Older Adults, Technology, and the Future of Long-Term Care

Published In Nursing Home

December 15th, 2015

I tend to spend a lot of time in my work as a geropsychologist thinking about technology. Which is an interesting thing, when you think about it – older adults aren’t exactly the first demographic group that people think of when they think of technology consumers (much less older adults living in nursing homes – more on that later).

Focusing on one extremely important area of technology consumerism – information technology – we can see that amongst the different age groups, older adults do tend to currently have the lowest rate of adoption and use of internet and information technology. Only about one-half of all older adults make use of email or the internet, compared to nearly 90 percent of those ages 18-64. And, of course, internet and email use drops off significantly after the age of 75.

But, as I think it’s probably obvious to most who are reading this – this is a picture that’s rapidly changing. A corollary of the fact that older adults tend to have the lowest rates of technology use compared to other demographic groups is that older adults currently represent the fastest-growing age group of technology users in the country, with their rates of adoption going up year upon year.

When you really stop to think about it– this makes sense. The middle-aged technology consumers of today (me) are the older adult technology consumers of tomorrow. We will demand wifi, tablet computers, streaming options for television and music entertainment, etc. This has fairly significant implications for the retirement homes, assisted living facilities, and nursing homes of tomorrow – with “tomorrow” increasingly becoming today!

Technology in Today’s Nursing Homes

Nursing homes (which is the environment where I spend most of my time) are generally stuck using basically 80s-era technology when it comes to how they run their operations and offer entertainment options for their residents. Television is typically offered via a limited, fixed menu of cable television options (at my nursing home at the VA, I believe we offer about a dozen channels via a dish subscription). If a resident would like to watch a movie, they would need to have a DVD player in their room, and then find a way to borrow a DVD from someone (perhaps their Recreation Therapy service, or a volunteer, friend, or family member).

Currently, only around one-third of US nursing homes offer free wifi to residents (while over three-quarters of residents at senior retirement communities do – a pretty big gap!). These numbers will continue to rise in the future. Those who are increasingly the older adults of today – which, in the US, primarily means baby boomers – are going to be the most technologically demanding group of older adults that the world has yet to see. If a facility wishes to serve the needs of the residents, these residents will need access to wifi, Netflix, Pandora, email, internet, etc.– and those that ignore these demands will see competitors eat their proverbial lunch.

But what about technology use for the nursing home staff?

Like I said, nursing homes (perhaps not so much assisted living facilities and retirement communities) are still largely stuck using 80s and 90s-era technology. Electronic medical records (EMR), are only the standard within a systems of care that offer long-term, skilled nursing (such as the Department of Veterans Affairs). The eponymous call-bell – that thing that allows residents to call nurses so they can receive assistance? It has not changed much at all since the days that residents used to actually carry real bells that they rang for nurses (I’ve previously proposed some changes to call-bell technology here and here, in fact).

At a certain point, call bell technology will change for nursing home residents. Much like how we can now order pizzas online, we should be able to do the same for nursing staff.

The Nursing Home Technology Wish List

What about other technological advancements – let’s just say we had unlimited funds and imagination… what other kinds of enhancements would we like to see in US nursing homes?

Here are a few, off the top of my head:

  • Radio-frequency (or similar) technology to track the location of nursing home residents anywhere or any time they are in a facility. Benefit would be a significant reduction in the amount of time spent locating residents for medications, treatments, etc. – also would reduce safety concerns.
  • The ability for family and friends to create and stream pictures and music directly to residents for the purposes of soothing and comforting them. I talk about the idea here. It’s a tried-and-true intervention to make sure residents have family photos, albums, familiar music – why not “supercharge” this by giving families the ability to pipe photos and music directly to patients’ rooms?
  • On a related note – what about enabling residents and families the ability to directly video call each other (instant FaceTime, anyone?). This also could be used for remote monitoring by nurses.
  • Robot pets! I talk about this in some detail here, with an in-depth discussion about the Paro Robot, a $6,000 “therapeutic robot” developed by Japan’s Advanced Institute for Science and Technology (AIST). If that price tag scares you, it’s worth noting that Hasbro has recently come out with a robot pet they are offering, as a sub-100 dollar alternative (here). The idea here is that animal therapy really confers lots of benefits to the health and well-being of older adults, and robotic pets have the promise of delivering those benefits, but without all of the risks of infection, bites, and whatnot associated with live animals.
  • Making nursing homes in general “smart” nursing homes. With more real-time monitoring and remote control mechanisms, we could outfit older adults with sensors to help better predict (and prevent) falls. Sensor technology and autonomous driving technology (think Google cars) could also be used on wheelchairs to extend the ability of cognitively impaired older adults to use their motorized wheelchairs longer –thereby granting them independent mobility for that much longer.

The Limits of Technology

So, what are the downsides of all of this? Technology for all, right? Well, this is the problem with technology positivism – when you have the proverbial hammer, everything looks like a nail. In other words, maybe not all nursing home or aging-related problems can (or should) be solved with a technological fix.

For one thing, the problems with privacy and surveillance technology in the everyday world for everyone else (young and old alike) is well-known, what with the controversies regarding online privacy and corporate data-mining, as well as the activities of the US government spy agencies. We, at least, can (theoretically) petition our government to back off. We can opt out of using various technologies, or opt for encrypting our communications (for now) to insure privacy.

Older adults don’t get that right to opt out – do they? So, if you’re an older adult in a nursing home, should the assumption be that you get no privacy at all, and (for your safety, of course), you should expect to be monitored and surveilled 24/7? I wonder if that message could be damaging to our older adults.

And robot pets? On the one hand, a clean, hygienic, and trouble-free robotic companion to soothe agitated and worried (or lonely) older adults may sound like a great idea – particularly if it works! But, are there ethical concerns here? Is it right to deceive an older adult into thinking they are playing with a real animal (which, I assure you in my experience with using Paro, some do)? What about the idea of replacing real human contact with robots or virtual beings? Is that something we should question?

I am a big technology booster, and I believe it is certain that facility-based care will most certainly be changing over the coming decade or two, in the same way that larger society has been changed by technology. However, I think it really behooves us to take things slowly. Technology is not a panacea, and we need to make sure that the privacy and dignity of the older adults we care for is at the forefront of what we do (intelligently balanced with safety, of course!).

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