“To care for those who once cared for us is one of the highest honours.” -Tia Walker
One of the most difficult decisions is to know when to offer care to an elderly loved one. This is most often misconstrued as, if nothing else, a loss of independence, dignity and privacy. One needs to maintain a high level of tact and understanding to overcome any kind of resistance that will inevitably be encountered. Any offering needs to be thought out and discussed in detail and the loved one should understand that loss of independence isn't a personal failing.
The usual options are to place the elderly with relatives or in care homes. But every effort must be made to keep them in the comfort of their own homes and environment to help them lead productive lives. The focus should shift to prevention and proactive care. Rapid support close to home in times of crisis, good acute hospital care when needed, good discharge planning and post-discharge support. good rehabilitation and re-ablement after acute illness or injury, high-quality nursing and residential care for those who need it, choice, control and support towards the end of life and integration to provide person-centred co-ordinated care are key components.
As our population gets progressively older, by 2030, one in five people in England will be over 65. However, as people age, they are progressively more likely to live with complex co-morbidities, disability and frailty. People over 65 account for 51 per cent of gross local authority spending on adult social care and two-thirds of the primary care prescribing budget, while 70 per cent of health and social care spend is on people with long-term conditions. This data further makes a case to find technological solutions to elderly care, motivated by a need both to improve services and to save costs. Most of the technology will be in monitoring and surveillance using telecare, telehealth and mobile health and the other in assistive technologies to help people for mobility needs.
Increased adoption of mobile technology by the elderly and favourable results from the “Three Million Lives” campaign has stimulated efforts in finding solutions using technology and remote care especially in chronic diseases like diabetes.
As diabetics get older, they have more comorbidities, mobility becomes restricted, suffer more mental health problems and self-care becomes more difficult. Blood sugar control becomes a problem, they develop foot problems, pain, nutritional problems, have falls, find it difficult to exercise and need more acute hospital admissions. It becomes more difficult for people to keep appointments. Telehealth and telecare by remote monitoring and intervention by appropriate personnel is able to more efficiently deliver care and prevent neglect, which is clinical and financial implications.
However, as the diabetic moves on in the journey, when they are completely unable to cope, they may need to be shifted to a care home. Residents with diabetes within institutional settings appear to be highly vulnerable, neglected group of subjects, and have more complications, nutritional impairment, increased hospitalisation rates and high levels of physical and cognitive disability. Diabetes is often unrecognised especially in those with mental health needs. There is often a lack of specialised diabetes care and lack of proper planning leading to poor results in this setting. Such barriers can be broken with the help of Mobile Health, where the residents may be linked with specialised diabetes care, nutritionists, mental health experts and appropriate blood sugar monitoring and intervention done whenever needed. This would necessitate a well-designed, individualised, and implementable care plan, implementation of which would become easier.
The scope of digital health in the elderly care is immense, but extreme care must be taken so that it is not overzealous and imposed, so that this does not come across as being intrusive, which will lead to increased resistance of adoption. It is indeed tricky to build a simple, easy to use system, which will be adopted widely, but does not sacrifice independence. The reason for use of mobile technology is that it is increasingly being viewed as being part of one`s life by the elderly. The bottom line here is to develop solutions with maximum client delight and not awe. This will require cultural shift that maybe achieved by design thinking, leadership, development of skills and working practises and security and management of data.
“Christmas is doing a little something extra for someone”. Charles M. Schulz
The New Year always brings worries in Diabetic clinics; when numbers - namely blood sugar and cholesterol go in the red. Research has shown that in a majority, this is transient and most New Year resolutions are effective in handling them before even they start wavering. Reams of literature and even social media still hasn`t been able to decide on the appropriate etiquette for the diabetic and the pre-diabetic. But there are extremely useful guides, whether it is recipes or suggestions on various kinds of exercise and even travel and holidays. This is up to the individual but we believe this is a time to enjoy, connect and liberate oneself and bond with friends, family and the greater community.
It is vitally important that not just the person but the people around need to be aware and educated so as to help people make this season extremely memorable. However, this should not lead to intrusion and policing, which will be counterproductive.
In today’s world of digital health, remote monitoring with wearables, use of cloud services in monitoring blood sugars and use of telemedicine can enable people to enjoy themselves because people are always `connected` and help is always at hand. Digital health has emancipated the individual from the inconvenience of travel and restrictions of time and space and continuous help is available much before disaster strikes. However, a sense of self responsibility needs to be inculcated year long, so that the festive indulgence is tolerable.
Though the holidays are a time for festive cheer, for some it is a bit of stress and loneliness. Family issues, bereavement, monetary and employment setbacks along with negative reflective thoughts often dominate leading to depression and alcoholic binges. This could spell doom for diabetics. Help is needed, sometimes proactively. Though a fair amount is being done in this field, remote assistance with use of telemedicine by personnel trained in mental health could provide tremendous support in this field. Santa now has more things to pack in his sack.
“To eat is a necessity, but to eat intelligently is an art.” – La Rochefoucald
One of the most difficult decisions that anyone needs to make is to decide upon the best diet that satisfies both the body and the mind. Despite the information explosion regarding nutrition and myriad apps, confusion still remains as to what or what not to eat. Though details of diet is not the aim of this discussion, the goal of any diabetes diet plan is to improve blood glucose, blood pressure, and cholesterol numbers and keep weight on track. This along with exercise reduces diabetes complications like heart disease and stroke. Though personal judgement is paramount, professional help from a nutritionist is desirable.
