When I was invited to join policymakers, administrators, clinicians, researchers, and leaders at the International Summit on Innovation and Technology in Care of Older People (IS-ITCOP) at the Columbia University School of Nursing for two days in June, little did I know my most memorable takeaway would be TESSA the talking flowerpot robot. The purpose of the summit, funded under a National Institutes of Health grant, was to build a research agenda that will lead to safer, higher-quality, more accessible, and equitable long term post-acute care.1
Experts estimate that by 2050, the worldwide population of people at least age 60 will nearly double to 22 percent, or about two billion individuals.2 Many of these people will require long term care (LTC) in the community or in facilities, such as assistance in their activities of daily living, as they age. Older adults’ activities may be supported by informal caregivers, such as family, friends, or neighbors, in addition to health care professionals, to ensure they maintain the highest quality of life with the greatest degree of independence, autonomy, participation, personal fulfilment, and dignity, while respecting their preferences.
What does this have to do with a talking flowerpot? With shifting demographics, an aging person’s support system may benefit from new care innovations leveraging technology. Care technology is not limited to electronic health records or telehealth, but includes a wide array of patient-monitoring, adaptive, and supportive technology that may be supplemented by artificial intelligence. Older adults in long term care systems have multiple medical conditions that are complicated by increasing functional decline and cognitive impairment and often accentuated by social risk factors related to financial resources and a safe environment. Can a talking flowerpot or other such innovation help address some of these needs?
Gregory Alexander, PhD, RN, FAAN, FACMI, FIAHSI, from the Columbia University School of Nursing, emphasized in the summit introduction, “One international strategy for improving the quality of care in the world’s long term care systems is the efficient and competent use of innovation and technology. Unfortunately, there are many gaps in our evidence base about how technology can be used to support the care of older people in long term care. IS-ITCOP serves as a beacon of collaboration and innovation, dedicated to exploring how technology can reshape the landscape of care delivery and improve outcomes for older adults in need.”
For the summit discussions, the IS-ITCOP participants, representing a range of perspectives and expertise from eight countries, referred to the World Health Organization’s definition of long term care: “national system that ensures integrated long term care that is appropriate, affordable, accessible, and upholds the rights of older people and carers alike.” Multiple keynotes and small-group discussions focused on the following four pivotal subjects, and related details listed below them lie at the heart of future long term and post-acute care needs, with an emphasis on leveraging technology that is accessible, acceptable to users, and actionable.
1. Emerging Models of Care and Technology in LTC
2. LTC Workforce of the Future
3. Transparency and Accountability in
Quality of Care in LTC
4. Safety and Privacy Considerations in LTC
I asked Dr. Alexander about how bringing together international perspectives of leveraging technology to improve care for older adults added value to the summit.
He shared that many countries face similar challenges associated with caring for older adults in their communities. However, we each have our own cultural and values-based perspectives that drive our decisions about how best to care for older adults. Sharing these perspectives helps us to realize differences between us.
For example, one international issue discussed was related to the emergence of robots to assist with activities of daily living, such as getting older adults to the bathroom. In 2009 in Japan, a robot was created that attached to the wall to lift the person up and out of bed and over the toilet so they could go to the bathroom. In a different discussion, cultural sensitivity issues in care of older adults were shared among attendees, including important aspects of equity while valuing a person’s culture.
These discussions were robust, sometimes intense, and very productive in highlighting the challenges of advancing technology and identifying opportunities to advance research in this area. The diverse perspectives of the summit participants from the worldwide community revealed several common themes that will serve as the foundation for the development of a formal research agenda.
How did an egg-shaped looking robot, which wears a woolen jacket and hat, has blinking eyes, and sports a flowerpot on its head fit into such a deep discussion? One advantage is that it is not scary like some technology can be perceived. Technology like TESSA is in use in thousands of care homes in the Netherlands and other European countries and offers support for people in their residence, whether in a home, assisted living residence, or nursing facility, and reminds users to do important daily activities, including taking medications, eating, and preparing for appointments. It also can offer routine guidance on tasks, provide social stimulation, learn common behaviors, and monitor for deviations, such as missing a meal. Technology like this can also provide health monitoring information to caregivers and health care providers as well as support the patient in preparing for health care visits.3
It was fascinating to consider that innovations containing advanced health information and support technology can be creatively embedded into common pleasurable human experiences through talking flowerpots, robotic cats and dogs, or other nonintimidating everyday objects to maintain a more homelike environment. While the summit discussions covered all types of technology and the resultant research agenda will address them all, I believe that such user-friendly and “fun” technology innovations represent the cutting edge of person-centered technology advancement.
I also asked Dr. Alexander about his impressions of the exciting new opportunities for advancing research in this population that were identified during the summit.
He reiterated that the summit focused on four topical areas, including emerging technologies, workforce, transparency and accountability, and privacy and safety. In each area, there were many opportunities discussed to advance research among older adult populations who live in and want to live a vibrant life in the community. There were discussions about how improvements in long term care through technology could increase efficiency, accessibility, early identification, and interventions that could help people stay in the community longer. For example, attendees discussed the importance of exploring interoperability, benchmarking IT capabilities, and recognizing successful models of care that have good outcomes.
One participant’s assessment exemplified an important theme of the discussion: “Having technology, interoperability, and the ability to benchmark organizations means you can then look at those ones that are doing exceptionally well and ask, ‘What is it about these organizations and the models of care that they’re delivering that is good?’”
Many of these existing and potential additional functions of such care-support robots are relevant for discussions about how to address myriad social and care need gaps, technology capabilities and cost gaps, and ethical and legal issues. I appreciated the unique opportunity to participate in the IS-ITCOP summit and look forward to the future issuance of the research agenda resulting from this meeting seeking to leverage technology through innovation to lead to safer, higher-quality, more accessible, and equitable long term post-acute care.
Daniel Ciolek is associate vice president of therapy advocacy for the American Health Care Association.
References
1. NIH. Project Number - 1R13HS030051-01. A Roadmap for Research: The International Summit on Innovation and Technology in Care of Older People (IS-ITCOP). https://reporter.nih.gov/search/wOxfBSJNpEuAkcZS2UhaVQ/project-details/10906519#similar-Projects
2. World Health Organization. Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
3. Ageing well in a digital world. TESSA. https://www.aal-europe.eu/tessa/