“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.