A national US survey has found that many clinicians have reservations when it comes to providing telehealth care to older adults, even though many stand to benefit from its accessibility, lower costs and faster referral times.
A sweeping national survey of doctors, nurses and other healthcare providers reveals that nearly 60 per cent believe it’s ‘dangerous’ to provide telehealth to older adults due to patients’ medical complexities.
Another 60 per cent say telehealth is an unrealistic option for seniors with physical or cognitive challenges.
These are among a host of unexpected survey findings from 7,246 US clinicians who offer telehealth to older adults.
The results not only shed light on perceived concerns that can impact care but point to the need for industry-wide guidance on how to improve telehealth for this fast-growing patient population.
The survey and its accompanying journal article, authored by West Health researchers and their collaborators, appear in the latest edition of Telemedicine and eHealth.
“I was shocked that so many clinicians believe it’s not safe to use remote care with seniors who have complex medical histories or disabilities,” says Liane Wardlow, PhD, senior director of Clinical Research and Telehealth at West Health and a lead author of the study.
“Our telehealth infrastructures must be designed to account for these factors. The greatest danger of all would be to exclude older patients from remote care.”
Wardlow also found it alarming that most clinicians who responded to the survey say that people ‘over a certain age’ can’t be cared for well using telehealth.
“To agree with such a general statement about older people is a red flag that may indicate some level of age bias,” says Wardlow, a founding member of the Collaborative for Telehealth and Aging, led by West Health.
“These findings tell us loud and clear that healthcare providers need better support, more education and specialised guidelines to provide effective and equitable telehealth to older patients.”
On the bright side, the survey showed that 68 per cent of clinicians say they ‘often’ or ‘always’ work to ensure older adults and their caregivers are prepared and understand what to expect from a telehealth encounter.
And 62 per cent ‘often’ or ‘always’ account for older adults’ physical and cognitive differences.
Telehealth use among older adults has catapulted since the start of the Covid-19 pandemic, offering benefits such as reduced costs, greater accessibility for those with mobility issues or in rural areas, and faster referral times.
But research has shown that despite these benefits, many hurdles exist for older patients—hurdles that the Collaborative for Telehealth and Aging is working to address.
The online survey, conducted in March, was designed to help researchers understand how clinicians are using telehealth to care for older adults, as well as the perceived challenges and benefits of telehealth. Survey respondents include physicians, nurse practitioners, nursing professionals, physician assistants, mental/behavioural health providers, or occupational or physical therapists, and serve a patient population composed of at least 10 percent of older adults.
Agetech World podcast: The age-old lessons we can learn from Japan
With governments across the globe facing a ticking timebomb when it comes to funding the care needs of their ageing populations, a leading social and medical anthropologist has told the latest Agetech World podcast that there is much Japan can teach policymakers.
Click here to listen to the latest Agetech World podcast
Among Dr Iza Kavedžija’s main research interests is exploring the lived experience of ageing in urban Japan.
The Assistant Professor of Medical Anthropology in Cambridge University’s Department of Social Anthropology has lived in Japan and conducted extensive ethnographic fieldwork with two distinct groups of people in the Kansai region.
This led to her first in-depth study, Making Meaningful Lives: Tales from an Ageing Japan, and has underpinned a series of journal articles addressing a broad range of topics including care, hope and hopelessness, and happiness and gratitude.
In conversation with Agetech World, Dr Kavedžija said Japan had long been known for its widespread respect for the older population and its sense of obligation to caring for them.
The country has one of the world’s oldest populations, with nearly 30% of its 125m inhabitants aged over 65. This age group is expected to account for 34.8% of the populace by 2040.
Whilst this is inevitably putting a strain on Japan’s long-term care system, the country’s politicians and wider society are continuing to learn, evolve, and devise radical solutions to meeting this growing demographic challenge.
Japan has always had a strong tradition of family caring for its older citizens. But to this has been added a Long-Term Care Insurance (LCT) scheme, a complete package for the over-65s covering both the financing and the implementation of social care according to needs, supported by mandatory premiums levied on those aged 40-plus and co-payments from users.
Further responding to the nation’s ageing society, Japan is preparing to introduce a new Community-based Integrated Care System by 2025, with the aim of ensuring the comprehensive provision of health and nursing care, housing, and livelihood support.
Japan has also been working on developing robots to automate care for older adults, and other innovations include government investment in non-medical activities that can help prevent age-related illnesses; helping the over-65s flourish by working with them in their homes and communities rather than expecting them to conform to current societal norms or live in neglect; and making their towns and cities easier to navigate so seniors can still participate in everyday life whether for pleasure or work.
The number of residential homes is restricted with the emphasis on community care
Asked what Japan can teach the likes of the UK – which is facing a soaring health and care crisis – Dr Kavedžijan said: “I think there are many things that Japan has paid close attention to.
