Electronic Health Reporter

By Adrian Johansen, freelance writer; @AdrianJohanse18.

In the age of COVID-19, the role of technology in supporting senior care has perhaps never been more important or apparent. Telemedicine is increasingly proving its power to ensure continuity and quality of care from the safety and security of the patients’ home.

But today’s technology is about far more than just protecting seniors and the vulnerable from potential exposure to the virus. Now, more than ever, technologies are being developed to optimize patient care and to support seniors who wish to age in place, living out their golden years independently at home.

As promising as these technologies may be, however, it’s not all roses and champagne. The reality is technology is developing so quickly that it can be hard to keep up, particularly from a moral and ethical perspective. We’re only just beginning to understand the implications of this tech invasion. It might prove to be a tremendous help but also a tremendous harm for some seniors.

Before we jump too quickly on the technology bandwagon when it comes to senior care, there are some ethical considerations we need to keep in mind.

Why It Matters

The simple fact is that today’s technologies are making it easier than ever for seniors to remain in their own homes without putting their health and safety at risk. Thanks to an array of new smart technologies, caregivers can remotely monitor their loved ones from secure portals that can be accessed on most any mobile device.

The devices allow caregivers to monitor the physical activity in the home through motion detectors, including the ability to identify potentially significant changes in activity patterns. Wearables can even remotely track users’ vital data, such as heart rate, blood pressure, blood glucose, or sleep quality. Best of all, caregivers are able to receive immediate alerts when monitors detect an emergency, such as a fall or a medical issue.

Not only that, but caregivers can also use smart systems to emulate the kind of continuous care seniors would traditionally receive at an assisted living facility. They can monitor and remotely control the home’s temperatures, for example.

And, for seniors who are experiencing cognitive decline, caregivers can set up medication reminders — with the medication’s name and proper dosage — on their loved one’s smartphone, tablet, or PC. Since memory-related medication non-compliance is a particularly common, and particularly dangerous, health challenge for seniors, this may well be the key to your loved one’s health and longevity.

(Un)Equal Opportunity?

With the roster of at-home senior care technologies growing daily, it might seem that we’ve finally found the answer to helping seniors remain in their homes and retain their freedom without compromising their health and safety. But the fact remains that these options are limited to a privileged few.

Research shows that nearly half of the senior population in the United States does not have internet access. Research also shows that the technology gap among seniors continues to be substantial. Only around 35% of people over the age of 65 own a computer, while about 69% own cell phones. However, only around 40% of seniors with cell phones have a smartphone.

And this technology gap isn’t just about reluctance to learn the new tech. It’s often due to the inability of seniors to pay for the new technology when they’re trying to survive on a fixed income. This means seniors who are least likely to be able to afford skilled nursing care are also those for whom these independent-living technologies are financially inaccessible.

Learning Curves

Cost constraints aren’t the only factors contributing to the senior technology gap. Cognitive challenges may make it difficult, if not impossible, for seniors to understand the technology being introduced into their homes, much less give informed consent to its installation.

This raises important ethical questions concerning patient privacy and autonomy, especially as home surveillance capacities grow. In a recent survey of seniors’ attitudes toward telehealth in the wake of the coronavirus pandemic, only 52% stated they felt comfortable using the technology, while more than 30% claimed they were uncomfortable with it. Privacy issues and the ability to use the technology were cited as the most significant concerns.

These are not insignificant considerations. Healthcare practitioners are obliged to ensure that their patient care strategies adhere to the highest ethical standards. For instance, students training to become certified nursing assistants receive vigorous training to prepare them to maintain the highest ethical standards in caring for seniors.

That does not mean, however, that questions of informed consent, privacy, or seniors’ cognition should prevent them from accessing these all-important technological resources. Rather, it means that a more thoughtful and person-first approach must be taken to support the ethical use of technologies.

This is what is too often lacking in senior care, as noted in a recent study published by the National Institutes of Health (NIH), which found that bias, even at an unconscious level, continues to limit the quality of healthcare provided to seniors. The study found, for example, that patients defined as “elderly” are more vulnerable to service “rationing” and lower levels of patient education.

Thus, even when “elderly” patients are provided with senior care technologies, less effort may be made to educate them on the purposes and uses of the technology. Ethical use depends on the concerted effort of the healthcare team to support patients in the appropriate use of these tools. This may include customizing the tools to meet individual patients’ needs and protect their autonomy in determining how these tools are used in their homes.

For example, voice activation technologies allow patients with mobility challenges, or cognitive challenges impacting their ability to use keyboards or other devices, to call up the services they want. This puts power into the patients’ hands, where it should be, whenever and wherever possible

The Takeaway

Smart home and telehealth technologies are making it easier than ever for seniors to live more independent lives in the comfort of their own homes. These devices can help caregivers and healthcare teams support seniors’ health and safety through continuity of care and specialized, needs-based technologies.

However, a number of important ethical challenges must be addressed if these technologies are going to live up to their vast potential for improving senior care and quality of life. One major issue is the wide technology gap which low- and fixed-income seniors face. In addition, seniors with cognitive deficits may require specialized education and support to use new technologies freely and effectively, as a matter of choice rather than coercion.