Scalable, accessible, and personal: Can technology help address seniors’ mental health struggles?
Technology and mental health are a double-edged sword. On one hand, there’s a never-ending discussion about the negative implications of too much screen time and endlessly scrolling through social media feeds. From another perspective, technology provides us with a valuable means to connect with others we may not be able to see in-person and can alert us to trends in our thinking and functioning, both positive and negative, that we may not be aware of ourselves.
For older generations, we are somewhat less concerned about screen exhaustion, and digital health technology has enormous potential to help address unmet care needs and enhance existing care provision. Not only the desire, but the need for technology as a means of supplementing existing care options is pressing.
Keeping in mind that everyone faces very different trajectories as they age, there are a number of challenges that we face as a society in terms of managing a large cohort of older people. For example, social isolation, depression, and dementia are commonly related mental health problems faced by seniors that can result from a host of different factors, including lack of mobility or frailness, and often perpetuate one another given the difficulties individuals face in getting adequate treatment. Social isolation, loneliness, and other mental health problems can have a significant impact on health outcomes and quality of life.
Demand Far Outstrips Supply
People aged 85 years and over make up the fastest growing age group in Canada. In a 2015 Conference Board of Canada report, it was estimated that by 2026 over 2.4 million Canadians age 65 and over will require paid and unpaid continuing care support.
An increased number of older people, often with greater care needs than younger cohorts, will require more care — but how will we manage to provide the required additional support?
Physical ailments, in additional to mental health issues, can drastically limit an older person’s access to care from an environmental perspective, meaning, they may not be able to travel to appointments. Older people may also lack access to care for economic and financial reasons. Formal paid care services can be costly and are out of reach for a significant proportion of the elderly population who live under constrained or fixed budgets. For seniors in long-term care facilities or nursing homes, they may face less than optimal conditions when it comes to having consistent, quality care in place. And, there is plenty of research in place that shows how understaffing erodes the quality of life of residents.
Could technology be the glue that holds the (aging) system and its (aging) patients, together?
Though we are only beginning to determine how we might address senior mental health using technology, there are some positive indications that efforts are ramping up. Earlier this year Amazon hired a geriatrician who has focused on treating elderly patients with complex medical conditions. Still, though there is some innovation in this area, there are numerous areas where greater time and resources are needed in order to figure out how we can address these issues.
The Mental-Physical Connection
It is important not to lose sight of the fact that mental and physical health are both dynamic and interconnected. Physical ailments, even those as seemingly minor as a sore back, can lead to a lack of mobility, making an older person vulnerable to isolation since they are unable to get outside of their homes at a usually interval. In some instances, patients are prescribed pain killers, namely opioids to help manage their symptoms, though sometimes these medications can have deleterious effects on mental health. A new study found evidence suggested that suicidal ideations and suicide attempts are linked to opioid use and pain sensitivity in the elderly. Similar recent research contributes to a growing body of research that bolsters our understanding of how physical function and depression interact. Researchers found that better muscle strength, balance, and higher walking speed were significantly associated with less depressive symptoms. This relationship has been observed in even more subtle forms. For instance, almost a quarter of adults who had undergone a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive functions.
Advances in telehealth have been a boon to some older people who can use these services, like their younger counterparts, to address routine concerns and provide standardized interventions, such as cognitive behavioural therapy. Research has shown that internet-enabled cognitive behavioral therapy (IECBT) is an effective method of treating anxiety and depression in older people. In the study, the experimental (internet-based) group mirrored face-to-face therapy, consisting of chat-based communication between the patient and the therapist. Online therapy can reach older people who are less likely to be referred for mental health therapy by their primary care doctor and can also help bridge environmental barriers to access.
In recent years, a range of different virtual assistants have emerged, many of which are operated using voice controls, an important feature for older people who may struggle with dexterity or vision problems, limiting their ability to use other forms of technology. By simply calling out to a Google Home or Alexa device, older people can check the timing of their appointments, play music, or ask general questions. These devices also enable the older person to connect with caregivers and their families, and provides them with a constant companion that is responsive around the clock.