“I think the Long-Term Care Insurance is one of a kind… that allows for the drawing on services from various sectors, so it is possible to create a mix of forms of support, whether it be home care, whether it be various forms of assisted living…so a lot of interventions that are in the community and a lot of providers that range from non-governmental to the state sector to the private sector, where one can create a plan of care and support with a care manager that’s tailored to the needs (of the individual) drawing from the broad range of services.
“It isn’t always the same sort of story where the plan has led towards institutional living.
“In this sense I think Japan has been particularly successful. Of course, as the proportion of older people is so high in the population, this system is somewhat coming under strain. I don’t want to represent it as a particularly rosy situation. It isn’t. There are challenges to it.
“But I think nonetheless that this very, very well thought out system of support is important and it also cultivates these various forms of dependence, or interdependence, where one can draw on different types of assistance.”
Dr Kavedžija added: “It actually also allows people to continue living relatively independent lives….it doesn’t necessarily mean they have to move in with their children.
“So, they think of older people as the ones who continue the tradition and social changes as something that is brought on by younger people.
“In this case, I think we have seen very clearly that it is older people themselves that have often been the active leaders in social change. They have been the ones often saying, ‘I know there is an expectation for me to depend on my older son, but I don’t want to be a burden on my children.’
“So, they cultivate various forms of care in the community and they themselves become very involved in a huge range of activities, volunteer activities, that foster support in the community and create these communities of care.
“That is, I think another lesson that would translate well elsewhere.”
But Dr Kavedžijan also gave a note of caution. “I don’t want to paint too much of a positive picture because certainly challenges are there. That is something that again is perhaps an important lesson, and that is to do with the circulation of care, as I like to call it, where we need to think of care in systemic ways.
“For instance, elder care largely depends on a volunteer workforce, and that had for many years often consisted of women.
“In order to support better care for elders I think it is necessary to consider in which ways we can perhaps support childcare. So, to think about these flows of care in a much broader way and try and foster support across the board rather than thinking of them as separate units…that are not intertwined.”
Agetech World podcast: Why it’s time to stop talking about generations
From post-war baby boomers to the current Generation Alphas, stage-of-life labels beloved of cultural commentators, researchers and marketers, will soon be a thing of the past, predicts the head of the globally influential UK National Innovation Centre for Ageing.
Researcher, teacher, writer and TEDx speaker, Professor Nic Palmarini, has told the latest Agetech World podcast he believes the arbitrary grouping of people born within a certain time frame and deemed to reflect the narrative of a particular period in world history, will no longer be a thing.
Click here to listen to the latest Agetech World podcast
Instead, the director of the NICA, said he expects to see a merging of the current peer groups to form one inter-generation, with no need for distinct categories.
“It is quite foolish to put cohorts who are born in very nearby years, but different years, different areas of the world, (and with) different experiences, to put them all together,” he said.
“We think that in the future there will be no more generations. We are literally thinking that there is a kind of fluidity on how we are interfacing our future society.
“My personal opinion, and again it is my opinion, but I think we are just going towards a sense of melting the generations one with the other and coming to one mega fluid generation where experiences are just more quickly flowing one to the other, not necessarily stopping at the station of each generation.
“And if you think, for example, what happened in the United States, where President Biden has been elected basically with the votes of the Gen Z, there is a sort of understanding of Gen Z and the Silent Generation (born up to the mid-1940s and including Joe Biden)…trusting each other, understanding each other, empowering each other, which I think is something we will see more and more often because, I guess, the only way to solve the main, or big issues, that we are seeing forward in our future…(is through) collaboration between the generations instead of framing the generations.”
He added there would always be some intergenerational conflict “which is good, because somehow it is making the generations in this case understand what could be the pain point that maybe others don’t see.”
The way to solve this discord he explained, was with collaboration.
“We know there is no other way. So I think that also this will probably lead us to a kind of inter-generation, as we call it.
“I keep on saying that the next generation won’t be called Alpha as they say. My point is it will be called ‘inter’ because it will be a generation made of many generations working together.”
Prof Palmarini was appointed director of the NICA in 2019. Headquartered in the North East of England, the NICA is jointly funded by the Medical Research Council and Newcastle University, and was set-up to work across academia, industry and the public to explore, test, and bring to market products which promote healthy ageing and wellbeing through life.
Prof Palmarini’s previous job was as head of AI for Healthy Ageing at IBM Research and AI Ethics Lead and Research Manager at the MIT-IBM Watson AI Lab in Massachusetts in the US.
He has a decade of experience in research in supporting older adults’ autonomy and independence, and his internationally-recognised career has demonstrated his commitment to exploring the impact of technologies and their applications in the life of the ageing population and people with disabilities.
With the longevity sphere potentially worth trillions of pounds in the UK and worldwide, a major part of the NICA’s work is to convince industries, such as the big technology players, the health sector, entertainment, fashion, and financial services, of the importance of targeting age discrimination through collaboration, innovation, exchange and interaction.
