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Smartphones and health -- not quite ready for older adults and chronically ill

Smart phone app futurists take heart -- your blood pressure (is/may be/isn't) trending up (down). So this week's Pew Research Smartphone Ownership Survey reports that 24% of the 50-64 age group and 11% of the 65+ population have smartphones. That's good, they are incredibly useful -- navigation, Internet searches, e-mail/chatting, maps, reading a book, and on and on. But meanwhile, while they are still ramping up, it seems that the world is going a bit mobile healthy crazy, which will not help those most in need of these apps until adoption further grows, never mind trusting health data transmitted through a phone. The NY Times (April 25) expresses concern: Can a smart phone save your life? (Congrats to Independa for its senior monitoring mention.) Maybe, but there are problems. Watch a video of Eric Topol at the Aspen Ideas Festival: Yes/no, oops, let me restart this app!) And last, but definitely not least, IBM's new report about IBM scientists 'envisioning' a number of 'future' devices for better self-management of health and monitoring of seniors that will encompass diet support, caregiver notification, blood test and mobility.

Look back to look forward. I appreciate that we are in one of those 'Look over there' technology eras, where we are regularly distracted and pushed/pulled by the latest trends.  Social networking (Facebook, Twitter, LinkedIn, Oh my!), crowd sourcing that more people liked this particular tweet or Facebook entry. Sigh. Health professionals are trying so hard to figure out what to do with this phone that's useful and may, as Dr. Topol notes, 'transform the world of healthcare.' Just not yet, please. Wait until version 2. For your amusement, these forums verify that touch sensitivity on the Droid screen is most definitely not adjustable. In fact it is insanely sensitive to accidental 'swypes' that may just launch your blood pressure off to your doc before you're ready, never mind, accidentally calling your cousin in Idaho. The Aspen video demonstrates using smart phones to track and treat chronic disease... and, uh, v2 should be better. Watch Dr. Topol get a blood pressure cuff onto an arm, trying to balance its connection to an iPhone connected to a docking station calibrating blood pressure. As the Times notes, the mHealth industry is very new, still wellness-oriented, and currently in search of a viable business model. And that model cannot simply be advertising, WebMD not withstanding.

IBM's report predicting the future should frustrate today's vendors.  The future will engage us if we're not moving enough -- I think that's out now in Fitbit.  Monitoring medication adherence exists -- not at any sort of tipping point, despite the issues with non-adherence. But it may take off after IBM helps integrate FitBit with the blood pressure cuff and weight scales. Elder care -- devices for tracking location (Active Care, Mobile Help?) exist -- Not knowing about these, IBM suggests that if they existed, maybe linking them to, you guessed it, medication adherence and tracking blood pressure. They envision a world in which devices could predict conditions that could lead to a fall --  see WellAWARE, QuietCare, AFrameDigital, GrandCare, BeClose. But IBM should discourage vendors whose products cost more than the $100 ceiling noted by the responders in their survey. Of course, as Computerworld notes, IBM's value add to the device market will be 'going a step further, integrating mobile and home-based devices with web-based resources, electronic and personal health records.'

In the tomorrow world, how can IBM help?  Perhaps they are already considering this, let's hope. but why not establish the IBM research lab that takes under-adopted existing technologies in the market and bundles them into combinations that help drive down costs based on IBM's help in obtaining committed volumes -- and demonstrate the value of integrated solutions.  Using their access to healthcare industries, provide incentives for entrepreneurship, but also provide resources to validate, test whether devices work separately or together, help design new user interfaces and most important, help reduce the risk inherent in new market categories. Meanwhile, Dr. Topol asked his audience how many are using Twitter and notes that he is benefiting greatly from the insights coming to him in these 140-character bites. I hope he is extremely choosy about who he follows and can wade through Tweets (even cutting out the personal ones) that can read like the shouts across the cacaphony of Penn Station.






Great article. It is amazing how many of these devices are out there already, yet here is a multi-billion dollar company predicting them. It clearly shows how much work the aging in place community has to do. In the internet debate many years ago I remember the term "the Last mile" problem. Getting from the major access point into the house was the hardest and most expensive part of the problem of wiring the country. It appears that aging in place technology struggles under the same issue.

Laurie - as always very insightful comments. I don't think we should start jumping up and down yet re: smartphones and the elderly. This survey has a margin of error of 4.5% and past surveys have indicated that the 65+ market is closer to 3% penetration of smartphones. As you say, they are quite difficult to use for those who might not have the dexterity of a 30 year old. Version 2.0 will be much better but I hope the mhealth developers remember that for the frail elderly, those who consume most of the health dollars, the apps will need to look much different

In our research, both published (Sterns, 2005; Sterns & Mayhorn, 2006) and just finishing up (Sterns, Sterns, Allen, Hazelett, and Lax, 2011) we have demonstrated that smartphones are completely usable by older adults. They do require training, which is essential, but it is minor. In our research we teach older adults to use the entire device in about 20 minutes. After that, using apps for self-management is incidental. I have encountered these ageist comments for 10 years from grant committees and health care professionals.

The iPhone has gone a long way to providing a device that is usable, portable, and intuitive for a vast majority of individuals. From its design improvements, many other devices have significantly improved. We do not criticize the car in this way just because it requires some driving education to use and causes many injuries per year. I do not think we should dismiss the smartphone as ready to change health care because of a lack of knowledge of proper introduction of devices to the population intended to use it, or that it is not applicable or even interesting to some users.

The smartphone is how we will have the efficiencies required to serve the 40 million older adults that are going to overwhelm the health care system. We do not need every older adult to have a smartphone to get started. We need to start as each older adult takes on the challenge, get a properly structured training on the entire device, and gains the benefit of this highly flexible, connected platform.

Anthony Sterns


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