Home, sweet home.
Home is often synonymous with familiarity, comfort, security, love and much more. Many of us hope to grow older in our home (for as long as possible), instead of moving to an assisted-living facility or a nursing home. This may require some home modifications, and perhaps new support and services to meet the evolving health and social needs of older adults.
Remote-monitoring technologies and other virtual-care services appear promising to support aging in place. Remote patient monitoring is the delivery of healthcare services to people outside of conventional clinical settings (for example, at home) using telecommunication technology.(1) These technologies transmit health data (sometimes in real time) about a person to their care provider through a variety of devices (for example, sensors, wearables devices, handheld devices, mobile smartphones, implantable devices, blood-pressure monitors, and technologies using artificial intelligence to analyze speech and behaviours).(1-2) These technologies can be used by care providers to observe a person’s health status (for example, their vital signs and symptoms) and behaviours (for example, medication adherence) from a distance.(2) Many programs currently exist to remotely monitor people who have chronic conditions like diabetes, heart failure, chronic obstructive pulmonary diseases, or for patients who are transitioning back home after a surgery.
And that’s not it. The technological landscape is evolving rapidly, and the scope of possibilities keeps growing exponentially to also include remotely monitoring people’s wellbeing and home environment. Technologies are now increasingly used to remotely monitor activities of daily living of individuals with the goal of tracking their health status and foreseeing the risks associated with aging in place.(3)
What can we learn from the body of research evidence about remote-monitoring technologies and whether there are fulfilling their promises?
What the research tells us
There is a growing body of evidence about the purposes of remote-monitoring technologies. These purposes include:
- helping people manage their care needs at home for as long as possible (for example, increased autonomy, improving medication adherence, or increase comfort, convenience, and flexibility in chronic disease management);(4-7)
- supporting post-discharge monitoring to avoid hospital readmission or intervene earlier to mitigate negative health impacts (for example, faster clinical decision-making, react to critical situations, call for help in the case of an emergency and issue warnings if unusual behaviours are detected);(8-11)
- enhancing safety (for example, preventing falls and wandering);(5;12)
- improving access to specialist care (13) or overcoming workforce shortages (particularly in rural and remote areas);(14) and
- reducing or preventing the use of unnecessary care (for example, hospitalization, hospital stay, consultations, outpatient visits and follow-up, and emergency department visits).(7;9;15-18)
There is a wide array of things that can be remotely monitored, including:
- physiological parameters (for example, blood pressure, heart rate, weight, electrocardiogram, fever, oxygen level) (12;19);
- routine actions (for example, phone use, room presence, bed/chair occupancy, toilet usage, fridge, pantry access) (12;20); and
- home environment (for example, temperature and CO2 level).(11)
Despite its promises, the clinical effectiveness of remote-monitoring technologies is still debated among researchers.(1) Nevertheless, there is evidence that remote-monitoring technologies can:
- improve access to quality health information;
- help make informed decisions;
- increase feelings of security and autonomy;
- help make clinical decisions more rapidly;
- reduce hospital readmissions;
- help patients living in rural and remote areas to manage their health and care; and
- support medically unstable patients as they transition to stability at home.
A lot of interest, but also many issues still to be addressed
The 2021 Digital Health Survey commissioned by Canada Health Infoway revealed that many Canadians have an interest in a variety of electronically enabled health services, and the, many expressing an interest in:
- taking part in a remote patient monitoring program using a device to manage a chronic health condition (47.2% of respondents); and
- taking part in a remote patient monitoring program using a device to manage symptoms related to COVID-19 (40.2% of respondents)
While these survey results show a lot of interest in using remote-monitoring technologies, there is still a lot of work to address various sources of concerns among potential users (notably about the acceptance of such technologies, how it may impact their lives and identities, and how to protect their privacy). We also need to put in place strategies to bridge the ‘digital divide’. The digital divide refers to the socio-economic and demographic factors such as age, income, ethnicity, place of residence, education and health status that contribute to unequal access to digital infrastructure and technical capacity of individuals and communities to access information and use the internet.