The diagnosis of an inappropriate blood sugar is quite daunting and sometimes nothing short of bereavement and the rule book in the form of do`s and don’ts stare in their faces. Motivational interviewing and better psychological and nutrition techniques may need to be used to ensure long-term adherence and good results.
Eating disorders occur more frequently in diabetics and need to be managed diligently for better blood sugar control and thus prevention of further complications.
In the UK, 76% of adults use mobiles and collectively, UK consumers check their smartphones over a billion times a day. The widespread use of this technology and the level of engagement have the potential of changing the way clients engage with their healthcare providers leading to more involvement in their self-care. At the American Heart Association’s annual Scientific Session 2015, data was presented demonstrating that wearables to track diet and activity behaviors – in combination with remote “coaching” from a health care professional – they actually made better choices and adopted healthier lifestyles. Specifically, the study showed that those patients who were engaged via mobile devices actually increased fruit and vegetable intake, decreased sedentary screen time and decreased their saturated fat intake. In addition, engaged patients appeared to have increased moderate-to-vigorous physical activity. This shows a clear trend towards adoption of healthier lifestyles with the use of mobile technology.
Though futurism is an imperfect science, mobile technology has the potential of becoming the constant companion in life`s journey. The journey is just beginning.
“Physical fitness is not only one of the most important keys to a healthy body; it is the basis of dynamic and creative intellectual activity.” John F Kennedy
The growing number of diabetics and the disconcerting number of projected prediabetics are now making us look at behaviour and lifestyle modification including exercise as an important preventive and therapeutic strategy.
Exercise is very important in maintaining the energy balance for long term weight loss, which would need unrealistic dietary calorie restrictions on its own. In the UK,
66 per cent of men and 56 per cent of women over the age of 19 meet the guidelines for participation in at least moderate intensity activity. Along with a 44% increase in gym spending in the last year, mainly due the availability of budget gyms, there is an increase in activities such as cycling, park runs and open water swimming. Running is now the fastest-growing sport in the country. Sport England revealed that 35.5% of people participated in at least one sport once a week, with swimming and running being the most common.
What is driving these numbers is the adoption of technology such as high-tech sports gear as well as wearables and mobile applications that track and monitor results,providing feedback and even mentor fitness enthusiasts. This group is 45% more likely than the average Internet user to download free apps once a fortnight and they are 35% more likely download paid apps two to three times per week. They are 33% more likely than the average British adult to own a smartphone and 52% more likely to own a tablet. 46% of this group access the Internet more than once a day on their mobile device. In the past four weeks, they have spent an average time of 685 minutes on Facebook, 73 minutes on Twitter and 36 minutes on Pinterest.
One of the issues with the wearables adoption is that the people most likely to use wearables are those who need them least. A survey found 48 percent of users are younger than 35, affluent and highly motivated. A further evolution of technology is required to increase affordability, ease of use and ultimately to increase adoption of wearable health promoting devices.
Unfortunately, the adoption of exercise as a consistent lifestyle behaviour is hindered by psychological barriers which include low fitness, pain, boredom, lack of stimuli, comparison with other individuals, body image dissatisfaction, time and weather constraints. Cognitive strategies by motivational and mental health professionals may help to make physical exercise enjoyable, personalised and sustained. If needed other enjoyable forms of exercise may need to be adopted. Such an endeavour can be done using telehealth and mobile technology so as to suit the time and place of both the provider and the client.
“The true secret of happiness lies in taking a genuine interest in all the details of daily life.”-William Morris
Even though it was widely expected, it is still quite disheartening to know that a recent big Dutch study says that almost half of 45-year-olds will develop so-called prediabetes, an elevated blood sugar level that often precedes diabetes, 30 percent would develop full blown diabetes and nine percent would start taking insulin. This means that one in three healthy 45-year-olds will develop diabetes in his or her lifetime. Though this population sample is mainly white and Caucasian, the results in the UK could probably be worse as there is a significant ethnic minority population. Type 2 diabetes is known to occur 6 times more likely in people of South Asian descent and 3 times more likely in African and Afro-Caribbean people.
To the already overburdened healthcare system, this is a huge burden that needs to be tackled. Currently, the people with pre-diabetes would qualify for an intensive lifestyle prevention programme in the form of education, diet and exercise management. Though successful in scientific studies, these results are not replicated in the real world. The problem is that these people do not show any symptoms and the prevention of harm is not well appreciated. The management is challenging which needs a lifetime commitment and thus calls for a change in behaviour.
The UK has an excellent programme of structured diabetes education which is free. This is key and can be life changing. Most people who attend these have reported definite benefits. Diabetes education helps people to stay healthy, live well, and avoid expensive and life threatening complications. Though there is commitment to improve access to diabetes education, statistics show otherwise. For example in England, just 3.8% of newly diagnosed diabetics attend diabetes education. Not attending a course is wasteful, not only in terms of finance, but also a lost opportunity for people with diabetes.
The problems are manifold. There is uncertainty amongst healthcare professionals about the value of this education and inadequate data as to who is attending. For pateints the issues are - location and timing of courses, long waiting times, some do not appreciate the term “structured” education. Along with this, there is also the difficulty in getting paid time off from work.
Considering the importance of education in self-empowering and self-management of these people, it’s now time for some novel approach. There is a need of making this education easily accessible with the use of mobile technology, so that people can access these at a place and time of their choice. Use of online tools and telemedicine will facilitate healthcare and education. The mobile coverage of this age group is close to 100% and this has potential to transform this issue