Robots and Avatars
Senior care assistant robots are becoming increasingly popular. Hasbro makes Joy for All Companion Pets geared towards helping senior stave off loneliness. In November, Hasbro and Brown University teamed up on the Affordable Robotic Intelligence for Elderly Support (ARIES) project that is aimed at better understanding how the robots can assist older adults who have mild dementia or may otherwise be in need of daily reminders. The researchers will be looking to develop new sensors for the robots, in addition to communicative purrs, growls, or gestures that can guide the older person toward their medication or another object. The three-year project is supported by a $1 million grant from the National Science Foundation
Senior care assistant robot, ELLI Q, is connected to a tablet and suggests cognitive or physical activities, like playing a game or going for a walk. The robot will remind you to take your medicine; it also reads body language. Another company, GeriJoy uses an Android tablet with talking pet avatars to help ease the burden on those caring for someone with dementia. GeriJoy uses audio from remote caregivers based in the Philippines (where English is an official language) to provide seniors constant companionship and 24/7 monitoring. As is the case with voice-based digital assistants, robotic pets are also making the rounds in care homes and senior facilities.
While augmented and virtual reality (AR/VR) applications are taking mainstream audiences by storm, they’re also presenting unprecedented opportunity in digital health, and can offer particular value when it comes to senior mental health care. VR, in particular, allows seniors to explore different places and revisit old memories in locations they’ve been to in the past. For example, the Google Earth Virtual Reality Program has been used to allow seniors’ to relive memories — an activity that activates dopamine in the brain, and can potentially serve as a therapeutic treatment option for Alzheimer’s patients.
Researchers are looking at VR to develop new ways of treating mental disorders including Alzheimer’s disease. The technology is also being studied as a potential means to reduce pain, opioid use, anxiety, stress, and social isolation. VR is enabling clinicians and researchers to better understand executive functioning and neuropathways — tasks that have been traditionally difficult to undertake in clinical settings.
Both San Francisco-based Aloha VR, and Boston-based Rendever, are developing VR solution tailored specifically towards senior care and the results having been positive so far, including with dementia patients. VR is available directly to consumers — for instance, Samsung’s Gear VR headset retails for $100, though overall prices range from $15 (for a Google Cardboard headset) to nearly $600 (for an Oculus Rift headset). The devices are also making their rounds in long-term care facilities.
Many of the technologies described above are capable of creating a degree of caregiver confidence when they cannot be in direct contact with the person for whom they provide support. Knowing that routines are being followed and that the older person has a robot, avatar, or digital assistant to call on may not be an adequate substitute for face-to-face care, but it does provide some peace of mind in their absence.
Access to Technology
As with any consumer-facing endeavour, the question remains: if you build it, will they come? When it comes to senior care, while it’s incredible that all this technology exists, to what extent are all these devices and solutions usable, particularly by older people? Guidelines based on sensory-impairments (e.g. vision and hearing) as well as mobility and cognition are important to keep in mind when determining the usability of technology for older people. Researchers have identified a number of criteria that can facilitate older people’s uptake of new technology. These questions apply to all technology aimed at senior populations — whether the technology seeks to improve mental or physical health.
- Are the fonts large enough?
- Are the audio frequencies too high?
- Are online forms expiring before the older person is able to complete them?
- Are icons far enough apart to avoid pressing on the incorrect icon?
- Are the terms and verbiage being used intuitive?
When we’re healthy, able to see, hear, and speak clearly, it’s hard to think about the ways in which we’d struggle to call our family, read our emails or messages (or even books or newspapers!). In the absence of our ability to do one or several of these activities, we lose some degree of agency, which can compound any other mental health challenges that may exist, like depression or anxiety. Developing and designing technology for senior mental health care is a challenging task, though a necessary one. Mental health is a societal-wide problem that has been traditionally under resourced and discussed though this has not always applied to the mental health challenges faced by seniors. To this extent, it is quite possible that advances in digital mental health care tailored at seniors will benefit the mental health community at large.
Aging-in-place — meaning, growing old in the environment or home we’ve spent our later years — is an ideal for many of us, though a reality for few. Fortunately, technology, like VR and robots, is improving the aging experience for seniors and caregivers. Decreasing isolation and supporting social connections can help improve both mental and physical health outcomes and overall quality of life.