Real World Health Care Blog

Tag Archives: Aging

Need a Doctor? There’s about a Hundred Apps for That

Remember when the only personal device people had to monitor their health was the trusty old bathroom scale, and maybe a blood pressure cuff they could use at their local pharmacy? What a difference a decade makes.

Linda Barlow

Linda Barlow

An explosion of personal, wearable, or otherwise easily accessible devices and apps used to track activity and fitness levels, monitor health problems, and even diagnose disease is well underway. In fact, more than 360 health and biotech (and nearly 390 fitness and sports) apps and products were exhibited at January’s International CES® in Las Vegas, including a new wave of trackers, online tools, wristbands and apps that collect your vital signs for medical purposes.

“Consumers now have more of an opportunity than ever to take control of their own health through technology,” says Kinsey Fabrizio, director, Member Engagement, Consumer Electronics Association (CEA)®. “There is a real convergence of technology in health and wellness, and with design advancements, improving tech and widespread adoption of mobile devices, consumer-centric care is now possible.”

According to Ms. Fabrizio, one of the hottest trends in personal health and fitness technology is devices that link to smartphones. One example of such a device is a fertility sensor from CES exhibitor Prima-Temp: a self-inserted, wireless temperature sensor that continuously and passively tracks a woman’s core body temperature, detecting the subtle changes that occur before ovulation, then sends an alert to her smartphone when she is most fertile. According to the company, understanding reproductive health and natural fertility signs can help couples avoid costly infertility treatments.

Another example comes from another CES exhibitor, Qardio: a wireless blood pressure monitor that offers a full year of battery life for 400 measurements versus the 80 available in typical monitors. The company claims the device—compatible with both iOS and Android—is the only wireless monitor that can track irregular heartbeats over time, providing users with warnings that they should consider contacting a doctor if the irregularity continues.

Wearable technology like fitness trackers, smart watches, and even pain relief technology also took center stage at CES. During a CES presentation, “The Potential of Wearable Technology,” CEA Director of Business Intelligence, Jack Cutts, pointed out that fitness trackers, “have made wearable tech mainstream, and that the newest generation of smart watches are more refined and are becoming the go-to wearable device.” Looking to the future, he said “other wearable technologies, such as smart fabrics and implantable devices, are still being explored.”

Ms. Fabrizio notes that healthcare technology also has become critical to aging in place, as evidenced by several exhibitors highlighting “lifelong tech” solutions that help seniors stay in touch electronically with providers, family members, emergency responders and other caregivers. One example is CES exhibitor MobileHelp, a mobile medical alert system that uses GPS medical alarm location technology to pinpoint the user’s exact location, so the closest available emergency responders are dispatched no matter where the user travels.

Some in the healthcare field—including attendees of CES’s Digital Health Conference—have raised concerns, not only about the privacy of patient data as it streams through the Internet and resides in the cloud, but also that people’s reliance on health and medical devices and apps will push the professional healthcare practitioner out of the equation. Some worry that no self-diagnosis technology can replace the in-person treatment available at a practitioner’s office, while others point to the ability of technology to increase the value and productivity of physicians.

Ms. Fabrizio adds that device and app makers are looking to help shape the future of digital health with products people can access easily. To that end, CEA, which represents 2,000 companies, formed a Health and Fitness Technology Division last year. The goal of the Division is to raise consumer awareness of how consumer electronic devices can help improve health and fitness as well as help manufacturers navigate the marketing, regulatory and myriad other challenges facing this nascent marketing segment.

“These CEA members are making products that are seamless with what people already do,” Ms. Fabrizio concludes. “They are more than fun; they provide valuable data that drives healthier behavior and preventive health benefits.”

Are consumer apps and devices for tracking health and fitness helping you improve your health? Share your opinion in the comments section.

Keeping Minds of Seniors Sharp: Some Answers Emerge

As a member of the Atari Generation, I remember my parents telling me to limit my time playing video games. Well guess what? Now I can tell them that if they want to improve their ability to fight cognitive decline, they should increase their time playing video games – at least when it comes to the games from www.Lumosity.com. A well-designed study published in PLoS One found cognitive benefits for seniors. No, this is not a paid advertisement. None of the funding for the study came from Lumosity. The study was funded by the government of Spain.

