IEEE-USA in the News:

Geriatric Healthcare Technology Offers Hope for ‘Aging in Place’

By Georgia C. Stelluto

Early prototypes of programmable walkers, “smart toilets”; monitoring devices with disembodied voices reminding people about daily tasks; emergency detection and response devices; passive sleep and gait monitors; and a robot named “Pearl” — just a few of the technology efforts that engineers have designed and are testing. Such products will help the elderly age with dignity and grace, according to speakers at a workshop on geriatric healthcare on 4 June at Mitretek Systems in Falls Church, Va.

Moderator Frank Ferrante, chair of IEEE-USA’s Geriatric Care Working Group, welcomed attendees with an overview of the symposium agenda. And co-sponsors IEEE-USA, Intel and Mitretek Systems presented speakers for Addressing the Healthcare Needs of Our Aging Population with Technology, who offered attendees viewpoints and information from medical, engineering, homecare, government, insurance, and policy perspectives.

Elder Care is Returning Home

Michael Rozen, chair of IEEE-USA’s Medical Technology Policy Committee, moderated the first of three symposium sessions — identifying the particular needs and problems unique to elderly healthcare. Session I speaker Michael Rosen, the outgoing director of the rehab engineering labs at National Rehab Hospital, told participants that the goal of technology efforts on behalf of the elderly is to “help them ‘age in place’ — at home, rather than in assisted living or nursing facilities.” He pointed to seven applications currently under development that would help the elderly achieve this goal: emergency detection and response devices, activity tracking, task monitoring, health maintenance, cognitive support, enhanced communications with the outside world, and unlimited access to information and stimulation. Rosen also said that devices such as e-mail, instant messaging, televisits via video cell phones, special interest chat rooms, online photo albums, and web-based advocacy and politics all help elderly people stay motivated and socially connected.

Terry Dishongh, senior staff researcher for Intel’s Proactive Health Strategic Research Programs, spoke to attendees about saving on costs for the future by considering home healthcare for our elderly. “The worldwide age wave is coming,” he said, adding that “today we have 34 million elderly, and in 2025, we’ll have 74 million.” Dishongh targeted statistics showing that 80+ years is our fastest growing age group, with women outranking men by 2:1. He said that “boomers” and their younger siblings are willing to spend big bucks on elderly healthcare — but that the world is already trying to cope with a shortage of nurses and caregivers. Dishongh stressed that the global challenge is to increase the quality and care of life for twice the number of seniors, while reducing healthcare costs. “If we put supportive technologies within reach of the everyday lives of our seniors, the good end result is that our seniors can age at home,” he said.

Session I ended with speaker Peter Boling, M.D., a professor of medicine at Virginia Commonwealth University in Richmond, Va. Boling addressed the special challenges doctors face when dealing with the elderly. He cited specific problem areas, such as non-compliance with physicians’ orders, personal data chips with incorrect information, error-ridden central data files, IT informatics problems, and widespread misinterpretation of the Health Insurance Portability and Accountability Act of 1996 (HIPPA). Dr. Boling said that in some cases such misinterpretations have caused providers and their staffs to resist sharing important medical data with other providers that could help critical healthcare processes for seniors move along more quickly and affect more successful outcomes.

Developing Technologies: From ‘Smart Toilets’ to ‘Intelligent’ Wheelchairs and Beyond

Majd Alwan, an assistant professor of pathology and program coordinator for eldercare technologies at the Medical Automation Research Center for the University of Virginia (UVa) Healthcare System, led the program’s second session. Alwan spoke about how technology-enabled, high-tech healthcare and low-cost, in-home and assisted-care technologies currently in development at UVa could provide novel technical solutions to improve quality of life for our growing aging population. His research has focused on sensors strategically embedded in a person’s environment, and passive sleep and gait monitors. Alwan noted that the greatest challenges to the Center’s efforts have been privacy; acceptance by older adults and their children; compliance; early adoption, proliferation and deployment everywhere, including rural areas; and funding and reimbursement. He said that minimally invasive sensing monitors and partnerships with volunteers already in assisted living facilities would help alleviate some of these obstacles. Alwan’s future work on technologies for the elderly will include economic impact assessment studies; larger and longer studies in different care settings; and testing a robotic walker that, properly programmed, would help direct and take the elderly exactly where they want to go — with no guesswork.

Howard Wactlar, vice provost for research computing at Carnegie Mellon University, told participants about “care media” — automated video and sensor analyses under development for nursing homes. The goal is for automated detection of behavioral and psychological systems of dementia to enable earlier intervention for sustained quality of life. Wactlar indicated that the main problems he has encountered in this test program were privacy protection in public places and participant aversion to monitoring in private spaces (i.e., “smart” toilets). His future work will involve monitoring tremors and facial expressions; testing sensors in chairs, beds and carpeting; and radio frequency identification tags in clothing and on utensils. Wactlar said the ultimate goal is “for the elderly and their caregivers to be able to go from a constrained, skilled-care environment to less structured and more independent living.”

A Robot Named ‘Pearl’

A professor of electrical engineering and computer science from the University of Michigan, Martha Pollack addressed technologies that would assist the elderly suffering from cognitive impairment, with an emphasis on cognitive orthotics — such as “intelligent” wheelchairs, activity cueing and autominders. Pollack said that creating and developing such devices “will reduce the caregivers’ burden, improve performance and routine functioning for the elderly, and support longer aging in place.” She stressed the need for devices that both intervene and interact with elderly patients. For instance, activity cueing — for the severely cognitive impaired — guides a person through tooth brushing and hand washing.

