Scholars are investigating the challenges of using digital health technologies to care for adults with cognitive disabilities.
Most Americans face cognitive decline by age 70. Older people who experience cognitive impairment face “unique challenges” that the healthcare system may not be equipped to address. To meet the needs of a growing aging population, technology companies are developing digital medical tools that promise to transform patient care. However, expanding access to these innovations is not without risks.
In a recent article, Kathryn Huber and Tara Sklar, law professors at the University of Arizona College of Law, examine the regulatory challenges of integrating digital health solutions into clinical care. While many of these technologies are marketed as tools to improve quality of care, Huber and Sklar argue that further regulation is needed to protect older adults from the risks associated with using the technology. . They propose reforms that reduce barriers to access and adoption of these technologies while protecting vulnerable populations.
Various mental conditions such as memory loss and dementia are called cognitive disorders. As of 2023, more than 55 million people are suffering from dementia, with almost 10 million new cases reported each year.
Huber and Sklar explain that caring for this patient population requires significant resources and often places a strain on clinical teams and health systems. In response, digital healthcare developers are developing new tools such as remote patient monitoring devices that “deliver smart, personalized assessments” of patients by collecting, customizing, and analyzing data relevant to their care. I am.
Huber and Sklar explain how digital health technologies are emerging to transform where and how care is delivered to older adults with cognitive impairments. However, they warn that these innovations could be “more hype than promise” and question whether adequate measures are being taken to protect this population. Additionally, Huber and Sklar explain that it is difficult to regulate digital health technologies in a way that promotes widespread, effective, and safe use.
New digital health tools have many new features, including the ability to collect a variety of data, including patient demographics, location, clinical and family history, and more. By compiling and analyzing this data, pioneers of “big data analytics” promise “large-scale, long-term” solutions for older people living with cognitive impairment. However, some studies suggest that “the massive promises based on big data analytics may be overstated.”
Building on this body of research, Hoover and Sklar question whether technology built to attract profits and users will better support the individual needs of elderly patients. For example, they point out that some digital health tools have the potential to reduce the need for patient monitoring and promise convenience for providers and independence for patients. For example, Huber and Sklar argue that interventions that reduce the need for in-person visits can increase social isolation and loneliness among older adults.
Huber and Sklar argue that a “one-size-fits-all” approach to using patient data is unlikely to meet the “medically and socially heterogeneous” needs of older adults with cognitive impairment. are. Also of concern is the risk that technologies built with biased or flawed algorithms could perpetuate existing racial or cultural biases and exacerbate inequities in health care delivery, Huber said. and Sklar explain. They warn that these risks are more likely to occur in older populations with cognitive impairment, who tend to have higher rates of comorbidity and complex living and support needs.
Furthermore, Huber and Sklar argue that emerging digital health technologies lack the necessary protections to ensure the informed consent of patients and caregivers. They explain that the streamlined consent processes used by many of these platforms may not be able to meet technically challenging patient needs. Huber and Sklar also point out that existing regulations require additional safeguards to protect the privacy of caregivers being monitored in telecare settings.
Making digital health innovation affordable and user-friendly also remains a key challenge. Given that older adults may have fixed or limited financial resources, the cost of the device and the need for internet access may be a barrier to adoption, Huber and Sklar said. expressing concern.
Finally, older adults with cognitive impairments may require technical support to incorporate digital health into telehealth environments. Further complicating the accessibility and safety of new digital health tools, Hoover and Sklar say, older adults, especially those with cognitive disabilities, are more susceptible to online misinformation, fraud, and abuse. He explains that they are becoming increasingly vulnerable.
Despite these drawbacks, Huber and Sklar say there are significant benefits to incorporating digital health innovations into the care of older adults with cognitive impairment. For example, at the individual level, emerging digital health technologies may improve early detection rates of disease and give patients more opportunities to plan and access resources related to their care. At the community level, these technologies have the potential to enable providers to collaborate with multidisciplinary teams to serve underserved locations and populations.
To minimize risks and realize the benefits of these new technologies, Huber and Sklar propose policies aimed at protecting patient populations and promoting widespread and effective use. .
Huber and Sklar recommend considering additional funding channels to coordinate care across different clinical practices. They say coordinating care for adults with cognitive impairments is resource-intensive and poorly compensated. Huber and Sklar explain that increasing funding for coordinated care will help maintain the workforce to care for patients experiencing different levels of cognitive impairment.
Additionally, it proposes increasing Medicare and Medicaid reimbursement for integrating these technologies into patient care. Hoover and Sklar point to gaps in the current funding structure of Medicare and Medicaid as evidence that more support is needed to ensure older adults benefit from cheaper alternative options within the health care system. Pointed out.
While these goals may not solve all challenges, Hoover and Sklar say they will improve quality of life and provide important support for the care of millions of vulnerable adults. Emphasize that this is a major step.
