This article focuses on evidence about older people’s perceptions and use of telecare, telehealth and telemedicine interventions.
With the growing significance of ageing populations, the development and use of assistive technologies for older people is increasing. In June 2010, an $8 million project was announced in the US to test telemedicine for older people.1 The project, with 1,600 participants, aims to prove the health as well as cost benefits of assistive technologies to older patients. A combination of wireless sensors and telemedicine – used to self-measure vital signs – will be trialled over three years. The technology has previously been piloted on a small scale, with some success.
Here in the UK, the Telegraph recently featured the Whole System Demonstrator (WSD) Cornwall trial, interviewing a 62-year-old service user with chronic obstructive pulmonary disease (COPD) who self-records his pulse, weight and blood pressure on a daily basis. These readings are automatically relayed to a community nurse who can act swiftly if the results are of concern. Both the patient and his community nurses report satisfaction with the system.2
Recent research by the University of Hertfordshire found that, among a sample of 112 older rheumatoid arthritis patients, almost 50 per cent of those with a mobile phone or email address would be happy to receive appointment reminders via these communication channels. A quarter of those with the technologies were also positive about getting medication reminders by text or email. The study suggests that these interventions have potential for achieving both health improvements (by increasing adherence and the likelihood of clinic attendance) and cost savings (by reducing admissions and perhaps also home visits).3
While there are other examples of older patients embracing assistive technologies, these are countered by studies that have recorded less enthusiasm among the client group.
Telehealth evidence database
The telehealth evidence database currently holds 48 entries relating to frail or older patients. There are numerous studies reporting positive attitudes from user groups towards assistive technologies. These include Swedish interview-based research involving older patients living alone and using telemonitoring devices.4 Overwhelmingly, participants revealed increased feelings of safety as a result of having the equipment installed. One respondent, however, expressed negative views of telemonitoring, labelling it ‘intrusive’. In this case, the patient actively avoided non-standard behaviour, such as having a 'lie-in', which might trigger an alert by the surveillance equipment.
This type of concern is taken up by a UK study into the effects of telecare on older people’s independence and level of social inclusion.5 Widely promoted as a means of maintaining and increasing independence, telecare can achieve the opposite effect if users perceive it as intrusive. Further, the ‘success’ of automation removes, at least partially, a level of social interaction between older people and their carers or other health professionals. In many cases, this link with the outside world is highly valued by patients, and replacing it with an electronic device is not considered a welcome trade-off.
A 2008 article from Help the Aged also suggested that older patients might suffer from the lack of contact with ‘real people’ that can result from using telemedicine.6
Recently, a Chinese literature review called for closer integration of the technological and social elements of telecare at the planning stage. This could improve the prospect of developing equipment that is better tailored to patients’ medical and social needs to facilitate ageing 'in place'.7
There are, of course, many telemedicine systems that combine remote care with home visits or phone calls, thus maintaining the social contact aspect of care alongside advancing technology. Such systems perhaps offer the best of both worlds for some older patients with long-term conditions.
The success of any telemedicine initiative in managing older people with long-term conditions is dependent on the degree of acceptance by the client group. Assistive technologies vary in terms of their complexity of use; their take-up by older people can, at least to some extent, be determined by ease of operation and level of intrusiveness.
As noted earlier, there is evidence of older people using these new technologies and devices successfully. Suggestions that older people face greater barriers to using technology than their younger counterparts do, however, have grounding in some cases. Consideration should also be given to the type of long-term condition being treated and how this can affect a patient's ability to use technology – depending on, for example, motility or mental health status.
Ageing populations will intensify supply and demand for assistive technologies, and this client group may, over time, become more influential in product development.
- 1StarTribune (2010). '$8 million project to test telemedicine for elderly'. StarTribune website.
- 2Telegraph (2010). 'Life-changing healthcare technology'. Telegraph website. Available at: www.telegraph.co.uk/health/healthnews/7956517/Life-changing-healthcare-technology.html (accessed on 6 September 2010).
- 3University of Hertfordshire (2010). 'Text and email alerts welcomed by older patients'. University of Hertfordshire website. Available at: www.herts.ac.uk/news-and-events/latest-news/Text-and-email-alerts-welcomed-by-older-patients.cfm (accessed on 6 September 2010).
- 4Essén A (2009). 'Many older people felt that electronic care surveillance increased their safety and enabled them to live alone in their own homes'. Evidence-Based Nursing, vol 12, issue 1, p 32. Available at: http://ebn.bmj.com/content/12/1/32.1.extract (accessed on 6 September 2010).
- 5Percival J, Hanson J (2006). 'Big brother or brave new world? Telecare and its implications for older people’s independence and social inclusion'. Critical Social Policy, vol 26, pp 888-909. Available at: http://csp.sagepub.com/content/26/4/888.short (accessed on 6 September 2010).
- 6Kohler M (2008). 'Telemedicine seeks to empower patients to manage their care'. British Journal of Community Nursing, vol 13, no 3, pp 135-7. Available at: www.ncbi.nlm.nih.gov/pubmed/18557576 (accessed on 6 September 2010).
- 7Tsai CH, Chuang BK, Lan YL (2010). 'The development and effectiveness of telecare from an integrated technological, humanistic and management perspective'. Hu Li Za Zhi, vol 57, no 4, pp 83-8. Available at: www.ncbi.nlm.nih.gov/pubmed/20661860 (accessed on 6 September 2010).