75-year-old “Grandma” Cheung has been living alone in Hong Kong since her husband moved into a nursing home three years ago after a stroke. She suffers from Alzheimer’s disease, arthritis and hearing difficulties. She seldom gets to see her three children, as they are all working abroad. Nonetheless, Mrs Cheung does not want to let old age stand in the way of learning, and so every Wednesday she attends a computer class at her local neighbourhood centre. By learning more about the Internet, she hopes it will provide her with a better way to keep in touch with her children and grandchildren.
As families are getting smaller and there is greater tendency for the young to move away, it is increasingly common to find older people living on their own. In addition, as we are living longer than ever before, population ageing is becoming a major phenomenon in many countries. Accordingly, addressing the health and well-being of older persons is now of crucial importance. According to the 2003 World Health Organisation statistics, older persons are the fastest growing age group worldwide. While our ageing population is a testament to our progress in healthcare, it also means that a “silver tsunami” is on its way. By 2050, nearly one out of every four people will be older than sixty years. This will significantly increase the burden of psychological disorders linked to ageing, such as dementia, depression and Alzheimer’s disease. Indeed, the annual cost of dementia and depression care are forecasted to exceed that of cancer and heart disease.
Fortunately, alongside this demographic transition, another major trend is taking shape – that of the mobile phone revolution. The use of mobiles today has spread exponentially and a recent review reported that over 70% of adults aged 65 years and older own a cell phone, even in developing countries. Given the rapid growth of mobile technology in the last few years, there is hope that mobile technology will provide solutions to expand health-care delivery options and tackle the mental health problems of ageing adults.
Mobile health or mHealth refers loosely to the use of mobile technology for health care. It can facilitate collection and rapid analysis of large volumes of data in real time, and provide a platform to administer medical interventions. There are a multitude of reasons why mobile technology may be especially beneficial to the elderly.One of the biggest problems for elderly patients is forgetting to take prescription medicines. It is estimated that only 50% of patients take their medicines as prescribed by the doctor. Mobile technology can help overcome this by providing personalised reminders to patients, without them having to visit the doctor’s clinic. Other studies show that regular use of mobile phones is associated with positive lifestyle changes and better self-management.
Mobile technology also offers a powerful complement to traditional tools that have been used to assess and monitor cognitive functioning. For instance, a recent study found that by collecting real time data from the cell phones of patients’ with bipolar disorder, researchers were able to predict the onset of suicidal ideation one week prior to in-person clinic visits. On a more basic level, Ravi Samuel, a psychotherapist working at Vision Age India, highlights how mobile phones can enhance social connectivity and improve communication between older and younger persons. This can be very helpful for people like Grandma Cheung, who live on their own and often tackle feelings of isolation and loneliness.
Despite their potential benefits, skeptics point out that the elderly may not so willingly jump onboard this mHealth revolution. Jotheeswaran Thiyagarajan, a research fellow at the Centre for Public Mental Health at King’s College, London argues that the elderly are often “technophobic” and may be reluctant or unable to engage with mobile-based applications. This creates a difficult situation – the demographic who stand to benefit most from mHealth are the ones who may be the least likely to use it. Overcoming this divide requires us to achieve two goals: firstly, to make mHealth more easily accessible to the elderly population, especially those who are living in rural areas and may not have be able to afford these technologies. Primary health care can play a crucial role here – general practitioners could keep a stock of smartphones to lend out to elderly patients whom they believe would benefit from continuous health-monitoring. Such a system would not need to cost much and GPs could collect unused smartphones as donations from their patients.
The second goal is making older people feel more competent in the use of mobile phones through specific incentives and educational efforts. Again, GPs may play an important role by offering training to familiarise the elderly with such technology. Volunteers could also be recruited to make home visits to elderly patients to teach them how the applications work.
It should be emphasised that positive change in terms of improved care, access and outcomes will not happen simply because mobile technology is available. In practice, it needs to be effectively integrated into healthcare systems, understood, trusted and accepted by its users. Healthcare professionals will not be keen to use applications that are unintuitive, or impractical – especially so if it will slow down the consulting process and compromise patient care. Hence when designing a novel health application, a competent team of engineers and programmers must take into account its usability and practicality from both the doctor and patient’s perspective for it to be widely accepted.
Despite potential challenges, the great beauty about mHealth is its wealth of possibilities for the future. Today, we use mHealth applications for simple blood pressure or heart monitoring. In the near future, electrocardiogram monitoring from the patient to the GP may be mediated by mobile applications in real time. And in the distant future? At the rate technology is growing, one can only begin to imagine.
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