successes, challenges and future perspectives

In a recent perspective piece published in the Nature Medicine Journal, researchers discussed the current achievements, challenges, and potential opportunities in using digital technologies, such as remote medicine and wearables in geriatric medicine and care.

Study: Digital health for aging populations. Image Credit: GroundPicture/Shutterstock.com​​​​​​​Study: Digital health for aging populations. Image Credit: GroundPicture/Shutterstock.com

Background

Life expectancy across the globe has increased significantly, with the older population comprising adults above 65 years expected to rise to 16% by 2050, compared to 10% in 2022.

This increase in the geriatric population exerts a substantial socio-economic burden on the health system since the chances of non-communicable diseases such as kidney diseases, diabetes, Alzheimer’s disease, arthritis, and Parkinson’s disease increase significantly with age.

The deteriorating cognitive and physical abilities also increase the probability of strokes and falls, which, exacerbated by the decrease in the younger workforce of caregivers, add to the burden on the healthcare systems.

The traditional methods of healthcare monitoring include in-person visits to the clinic and regular laboratory tests, which are expensive, inconvenient, and could result in delays in diagnoses. The infrequent nature of these clinic visits and laboratory tests also makes a longitudinal and continuous assessment of health conditions difficult.

The use of digital technologies such as wearables could offer options to continuously, remotely, but conveniently monitor older patients without affecting their safety or autonomy.

Furthermore, with the onset of the coronavirus disease 2019 (COVID-19) pandemic, telehealth or telemedicine technologies have improved, which can also be utilized in geriatric care.

Existing technologies

Wearable technologies provide a convenient and efficient option for older adults to non-invasively and continuously monitor their health conditions and track ongoing treatments for chronic health issues.

Various wearable devices can continuously gather biomolecular and biometric data and transmit alarms that can facilitate timely medical interventions during emergencies, such as a fall or a stroke.

The digital monitoring technologies currently being developed are broadly classified into four categories: wearable physical, chemical, multi-parameter, hybrid, and non-wearable sensors.

The physical sensors continuously monitor vital signs such as respiration rate, blood pressure, oxygen saturation, heart rate, body temperature, and electrocardiogram (ECG). Some also monitor physical activity through the number of steps and can assess changes in gait or detect falls.

Wearable chemical sensors offer the option of non-invasive health parameter monitoring using molecular data on changes in the chemical composition of biofluids such as saliva, sweat, interstitial fluid, and tears. Chemical sensors that employ optical or electrochemical detection methods can monitor glucose levels in diabetic patients, cortisol and potassium levels in cardiac patients, and levels of levodopa medication for individuals with Parkinson’s disease.

The hybrid sensing platforms that are being developed can simultaneously monitor the vital signs and the biochemical parameters through epidermal patches. These multi-modal platforms can continuously monitor physiological conditions and alert the patients and their caregivers to abnormal changes in the physiological parameters.

The simultaneous tracking of both physical and chemical parameters also simplifies the monitoring process, potentially increasing compliance among the patient population.

Non-wearable devices include smart digital systems inside the home that can monitor movement, posture, and behavior, and the data can be analyzed and used to alert health professionals or caregivers of falls or any other anomalies, increasing the safety of older patients in their homes.

Challenges and potential opportunities

Some challenges in designing digital medical technologies pertain to the target audience. Studies indicate that while older adults have no difficulties using a wearable device such as a watch, they prefer personal interactions and contact with healthcare professionals and have difficulty independently accessing telemedicine services.

The securing and processing the enormous amounts of data generated through wearable devices pose another significant challenge. The analysis of such large data calls for a multi-disciplinary approach involving artificial intelligence or machine learning methods to speed up the analysis to provide timely diagnoses and medical interventions.

The validation of the efficacy of wearable devices through large-scale clinical trials involving the geriatric population can significantly improve their acceptability. However, the technology continues to face challenges associated with narrow scope and limited accuracy and stability.

Potential opportunities to improve the use of digital health technologies in geriatric medical care include the development of smart homes with efficient communication and surveillance systems.

These smart homes consist of a combination of wearable sensory devices to monitor vital signs and biochemical parameters, electronic surveillance to monitor movement and behavioral changes, and efficient analytical platforms to provide rapid diagnosis and interventions that could help the elderly population live safely and independently in their homes.

Conclusions

In summary, the researchers provided a comprehensive review of the current digital health technologies, such as wearable physical, chemical, and hybrid sensors and non-wearable sensory devices at home that can monitor vital signs, biochemical parameters, and movement of elderly patients to ensure timely medical interventions.

They also discussed the challenges and gaps in the current digital health technologies, as well as potential areas of expansion and improvement that can provide elderly patients with the ability to independently and autonomously live healthy and safe lives.

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