By JOHN LELAND 16 feb 2009--Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.
Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.
A wireless sensor under Ms. Branch’s bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.
Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.
But the devices, which can be expensive, remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.
Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.
“I lost a very close friend recently,” she said. “She was also diabetic and she fell during the night. She didn’t have the sensors. She went into a coma.”
Without the sensors, Ms. Branch said, “I would probably be dead.”
Stories like Ms. Branch’s show the potential of relatively simple devices to provide comfort and independence to an aging population that is quickly outgrowing the resources of doctors, nurses, hospitals and health care dollars available to it.
The cost for Ms. Branch’s basic system, supplied by a health care provider called New Courtland as part of a publicly financed program, is about $100 a month, far less than a nursing home, where the costs to taxpayers can exceed $200 a day. In the two years Mrs. Branch has had the system, she has fallen three times and been stuck once in the bathtub, each time unable to call for help without it.
“On an individual basis, we’ve demonstrated that they can be very effective,” said Brent Ridge, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York. “But until they’re launched on a wide-scale basis, you just don’t know. Physicians might say, ‘I’m already overstretched, I don’t have time for all this data.’ ”
At a white ranch-style house in Middletown, N.J., Joseph Hayduk, 86, a retired Air Force lieutenant colonel, is greeted by a voice from a small box: “Good morning. It is now time to record your vital signs.” Mr. Hayduk has been using the device since 2006, after his second heart attack, through a program run by Meridian Health.
He stepped on a scale. “Are you experiencing more difficulty breathing today, compared to a usual day?” the voice asked. Mr. Hayduk pressed yes.
“That’s normal for me,” he said.
“Are your ankles more swollen than usual?” the machine asked. In patients with chronic heart failure, swelling or weight gain can indicate that they are retaining fluid. Mr. Hayduk pressed no. After a blood pressure reading, the device signaled that it had relayed the information to Meridian Health.
There, a nurse calls all 18 patients in the program daily, starting with the ones whose data call for urgent attention. One morning, Mr. Hayduk left the house before the nurse’s call. As he sat on his neighbor’s porch, he watched a police car pull up to his house to check on him.
Mr. Hayduk chuckled at the memory, but said that the system had allowed him to stay in his home of 37 years.
“This system’s invaluable to me, not only physically, but psychologically,” he said. “I don’t want to be in assisted living. That’s for people in wheelchairs and walkers.”
Philip Marshall, 85, another Meridian Health patient, uses a system tied to his cellphone to help him remember his medications. Mr. Marshall has high blood pressure and macular degeneration, and takes 10 pills a day. He cannot see a clock or work the buttons on most phones, so he uses a Jitterbug, a phone with big buttons and limited functions.
Drug compliance is one of the biggest problems for the elderly, especially those with memory loss. Until Mr. Marshall got Meridian’s Jitterbug system, his daughter Melanie, 55, said she had to leave work several times a month to help him with his drugs. “I’m answering the phone in meetings,” she said. “He’d forget whether he took a pill or whether he was supposed to take a pill.”
The system, which costs $20 a month, calls him after he is scheduled to take a pill and asks if he has taken it; if not, it asks him why not and sends automated alerts to his daughters.
“I worry a lot,” Mr. Marshall said. “All my life. So this gives me peace of mind.”
He added that knowing that a call was coming had helped him remember to take his medications before the phone rang.
This is the ultimate goal of personal health monitoring — that people who know they are being watched may modify their behavior to better their health. Jeffrey Kaye, director of the aging and Alzheimer’s and memory assessment clinics at Oregon Health and Science University, said one of the most useful health technologies was a cheap pedometer, because carrying one motivated people to walk more.
But Stuti Dang, who directs dementia care for the Miami Veterans Affairs Healthcare System and uses monitoring systems to track the vital signs of 400 patients, said one unforeseen consequence of the system was that “it somehow absolves their kin of the responsibility.”
“The daughter doesn’t have to call every day because she knows if something was wrong with her father, she would receive an alert,” Dr. Dang said, adding: “It’s good for the patient, but there needs to be personal responsibility. As a provider, I don’t want to be responsible for my patient 24 hours a day.”
Raymond Carroll, 59, a retired school administrator, said he went online every day to check on his mother, Viola Carroll, 85, who lives in a building in Queens run by Selfhelp, a nonprofit organization that assists Holocaust survivors. Mr. Carroll checks the temperature of her apartment and calls if it is too hot. Since a system of motion detectors called Quiet Care was installed three years ago, on a grant from Selfhelp, he said he probably called more often but visited less.
Marvin Joss, whose mother, Ray, 89, is also in a Selfhelp building, said the system had helped improve their conversations. “In the past, I tried to spend more time on, ‘How are you feeling?’ ” Mr. Joss said. “I still ask those questions, but now it’s more to an idea of having a conversation, not trying to listen for clues about whether she’s O.K. ”
The future of these technologies, and the terabytes they gather, can involve unprecedented information about the whereabouts and well-being of older people. In a program with Intel, Dr. Kaye is combing motion data for patterns that indicate the onset of dementia, years before the decline shows up on cognitive tests.
But until there is more research — and reimbursement — the technologies’ ultimate impact remains unknown.
“It’s not that we need new technologies,” Dr. Kaye said. “We need to use what we have more creatively. It’s all cool — but is it going to be helpful?”