David Sheon

David Sheon

Let’s back up a bit. America is aging. As the massive number of baby boomers reach their twilight years, we’re well served to think through the implications of a couple of statistics mentioned on the recent 60 Minutes story, Living to 90 and Beyond. The fascinating story finds compelling evidence that as we age, drinking a glass of any alcohol a day, consuming coffee, and gaining weight (but not to the point of obesity) all increase the chances of living past 90.

The story also mentions that by about 2050, the number of Americans over age 90 is projected to quadruple. It also reports that the risk of developing dementia doubles every 5 years starting at the age of 65.

Although more research needs to be done before we can say that games for your brain delay dementia, we can say that Lumosity improves the ability of seniors to stay attentive and alert thanks to the Spanish-funded study by Julia Mayas et al.

Recently, research on aging has begun to examine cognitive “plasticity” in seniors and its capacity to counteract cognitive decline. The aim of the Spanish-funded study was to investigate whether older adults could benefit from brain training with video games, with additional distractions, like randomly generated noises created by the researchers, to assess distraction and alertness.

For example, participants were presented with a sequence of numbers on the screen that they labelled as “odd” or “even” while ignoring irrelevant sounds such as drilling, rain, or hammering, just before being shown the number. In most trials the sound was consistent, while in a small proportion of the trials, interspersed at random, the standard sound was replaced by a random sound not presented earlier in the task. Other studies have shown that random sounds seemed to startle and take study volunteers off task, if only for a second or two.

The researchers hypothesized that if video game training improves auditory attentional functions as it does visual attention or executive functions, then older adults in the study who used Lumosity for training would show reduced distraction and maintain their level of alertness or prevent its decline.

Forty healthy adult volunteers aged 57 to 77 years were randomly assigned to either the experimental or the control group. The study was completed by 15 of the 20 participants of the experimental group and 12 of the 20 members of the control group. All participants had normal hearing and normal or corrected-to-normal vision. In addition to the random noise task, all participants completed a battery of cognitive tests to be sure that participants in both groups had similar capabilities.

Each participant assigned to use the computer video games had 20 sessions of game training. They practiced 10 video games selected from Lumosity’s commercially available package. The games practiced were specifically designed to train a variety of mental abilities, including speed of processing and mental rotation, working memory, concentration, and mental calculation.

Points were awarded to participants based on their performance and on the time taken to complete the games. To make sure the data wasn’t biased, participants were not allowed to play any other video game during the study. None of the participants reported any previous experience with video games. The control group did not receive video games training but participated in three group meetings during this time in which they socialized with each other but didn’t try the games.

All participants were measured for the ability to cope with distractions and stay alert before and after the study. On both accounts, those who used the video games improved compared to those who did not do the video games.

The ability to ignore irrelevant sounds improved after video game training by about 12 milliseconds, while those in the control group saw no improvement.

Similar pre- and post-training comparisons showed a 26 millisecond increase of alertness in the experimental group with no significant difference in the control.

One thing that makes this study stand out is its ability to transfer findings from the computer games to real-world improvements.

According to the study authors, “practicing video games of this type may offer some protective factor against the effects of aging and may potentially be recommended to older individuals, alongside other interventions found to improve mental functions. These include, for example, a long-term physically active lifestyle (improving executive control and speed of processing), aerobic exercise (improving cognition by increasing the volume of grey and white matter in frontal and temporal sites), or social networking and innovative solutions to connect people in a multimodal way with family members, friends and caretakers.”

So I guess that like when my parents told me to put down the joystick and play outside, I get to remind them to do the same. Just don’t be quick to dismiss video games as part of the equation to a healthier mind in our senior years.

Do you use Lumosity or any other brain training program? Have you noticed it helping you? We’d love to hear about it.

Taking Charge at the End of Your Life

Tim Prosch is author of AARP’s The Other Talk: A Guide to Talking with Your Adult Children About the Rest of Your Life, a book that helps parents and their children create a partnership to plan for the years to come, guiding them through important conversations and decisions about finances, medical care, and day-to-day living—before a crisis happens.

