Tuesday, July 31, 2012

Remote-sensing incontinence briefs

While sipping my coffee Sunday morning I happened across one of the doyens of NY Times political opinion, Thomas Friedman, turning his attention to the coming crisis in elder care. It is thrilling to see such attention lavished on an issue near to our hearts, but also fascinating to momentarily see our field through someone else's eyes. So how do our nation's pundits and policymakers perceive the challenges of long term care?

Mr. Friedman provocatively frames his discussion as a question of national priorities: caring for our own elders versus maintaining our military presence around the world. He argues that several "trend lines" including the aging population, rise in prevalence of dementia, and reduced savings of retiring seniors will soon combine to present the US with a stark choice: "between nursing homes in America and nursery schools in Afghanistan". The article is a sobering, realistic call for attention to a topic largely left out of the health insurance reform debates.

Yet, as is typical for his writing, Mr. Friedman offers a ray of light after describing the depth of the coming darkness. His prescription for an elegant, socio-technological fix:

Add up all these trend lines and you can see why, over the next decade, we must get more consistent economic growth as a society and, also, adds Daroff, come up with more policy and technology innovations that allow us to provide a lot more elder care, in particular aging at home, for a lot less money. That will require breakthroughs like remote diagnosis equipment in every home that can track a patient’s weight, blood sugar or lung capacity and dispatch it to a hospital, or clothing with sensors woven into the fabric that will be able track all physical indicators around the clock.
My fellow GeriPal readers, what do you think of this prescription? Is the iMedicalization of our elders with wearable monitors transmitting minute-by-minute status reports to the hospital a solution for keeping them affordably at home? If you could re-write the end of this article, what solutions would you suggest to our nation's policymakers? What should they know about the challenges of elder and long-term care? Or should the NIA indeed embark on a crash program to develop remote-sensing incontinence briefs?

[Photo: The latest in wearable medical technology for seniors, via Wikimedia Commons]

By: John Newman

6 comments:

Carol Levine said...

I saw this column and well and wondered if we had reached a Tipping Point in the zeitgeist when someone like Tom Friedman writes about elder care. Unfortunately he seems to have been led to believe that the solution is more nursing homes or more technology involving constant telemonitoring (to a hospital? Is he kidding?), when what is needed is more human and humane care. Carol Levine

Anonymous said...

We need to have more research and innovation in delaying frailty and reducing disability in our senior population.

ken covinsky said...

Fascinating post John--Perhaps Mr. Friedman has unwittingly presented in rather stark terms the limits of technology and telemonitoring.

Many think the answer to the complex medical needs of older persons is to just collect more and data on our patients, and act on all of this data in real time. But as Carol Levine describes, we really need more caring and perhaps not so much technology.

Mr. Friedman's writings are distinguished by an uncanny degree of common sense and pragmatism. So, I suspect that as he thinks about this more, he will recognize that virtually no older person would actually want to live in the manner he is describing.

Often, the goal of care in frail older persons is to free them from lives dominated by their health problems. The goal is to have their lives disrupted by their medical problems as little as possible.

Technology has its potential, but if we are not careful, technology risks taking us in the opposite direction. Many forms of telemonitoring already in use, such as those used in the VA health system, risk this unintended consequence.

Helen Chen, MD said...

On reading this post I started imagining surrealist Kubrick-esque dialogue:

"My briefs want you to contact the nurse, HAL."

"I'm sorry, Dave, I can't do that."

As Carol Levine and Ken have already noted, technology is not going to entirely solve our future eldercare problems. We need more effective, earlier interventions and more upstream preventive care to proactively address risk for functional decline/frailty before they occur. Of course, this takes will and resource allocation by leaders who may not understand the importance of this investment until it is too late.

NPFontana said...

What if we paid personal care givers of the elderly and disabled what professional athletes are paid and pay prof athletes what caregivers are paid? Until society values and rewards competent, compassionate care giving, until comfort and security at end of life is a priority, no data collection nor fancy technology will ease the journey at end of life for the millions headed down that path.

John Newman said...

My own 2 cents that I would offer to the powers-that-be:

1. Technology and "productivity" (the usual source of GDP growth) mean much less in medicine than other areas of the economy. Long-term care is an extremely human job. Until we create humanoid robots that can change a diaper and offer a warm, reassuring touch, there is no technological substitute for a human being spending a lot of time with the patient. We might be able to save money at the margins by reducing hospitalizations, but the idea of improving long-term care "productivity" by caregivers spending less time per patient is nonsensical. Instead of relying on the magic powers of economic growth, we should be figuring out how to continue to provide this labor-intense service in an age where labor is becoming ever more expensive versus goods or energy.

2. The US is right now in a uniquely poor position to provide labor-intense long-term care. Not because of deficits, but because among industrialized nations we make it hardest for semi-skilled non-organized workers to make a decent living. Long-term care requires a lot of caring and hard-working, but not necessarily highly educated or trained, workers. One family member might do the work or 2 or 3 hired caregivers, but to do so means giving up their income and often their own health insurance. We should make it far easier to family members to take long leaves of absence, with income support, health coverage, and help finding a new job afterwards. And we should work towards a society where caregivers (and all lower-skilled workers) can earn a dignified and secure living at their job. We need political and social innovation far more than technological innovation.