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Technologies for Aging and Caregiving: Challenges and Opportunities

In a recent webinar, George Demiris, PhD and Ashish Shah shared their experiences developing, testing, and implementing technologies that could improve the home as a care setting and help caregivers assess and address their loved one’s needs.

March 15, 2023
George Demiris and Ashish Shah
George Demiris and Ashish Shah
March 15, 2023

By Sungho Oh, PhD, MS, RN

Can technology improve the care given to older adults in their homes and reduce the burden on family caregivers? In a recent webinar, George Demiris, PhD and Ashish Shah shared their experiences developing, testing, and implementing technologies that could improve the home as a care setting and help caregivers assess and address their loved one’s needs.

The webinar, moderated by Pamela Cacchione, PhD, CRNP, Professor of Geropsychiatric Nursing at Penn Nursing, was the latest in the Caregiving NOW! series. The series is part of an initiative at Penn Nursing to create a roadmap for enhancing the well-being of caregivers in the U.S.

“We need to be more proactive, rather than try and catch up with those technological advancements that, whether we want it or not, are permeating our lives and health care,” Demiris said. A PIK University Professor at Penn Nursing and Penn Medicine, Demiris has applied biomedical informatics to nursing science to develop “smart home” interventions for at-risk older adults.

Shah provided an industry perspective as CEO of Dina, a digital health company. Dina focuses on technology that can help manage care across settings and provide caregivers a window into the care of their loved ones. Shah likened Dina’s platforms to “care traffic control,” borrowing a metaphor from the aviation industry.


Some promising examples

Demiris briefly described Sense4Safety, a project that evaluates a passive monitoring system for at-risk older adults in their homes. The research team places commercially available depth sensors that can identify escalating risk for falls in real-time. These sensors are not video cameras; instead, they extract information to calculate gate parameters, such as stride, length, or speed, which may indicate an increased risk of falls. That information can alert the family caregiver or a nurse to develop an individualized plan to reduce the risk and possibly prevent a fall from happening.

Shah described Dina’s platform, which includes a comprehensive caregiver marketplace that allows older adults and their families to coordinate all in-home services, such as personal care, home health, medical equipment, meal delivery, and home modification. The platform also addresses workflow problems in managing care beyond health care institutions into the home and community. It allows care managers, hospitals, and health plans to coordinate and track all the services needed by the people, especially, in transitions in care. Finally, these data can be fed back to both the caregiver and family, providing insights and recommendations to improve the well-being of the older adult.


Challenges in technologies for older adults

Although evolving technologies have great potential in caregiving arena, Demiris and Shah touched on a number of challenges in implementation among older adults and their caregivers. Some older adults may not have the digital skills required to use these technologies; some may not have broadband internet connections. Cacchione mentioned the potential for technology to exacerbate existing inequities and pointed to the need to address issues around the social determinants of health (SDoH), inequitable access to care, and resource inequality.

Demiris and Shah acknowledged that, in general, individuals with higher income levels benefit more from advanced technologies. Demiris pointed out the need to develop and test such technologies with teams that include diverse patients and families. Shah noted that not every home is ready for remote monitoring and that each home and situation should be evaluated so that the technology can provide personalized SDoH services and recommendations.

Demiris said that technology raises new issues around data ownership, storage, and use and called for more regulation to protect personal health information and gain the trust of older adults and their caregivers.


Designing technologies for aging and caregiving: recommendations

Many of these challenges can be overcome through intentional and inclusive design. The efforts should start early in designing the technology and include a multidisciplinary team.

No hurdle for clinical/administrative staff: Shah emphasized that technologies should make people’s lives easier instead of creating another hurdle. Integration with existing systems is critical, as is a simple, straightforward, easy-to-use interface. He added that technologies should fit into, rather than disrupt, existing workflows.

No burden on the caregiver: Demiris pointed out the danger that technology could add to caregivers’ burdens if they are responsible for explaining or maintaining new systems. “The technology needs to operate smoothly and efficiently,” Demiris said, taking the expectations and skills of multiple stakeholders, including family caregivers, into account.

Equity as central in design: the National Academy of Medicine recently released a discussion paper calling for equity to be an underlying theme for designing technologies rather than an afterthought. This will require a rethinking of some features of technology to make them more accessible to more people. For example, it might mean using lower-cost infrastructure so that more people can benefit from technology.


The role of technology in social isolation

The pandemic worsened social isolation, especially among older adults. During the webinar, a member in the audience asked whether technology is part of the problem or could be part of the solution. Demiris and Shah responded with their perspectives based on observations from their research and implementation of technologies.

Showing “we care about you!” Shah said that there is a two-way smart texting feature in Dina’s technology that directly engages older adults. This proved very important during the pandemic, when the engagement rate for texts went up to 80%. People also provided valuable feedback about this technology-based service and expressed their appreciation for this outreach.

But what about the human relationship? Demiris said that technology might positively and negatively influence loneliness among older adults. Despite the benefits of staying connected through technologies, some participants in his Sense4Safety study worried that the nurse would stop visiting them because of dashboard technology and remote check-ins. He stated that technology should be designed and implemented considering its impact on human relationships.


What lies ahead

Evolving technologies for aging and caregiving provide exciting opportunities for academia and industry alike. Although numerous challenges remain, the path forward calls for a focus on human involvement in the design and use of technological solutions. The journey will require a multidisciplinary team to clearly define the roles of humans and technologies and ensure a thorough understanding of human-technology interactions before implementation.


About the author

This blog was written by Sungho Oh, Ph.D., RN, a postdoctoral research fellow at the University of Pennsylvania School of Nursing. Sungho has an interdisciplinary background in home health care nursing and biomedical engineering.


Caregiving NOW! with George Demiris

Smart Home, Smarter Care: Enhancing Caregiving Through Technology, featuring George Demiris, PIK University Professor at Penn and Ashish Shah, CEO and Co-Founder of DINA, with moderator, Pamela Cacchione, Professor of Geropsychiatric Nursing and Ralston House Term Chair in Gerontological Nursing at Penn Nursing, and Nurse Scientist at Penn Presbyterian Medical Center

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