Better Care for Seniors with In-Home Medical Technology

In-home medical devices such as heart rate monitors and blood pressure cuffs for cardiac patients, glucose meters for diabetics, spirometers for asthmatics, scales to measure weight, and infusion pumps for medicine intake, are commonly used to gather data and transmit it to the patient, their families, caregiver, and/or medical provider. With an estimated 7.6 million people receiving home health care in the U.S. (National Association for Home Care & Hospice, 2008) and one-third of the U.S. households having at least one unpaid family medical caregiver present (National Alliance for Caregiving, 2009), the use of in-home medical devices is on the rise.

New to the world of medical devices are implants placed inside the body for a variety of conditions. The implants are still being tested and are at different levels of approval by the FDA. Each one is smaller than a dime and can transmit data to a remote device for a physician to interpret. One such implant measures cardiac pressure to indicate heart problems, another is a sensor that measures blood sugar continuously for patients with diabetes, and yet another one monitors tumor progress for up to many months following a biopsy.

In-home medical devices have become more portable and easier to use, enabling patients recently discharged from the hospital or who are managing a chronic disease, to receive continued care from the comfort of their own homes and sustain normal activity levels. Regular monitoring and instant response to a significant change in the person’s health is likely to prevent trips to the emergency room or admissions to the hospital, keeping medical costs down.

As costs for health care and long-term care rise, the support that in-home medical and safety sensing devices and wellness monitors provide is a less expensive option than hospital stays or repeated doctor visits. The needed care is delivered in a more desirable setting, better health results are achieved faster, and families and doctors are able to keep closer watch over the status of a patient. The individual and his or her family are put in the center of their own health care setting by taking on more responsibility for consistently maintaining their care requirements.

Cost of Inpatient Care Compared to Home Care (Per Patient, Per Month)

Condition Hospital
Costs
Home Care
Costs
Dollar
Savings
Ventilator-dependent
adults

$21,570

$7,050

$14,520

Congestive
heart failure
in the elderly

$1,758

$1,605

$153

Intravenous
(IV)
antibiotic therapy

$12,510

$4,650

$7,860

Source: National Association for Home Care & Hospice, 2008

Connecting patients to their doctors and families is easier than ever with health monitoring mobile phone applications, sometimes referred to as “connected health,” “telehealth,” or even “mhealth.” Generally, the monitoring system of choice is placed in the home or in/on the individual’s body. The patient or caregiver is trained to use the device. The data captured by the machine itself is transferred to a home computer through a USB, wireless connection, or cell phone and then transmitted to a health record management system at the doctor’s office, Google Health, or an independent service provider. The results are monitored for consistency. In the event there is an abrupt changed in the readings, the individual, doctor, family, and/or caregiver is notified.

The impact on real-life
People use connected health devices for three main reasons – chronic disease management, independent aging, and health and wellness.

Chronic disease management
Over 133 million Americans have chronic diseases with that number expected to rise to 157 million by 2020 (Centers for Disease Control and Prevention, 2005). With in-home medical devices, patients regularly track their health status, and physicians and family members can intervene when necessary.

Devices in this category:
Glucose meter, blood pressure cuff, heart rate monitor, weight scale, spirometer, medicine tracker, infusion pump, implant

Real-life application:
Bob has diabetes. He uses a glucose meter and cell phone to monitor his blood sugar levels. The cell phone reminds Bob to check his blood sugar regularly during the day. Using his glucose meter, he tests his blood. The reading from the glucose meter immediately transmits the data to his cell phone. The data is delivered to a diabetic monitoring service that maintains his long-term history and looks for abnormal events. If the reading is unusual or if Bob skips a test, the system automatically alerts Bob’s family, doctor and/or caregiver.

Independent aging
As the population ages, more people are living longer and ‘aging in place’ is typically the preferred senior housing arrangement. In 2030, when all of the baby boomers have 65, nearly one in five U.S. residents will be over 65. By 2050, this age group is projected to be 88.5 million, more than doubling the number in 2008 (38.7 million). The 85 and older population is expected to more than triple, from 5.4 million to 19 million by 2050 (U.S. Census Bureau, 2008).

In-home safety monitoring devices allow seniors to stay in their homes and family members to keep an eye on seniors remotely, saving on costs of long-term care or the need to move to a senior residence.

Devices in this category:
In-home and mobile medical alert system, wireless monitored automatic medication dispenser, individual GPS, scale

Real-life application:
Carolyn lives alone in the home she has lived in for 30 years. Her children live out of state. Carolyn has some cardiovascular issues and her cognitive abilities are not as sharp as they used to be. Each day, Carolyn gets up at 7:00 a.m., uses the bathroom, weighs herself, and goes to the kitchen to eat breakfast and take her pills. She then sits in the family room to watch the morning news. At 9:00 a.m., a message appears across her television screen reminding Carolyn to take her blood pressure, which she does, using a wireless-enabled blood pressure cuff that is on the table next to her chair. At 10:00 a.m., her daughter, who is 500 miles away, receives a text message on her cell phone that says “Mom is okay,” giving her peace of mind.

The safety monitoring systems, scale, wireless automatic medication dispenser, and blood pressure cuff setup around Carolyn’s house have determined that she got out of bed, used the bathroom, her weight did not dramatically change, she took her pills correctly, the gas stove is off, and her blood pressure is stable.

If something out of the ordinary would happen in Carolyn’s routine, the automated service, which is monitoring Carolyn’s activity, would alert her daughter by cell phone, and she could take appropriate action to care for her mother.

Health and wellness
Every year, more than 2 million deaths worldwide are attributable to physical inactivity (World Health Organization, 2003). Medical devices in this category revolve around either prescribed or personal fitness goals for better long-term health and quality of life.

Devices in this category:
Heart rate monitor, scale, mobile phone applications

Real-life application:
Brian has been put on an exercise regimen by his doctor because he is 75 pounds overweight. He uses a mobile wrist device to record his heart rate while he is exercising and a scale to record his body mass index and percent body fat. After exercising, he uses his personal computer (PC) to upload the data from his wrist device and the reading from his scale to a software program. He is able to record and view his personal training statistics and progress. In addition, he can send data to his doctor and fitness coach to get training and guidance.

Important to the success of the overall system is how the devices connect to each other, the services that support them, and the medical providers and families who need the information that is gathered. This is the focus of Continua Health Alliance, an international alliance of over 130 companies in the medical device and related industries. Continua is developing “guidelines for the emerging personal telehealth ecosystem for new and innovative products to radically improve health and quality of life as well as eliminate unnecessary costs from the healthcare system” (www.continuaalliance.org). Their efforts will show the advantages and cost savings of in-home medical devices to
the health care system as a whole, resulting in impactful evidence to share with insurance providers and doctors.

The FDA is also helping integrate in-home medical devices into the larger health care system. They recognize the potential safety concerns related to the products and are attempting to educate consumers. The FDA has launched a new and comprehensive Home Use Device website that includes downloadable brochures, lists of recently approved devices, alerts for recalled devices, and much more. www.fda.gov/homeusedevices