Tim Prosch

Tim Prosch

What can happen if you put off your end-of-life health care decisions until “the time is right?”

The Terri Schiavo case, which culminated in 2005, can put the answer to this question in stark relief.

Fifteen years earlier, Terri had collapsed at home, suffered severe brain damage and was put on a feeding tube to keep her alive. For the next decade and a half, she was yanked back and forth in a virulent tug-of-war between her husband and her parents about how she would want to be treated. Ultimately the courts got involved, pulling her off her feeding tube for 3 days in 2001, again for 6 days in 2003, and finally for 13 days in 2005, when she finally expired.

All of this drama and heartache could have been avoided if her wishes had been put in writing and had been thoroughly discussed by all interested parties.

While none of us will ever know what Terri wanted done at the end of her life, it is safe to say that her on-again, off-again existence and her increasingly toxic family dynamic are not what she or anyone else would wish for.

 

How can you avoid Terri’s fate? 

To begin with, it’s important that you understand that health care at your end of life will be a family affair, not just a personal decision. In most cases, it is not about you personally taking charge. It is about you preparing and empowering your family to take charge as you approach that final stage.

The-Other-TalkThe reason for this collaborative approach is that it is highly likely that you won’t be physically, emotionally, or mentally able to direct the final proceedings. Collaboration addresses the challenge for someone acting on your behalf to weigh the options and make decisions and to articulate what should be done in a way that reflects your thoughts about the end of your life.

As a result, it is critical that you start these conversations now while you are mentally sharp. Quite simply, the longer you wait, the less effective these discussions with your family will be, due to the natural deterioration of the aging brain.

In preparing for the end game discussion, you’ll want to take steps in two critical areas: guiding principles and parameters for medical treatment.

 

Step 1. Establish Your Guiding Principles

The first step in making your family confident and empowered in taking charge when the time comes is for you to confront and define what “being alive” means to you as you near the end.

For some people, it is fighting for every last breath. “Even one more day would be important to me. I would do everything I could to hold on to life.”

For others, it is living intensely, yet comfortably, in the time remaining. “I would rather be able to do what I want, to be with my kids, to enjoy life, even if it’s for a shorter time.”

Of course, neither one is the better approach because it is such a personal choice. But if you start now to build a clear understanding of your preferences with your family and your doctors, you can dramatically increase your odds of getting what you want.

 

Step 2. Set Parameters for Your Medical Treatment 

Step 2 in taking charge of your life (versus abdicating it to the medical community) is to put your preferences in writing. Equally important is to distribute and discuss your wishes with your family members and your doctors to ensure that your goals are clearly understood.

An effective and relatively inexpensive way to accomplish this is to consult with your legal advisor, then draw up a health care power of attorney. This document establishes your designated agent who will make health care decisions for you if you are not able to do so.

If you are in the “do not prolong life at any cost” camp, you will also want to explore two health care directives: the living will and the do-not-resuscitate (DNR) order:

  1. The living will establishes that you do not want your death to be artificially postponed. It states that if your attending physician determines that you have an incurable injury, disease or illness, procedures that only prolong the dying process should be withheld and the medical focus should shift to comfort care. This document must be signed by two witnesses who will not benefit from your death.
  2. The do-not-resuscitate (DNR) order is different from the health care power of attorney and the living will in that neither your health care agent nor you can prepare it. Rather, it is a written order signed by your physician that instructs other health care providers not to attempt CPR if your heart has stopped beating and if you have stopped breathing during cardiac or respiratory arrest.

Once you have shared your “what being alive means to me” documents (the health care power of attorney and, if relevant, the living will and the DNR order) and thoroughly discussed them with family and doctors, you all should acknowledge the possibility of revisions. Every time your health status changes in some significant way, you should have another discussion to clarify your views and expectations.

It’s okay for you to move the goalposts on issues pertaining to the end of your life. You just need to make certain that the people in your world know that you moved them.

Do you have a living will or DNR? What did you learn through the process that you’d like for others to know?

Click here to learn more about The Other Talk and here to hear an interview with the author from AARP.