Scholars examine the challenges of using digital health technologies to care for cognitively impaired adults.
Most Americans will confront cognitive decline by age 70. Older adults who experience cognitive impairment will face “unique challenges,” that health care systems may be ill-equipped to address. To meet the needs of a growing aging population, technology companies are developing digital health tools that promise to transform patient care. Expanding access to these innovations, however, 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. Although many of these technologies are marketed as tools to improve the quality of care, Huber and Sklar argue that more regulation is needed to protect older adults from the risks associated with technological use. They propose reforms to reduce barriers to accessing and implementing these technologies while protecting vulnerable populations.
A spectrum of mental conditions, including memory lapses and dementia, are referred to as cognitive impairment. As of 2023, over 55 million people suffer from dementia, with almost 10 million new cases reported each year.
Caring for this patient population, Huber and Sklar explain, requires substantial resources, which often strains clinical teams and health care systems. In response, digital health care developers are creating new tools such as remote patient monitoring devices that “offer smart and personalized assessments” of patients by collecting, customizing, and analyzing data related to their care.
Huber and Sklar describe how digital health technologies are emerging to transform where and how care is delivered to older adults with cognitive impairments. They caution, though, that these innovations might have “more hype than promise,” and they question whether adequate measures are in place to protect this population. Huber and Sklar explain, moreover, it is challenging to regulate digital health technology in ways that promote widespread, effective, and safe use.
Emerging digital health tools have many novel features, including the ability to collect a wide variety of data––such as patient demographics, location, and clinical and family history. By compiling and analyzing this data, pioneers of “big data analytics” promise a “large-scale, long-term” solution for older adults living with cognitive impairments. Some studies, however, suggest that “large-scale promises based on big data analytics can be overblown.”
Drawing on this body of research, Huber and Sklar question whether the individual needs of older adult patients are more supported by technology built to amass profit and users. They note, for example, that some digital health tools might decrease the need for patient oversight, promising provider convenience and patient independence. Huber and Sklar contend, for example, that interventions that reduce the need for in-person visits could increase social isolation and loneliness among seniors.
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 cognitively impaired older adults. Also concerning, Huber and Sklar explain, is the risk that technologies built with biased or flawed algorithms would perpetuate existing racial or cultural biases and exacerbate inequities in the delivery of health care. These risks, they caution, are more likely to occur in populations of older adults with cognitive impairments, who tend to have higher rates of comorbidities and complex living and support needs.
Moreover, Huber and Sklar contend that emerging digital health technologies lack the protections needed to secure the informed consent of patients and caregivers. They explain that the streamlined consent processes used by many of these platforms may fall short of meeting the needs of technologically challenged patients. Huber and Sklar also note that existing regulations need more safeguards to protect the privacy of caregivers monitored in remote care settings.
Ensuring that digital health innovations are affordable and user-friendly also remains a key challenge. Given that older adults may have fixed or limited financial resources, Huber and Sklar raise concerns that the cost of the devices and the need for internet access could impede widespread use.
Finally, older adults with cognitive impairments may require technical support to incorporate digital health into remote care settings. Further complicating the accessibility and safety of emerging digital health tools, Huber and Sklar explain, is that older adults, especially those with cognitive impairments, are increasingly vulnerable to online misinformation, scams, and abuse.
Despite these shortcomings, Huber and Sklar describe considerable benefits to integrating digital health innovations into the care of older adults with cognitive impairment. At an individual level, for example, emerging digital health technology could increase rates of early disease detection, providing patients with more opportunities to plan for and access resources related to their care. At a community level, these technologies might allow providers to coordinate with interdisciplinary teams and serve underserved locations and populations.
To minimize the risks and realize the benefits of these novel technologies, Huber and Sklar propose policies designed to protect patient populations and promote widespread, effective use.
Huber and Sklar recommend exploring additional funding pathways for coordinating care across varied clinical practices. Coordinating care for cognitively impaired adults, they describe, is resource intensive and inadequately compensated. Huber and Sklar explain that increasing funding for coordinated care would help maintain a workforce to care for patients experiencing different levels of cognitive impairment.
In addition, they propose increasing Medicare and Medicaid reimbursement for integrating these technologies into patient care. Huber and Sklar identify gaps in the current funding structures of Medicare and Medicaid as evidence that more support is needed to ensure that older adults can benefit from alternative, less expensive options within the health system.
Although these goals may not resolve all challenges, Huber and Sklar stress that these are important steps toward improving the quality of life and care for millions of vulnerable adults.