Prof Palmarini told the podcast that society also needs to rethink ‘age’ and the concept of retirement, especially as people are living longer thanks to medical and scientific advances.
He has no plans to retire, he said. “I’m very biased because on one side, not my research side, my father is 93 and is working. He is a doctor and he keeps on going to work, he drives, he lives his life like it was 20 or 30 years ago, which obviously teaches me one thing, that we all need a purpose to be that way.
“So, how do I see myself? I can’t think myself out of being engaged in things that matter to me, and I am very good in putting myself in things that matter to me. So that is my everyday job. I am curious. My job is to understand what are the dynamics happening now – and in the future.
“I am quite good in spotting what are the things that could be meaningful in the future, hence my future will probably be what I am doing today for the next whatever years until I die.
“I haven’t thought about retirement. Again, I don’t have examples in my day-to-day life of retirement. I have examples of people living their own life, being relevant to themselves and to others, which is something still I think we have to sustain and push, not for everybody. Do not misunderstand me. There are people that need to stop. People that need to slow down in certain stages of their life.
“I am saying in general we tend to think of this idea of retirement, like stopping being part of a society because that is how retirement, from a narrative perspective, has been designed.
“I think we have to go against the stigma of retirement; you just watch birds and take long walks every day, which is absolutely wonderful and must be done by whoever wants to do it, but also I think this idea of giving back permanently to others in the process of life, is something that we should have to start thinking more consistently, and understand that working in later life could be a blessing, not a bad thing.”
Global research partnership will tackle challenge of healthy ageing
A new UK-led research consortium has been formed to tackle one of the biggest challenges currently facing the world: healthy ageing.
The global partnership will bring together six UK organisations and 14 US and Canadian institutions to explore how humans age, with the aim of developing new interventions to support healthy ageing.
UK Research and Innovation (UKRI) has awarded funding from its Securing Better Health, Ageing and Wellbeing Strategic theme to the muscle resilience network, MyAge, which is leading on the initiative.
Together with five other UK Ageing Networks (UKAN) – the independent health advisory and delivery organisation, ATTAIN; Building Links in Ageing Science and Translation (BLAST); the Cognitive Frailty Interdisciplinary Network (CFIN); the interdisciplinary research collective, Extracellular Matrix Ageing (ECMage); and the Food4Years Ageing Network – it is hoped the award will not only strengthen existing partnerships but encourage collaborative, multidisciplinary research with the aim of alleviating the development of many of the illnesses and conditions often suffered by older people.
It is hoped this will ultimately lead to healthier ageing.
Common health conditions associated with an older population can include everything from hearing loss to cataracts, osteoarthritis, diabetes, obstructive pulmonary disease, dementia, depression, cancer, and stroke.
As people age, it is not uncommon for them to be living with more than one condition at a time.
With people living longer across the globe, all countries are now facing major age-related health, societal and economic challenges.
The number of people aged 60 and over has tripled since the 1950s, and according to the United Nations, the population aged 65 and over is growing faster than all other age groups.
The World Health Organisation predicts that by 2030, one in six people will be aged over 60, with the share of the population in this age group expected to have risen from one billion in 2020 to 1.4 billion by the end of the decade.
There are projected to be more than two billion over-60s by 2050.
Whilst an ageing population can bring many positive opportunities, not just for older people themselves, but their families, and society, it can also be associated with a host of potential problems.
These can include increased pressure on already over-stretched health services, to lack of economic growth, differing work and retirement patterns, a decline in the ability of communities and governments to provide adequate resources, and even a change in how families function.
Age-related opportunities, or otherwise, depend heavily on one factor, however. Health.
According to WHO, evidence suggests the proportion of life lived in good health has remained broadly constant, implying that additional years are in poor health.
Testimony from the UK suggests that adults, particularly women, often spend their last decade in poor health.
Dr Kambiz Alavian is a Neuroscience reader in the Department of Brain Sciences at Imperial College London, Deputy Director of UKAN, and co-lead for MyAge.
He explained: “This global consortium brings together a group of world-leading institutions and experts in ageing research. Through the exchange of ideas, expertise and capacity building, the interdisciplinary and cross-disciplinary partnerships will focus on transformative ideas that can generate scientific, interventional, and societal impact.”
The UK-North American project will focus on two broad areas of research.
One will explore the mechanics of ageing to foster the development of biological, pharmaceutical/nutraceutical, behavioural, lifestyle, clinical and societal interventions to promote healthy ageing and improve lifespan.
The second will be to develop novel interventions on topics ranging from biomedical to environmental and social factors that play a part in ageing.
Dr Alavian said: “True societal impact in this area requires a comprehensive understanding of the problem at all levels and a global effort to bring together solutions from a range of scientific disciplines.”
He continued: “We’re collectively very well placed to reach out overseas and are very excited about this collaboration. We are keen to hear from potential US and Canadian collaborators in industry and the academic sector and will be keeping the UKAN networks informed of future collaboration opportunities.”
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