Autominders (or prospective memory aids), for those with less cognitive impairment, provide patients with a personal model that can be adapted and scheduled according to a person’s life. In one such experiment, a $100,000 test-robot named “Pearl” reminded participants, by name, that it was time to make lunch, or that their favorite television show was on. Less expensive test models, called ubicomp platforms, are handheld or wearable devices that speak wirelessly to seniors in their home environment.

Visit the Talking Web Site

To end the second session, speaker Simon Liu of the information systems division at the National Institutes of Health (NIH) National Library of Medicine, informed attendees about the NIH Senior Health talking Web site. Liu noted that one in six, or 16 million people in the United States, have eye problems — with that number growing to 180 million worldwide. He said that NIH created the website for people with eye problems and disabilities, especially the elderly. Liu’s work now and in the future will be to attain more natural and human speaking voices, personalization and speech recognition capabilities for the web site. The NIH Senior Health web site is free to all at http://nihseniorhealth.gov.

The Potential of Aging

Luncheon speaker George Cohen, author of The Creative Age: Awakening Creativity During the Second Half of Life, shed new light on the potential for our aging population to blossom and peak creatively. Defining creativity as “bringing something new into existence that’s valued,” Cohen related: “Social and productive activities that involve little or no enhancement of fitness lower the risk of all causes of mortality as much as fitness activities do.” In his research of creativity and the elderly, Cohen found that 80 percent of people did their best creative work well after the age of 65. Further, 30 percent created masterpieces after the age of 80. “Loss is part of the human condition,” he said, adding, “in the elderly (and others), loss and adversity can act as triggers for creativity.” Cohen highlighed Henri Matisse’s famous and successful creative migration from painting to elaborate paper cut-outs as he aged. And to Grandma Moses painting her famous “How Long Can All This Go On?” at the age of 101. Cohen’s main point was that our creative capacities only get better as we age — and that “old age adds as it takes away.”

Public Policy, Regulatory, Legislative Barriers Inhibit Progress

In the afternoon’s third session, Jennie Harvell, a senior policy analyst in the Office of Disability, Aging & Long-Term Care Policy, with the U.S. Department of Health & Human Services (HHS), addressed some of the challenges facing U.S. healthcare, warning attendees that healthcare spending is rising faster than inflation. “Our population is aging,” she said, “with more than 80 percent of the U.S. population now surviving until at least age 65, as compared to 41 percent in 1900.” Harvell noted that while we are are surviving longer, 40 percent of U.S. citizens have chronic illnesses; and that both the prevalence of illness and multiple chronic illnesses are increasing. She emphasized that by 2050, older Americans with severe disabilities will more than double. In addition, Harvell said that “despite spending $1.6 trillion on healthcare, medical errors abound and medical information is not communicated across providers.”

Harvell reported that physicians treating patients with chronic conditions report poor or unsuccessful outcomes — related to receiving contradictory information from multiple physicians, adverse drug interactions and unnecessary hospitalizations. She supported President Bush in his call for standardized electronic health records (EHRs) as crucial to a sound National Healthcare Infrastructure. She emphasized that EHRs could help avoid dangerous medical mistakes, reduce healthcare costs and improve medical care. Among other HHS policy goals, Harvell cited creating a new, sub-cabinet level position of National Coordinator of Health Information in Technology in HHS, to ensure that most Americans will have electronic health records within the next 10 years.

Next, Mary Weick-Brady, a deputy division director, Division of Surveillance Systems, Office of Surveillance and Biometrics at the U.S. Food and Drug Administration (FDA), spoke about the FDA Center for Devices and Radiological Health (CDRH). Brady said that the main thrusts of CDRH were on migrating safe and effective use of medical devices outside of hospitals and into the home, as well as increasing public awareness about FDA regulatory authority. For more information, go to www.fda.gov/cdrh/cdrhhhc.

Next Steps

Four panel discussion leaders conducted the fourth and final session of the afternoon: Margaret Kraft, an assistant professor at the Marcella Niehoff School of Nursing at Loyola University-Chicago; Subrata Saha, a professor of biomaterials at New York State College of Ceramics at Alfred University; Parag Dalsania, director of the Geriatric Clinic, Veterans Affairs, at Washington Medical Center; and Joel Nitzkin, president of JLN-MD Associates. These four speakers encouraged audience participation as they discussed perspectives on the day-long symposium and next steps in technologies to help the elderly.

The panel concluded that advocates, vendors and manufacturers needed to understand all the perspectives and issues associated with healthcare technologies; and to consider evidence, barriers and the odds of success. Further, the panel said that national organizations must play a major role in advocating for legislation, regulation and quality assurance guidelines; educate their constituencies; assist manufacturers and vendors; and provide a venue for objective research.

For detailed information, program notes, the symposium program, pictures, and speakers’ powerpoint presentations, go to IEEE-USA’s Web page on the symposium at www.ieeeusa.org/calendar/conferences/geriatrictech/

 

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Georgia C. Stelluto is IEEE-USA’s Publishing Manager, and Managing Editor of IEEE-USA News & Views, IEEE-USA Today’s Engineer, and IEEE-USA News & Views E-Mail Alert.