research, director of inpatient geriatrics, and associate director of the internal medicine residency program at Northwell Health's Staten Island University Hospital. "I could have a 92-year-old breast cancer survivor who is completely independent and traveling the country on the plane by herself, visiting her family, socially engaged, and then another one who's her age or maybe 20 years younger [with] no history of cancer, and homebound, disabled."

Melissa Mitchell, executive director of the Global Coalition on Aging, echoed Szerszen, adding that social determinants of health play a key role in what aging looks like today.

Income instability, homelessness, and lack of access to nutritious food, transportation, and technology, can all impact individuals as they age. Thus, according to Mitchell, a primary measure of senior health is individuals' functional ability and not just the absence of disease.

"Functional ability is [an] individual's ability to do the things that they want to do, that they desire to do, to keep them where they want in terms of in their homes or in society or staying active," Mitchell said. "Absence of disease, of course, is fantastic. We want to keep disease away. But we also want to keep people as healthy as possible, starting as early as possible."

This focus on functional ability bolsters the concept of aging in place, which is gaining popularity among healthcare stakeholders. The Centers for Disease Control and Prevention defines aging in place as the "ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level."

There are clear health benefits to enabling seniors to age in place and a widespread desire among seniors to do so. But aging in place requires a technology infrastructure that ensures seniors have access to care as and when needed.  

HEALTH IT TECHNOLOGY CAN SUPPORT AGING IN PLACE

Healthcare technology has grown in leaps and bounds over the last few decades, and as a result, the technology framework needed to support aging in place largely exists.

"Think about what you put in your ear, what you put on your head, what you can wear, what you can put around your wrist, your ankle, your foot, even smart vests and clothes," Ryan said. "And let's not even get into exoskeletons. All of this technology, all these product concepts, and innovation, they all exist."

Perhaps the most significant technological innovation impacting aging in place is the screen, as it is the "gateway to connection to your friends, your family, your caregivers," he added.

Within healthcare, the advent of screen-based technology has enabled video-based physician visits, which skyrocketed during the COVID-19 pandemic. According to Szerszen, 30 percent of older patients used telemedicine, predominantly video visits, during the pandemic. That figure has since dropped, though it remains relatively high, with about 12 to 13 percent of older patients routinely using video platforms to access care, she said.  

And it's not just video visits — Szerszen's practice also leveraged the telephone to connect with seniors in their homes. They created a triage group comprised of medical students who couldn't be deployed at the hospital due to the in-person restrictions of the pandemic.

The group connected with older patients identified as high risk and provided telephone triaging and consultation.

"And I have to say it was quite emotional because they have uncover[ed] things that we would never [have] expected, like abandonment, for example," Szerszen said. "Like food shortages. And we were able to provide, at least in terms of the food shortages, we were able to provide those services to those patients. So, there's a lot to be done to connect [with] those patients and bring them into healthcare."

Remote patient monitoring, including through the use of activity trackers, is another category of technology that can support aging in place. Information provided by these technologies, such as how many steps seniors took on any given day, can be very helpful for clinicians, Szerszen noted.

Further, technology can help support the caregivers of seniors, who often are family members without medical training.

"Technology can help in monitoring. It can help in getting records altogether, making sure systems are talking to each other," Mitchell said. "And we're seeing more and more of that, which is certainly very encouraging."

As technology use becomes more ubiquitous among seniors, concerns about digital health literacy may emerge. But, according to the panelists, these concerns may not be entirely warranted.

While seniors certainly need to be educated on device use and supported through technical difficulties, the pandemic forced many older adults to become more comfortable with technology quickly.

"Particularly older individuals who sometimes are stereotyped [with people believing] that they're not able to use technology, when in fact it's something that can be learned and definitely was seen as vital and important in the pandemic," Mitchell said.

Mitchell believes it is ageism, and not chronological age, that drives notions around what seniors can and cannot learn about technology.

"I think we have lots of jokes in society about getting old and therefore not able to do things, not able to see, things like that," she said. "And I think we are inflicting this ageism on ourselves… these are challenges I think we're facing across society for an aging population, whether we're talking about technology, whether we're talking about the workplace, or whether we're talking about healthcare…It's very important for all of us to help be part of the change."