LeadingAge Magazine · July/August 2013 • Volume 03 • Number 04

Technology Energizes Wellness

June 28, 2013 | by Leah Thayer

The increasing sophistication of wellness programming goes hand-in-hand with increasingly sophisticated and user-friendly technology. Here is how some members are putting both to work.

Technology can’t solve every health challenge for aging services providers, but it can be used to systematically assess the impact of activities on individuals, detect emerging symptoms and conditions, and disseminate information to exponentially larger audiences. Through these and other applications, innovative providers are able to make earlier interventions, foster asynchronous learning and achieve better outcomes.

The benefits of technology for wellness programs are growing.

At a Mather LifeWays community, a resident’s progressing dementia had prompted staff to begin serving him meals in the health center dining room, away from his wife in the general dining room. Through data collected using an iPod Touch-based research tool called mOQOLD, staff saw that his behavior and emotions were actually better in the main dining room, where he was allowed to return to dine with his wife for as long as possible.

In a long-term study covering several hundred Oregon seniors living independently, a steady stream of data collected from their homes via motion sensors, computer logs and tech-enabled medication dispensers is providing researchers at the Oregon Center for Aging and Technology (ORCATECH) with evidence that changes in motor function often precede cognitive impairment. “Our ability to identify problems at the earliest possible moment is greatly improved,” says Tracy Zitzelberger, the center’s administrative director and research associate.

At Ecumen’s Bethany Community in Alexandria, Minn., a popular “chair exercise” class evolved from residents’ enthusiasm for an 8.5-minute video that was posted on Ecumen Connects, a private online community. “We posted the video so residents could do the exercises in the comfort of their own apartments, and then a couple of residents volunteered to lead classes for the greater community,” explains Wendy Halbe, housing manager at Ecumen Bethany.

At Christian Care Centers’ Mesquite community in Texas, a resident in decline—rarely leaving her wheelchair and often agitated—would rise and dance upon entering the community’s Snoezelen room, a multisensory environment that uses lighting, sounds, colors, images, music and scents to deliver stimuli. “She was much calmer and happier after leaving the room,” an effect that typically lasted for a couple of hours, says Holly Titsworth, corporate director of marketing and communications. The Snoezelen room’s effect on residents “is a wonderful thing to see.”

From remote monitoring and Wii bowling, to online social networks and tools for capturing memories, to phone-based educational programs like “Telephone Topics” (Mather LifeWays), a variety of tools are helping providers integrate new and existing technologies into their wellness care plans.

“I’m constantly looking for that magical technology that will help people stay in their homes, keep families connected and allow them to coordinate and manage care plans,” says Larry Jorgensen, chief information officer and vice president of information systems at Ecumen, which uses technology in a number of ways with regard to wellness programming. Many tech companies “have been nibbling at the edges,” he says, though some are “regurgitating and repackaging the same ideas,” especially those involving motion sensors.

Even as they integrate technology into their day-to-day wellness programs, innovative providers are experimenting with a wide array of technologies that unobtrusively collect and transmit vital health information.

  • For members who live off-campus, Ecumen offers a 24-hour “personal emergency response system” called VoiceCare. Users wear a waterproof pendant that, when pressed, calls an operator. A second activator is mounted low in the bathroom. Seniors sometimes resist it, says Randee Hall, director of community services and marketing at Ecumen Bethany, but “it helps them and their families sleep better at night because they know help is on its way if needed.” She is notified via fax each time a member activates VoiceCare, so she can check in with them accordingly.
  • As a supplement to VoiceCare, Ecumen is looking into GPS-enabled watches for people who wander and/or have health issues that could cause falls or seizures. Unfortunately, many options he has considered are “big, clunky devices with poor battery life,” says Larry Jorgensen, Ecumen’s CIO and VP of information systems. He continues to look and is evaluating one watch that is smaller and has a longer charge time.
  • A variety of providers use variations on automated and/or monitored medication systems. Some can be programmed to alert the individual when it’s time to take a pill, others can actually monitor the devices and share usage information with practitioners.
  • Ecumen and other providers use motion-detector systems in their communities. “We’d like to make them viable in homes,” says Jorgensen, but price has been a barrier, as has the need for the homes to have Internet access and a server.

 

Tsunami-like demographic and financial forces lend urgency to this search.

“Boomers are an enormous population that will need tremendous help as they age,” says ORCATECH’S Zitzelberger. Even if the aging services workforce grows commensurately, mounting costs will exert enormous pressure—from payers and providers alike—to keep people in their homes as long as possible, and to help geographically dispersed families stay connected. “We’re going to have to figure out how to use our human resources more efficiently, and also get an earlier sense of which individuals are most in need.”

ORCATECH is investing in identifying what those earlier cues may be. Its study, nearing its tenth year, uses sensors, tracking technologies and Web-based surveys to measure participants’ walking speeds, along with indicators of how much they move within their home, leave their home, and spend time online. For example, “we know that people who walk faster tend to live longer and not to get dementia,” says Zitzelberger. Besides slower walking speeds, cognitive decline is often preceded by wide swings in speed—walkers with “mostly good days, then all over the map, then mostly bad days,” she adds.

The problem is that infrequent doctor visits rarely reveal such incremental changes. “The way we practice medicine has barely changed in generations,” explains Zitzelberger. “We’re trying to shift the paradigm from our current health care and research system, where we assess individuals only every so often, to a day-to-day sense of how they are doing. A more accurate picture of health.”

Likewise, the mOQOLD (mobile Observing Quality of Life in Dementia) tool used at Mather LifeWays captures practitioners’ real-time assessments of individuals with dementia during everyday activities, based on a seven-point scale. Developed as a paper-based survey, with the responses later entered into a computer and analyzed, OQOLD went “mobile” when its data-entry element was adapted for the iPod Touch, which staff can carry in their pockets. Data is transmitted wirelessly to a server, and caregivers can download a variety of reports that analyze it and help them modify their activities and care plans accordingly.

In some ways, mOQOLD does not change how staff interact with or observe residents with dementia, says Perry Edelman, Ph.D., director of wellness research at the Mather LifeWays Institute on Aging. “The only difference is that we’re giving them a systematic and valid way of measuring the impact.” Now, for instance, dietary and nursing staff can use observations made during lunch to inform methods of improving participants’ food consumption.

mOQOLD has revealed some unexpected benefits for providers too. During care-planning conferences and family visits, for example, it gives providers a documented record of the activities residents and clients participated in and how they reacted to them. “In a way, it backs up staff,” Edelman says.

Scientific evidence has validated that aging seniors who exercise regularly tend to live longer and healthier lives while maintaining independence. Exercise is a comprehensive approach to healthy aging that should include strength and cardiovascular training. The benefits from a regime of weekly activity promote cognition, mobility, flexibility, balance and overall function in our growing elderly population. The 21st century has afforded us the luxury of senior friendly, high-tech exercise equipment to motivate, preserve and inspire participation for all modalities in our long term care communities.

At the Parker Center for Healthy Aging, Piscataway, NJ, the motto for residents, employees and community members is “You’ve Got to Move to Improve!” Our personal trainers and fitness equipment create a fun and welcoming environment which contributes to a continually rising membership. Currently, 75% of residents from Parker at Stonegate Assisted Living (45 people) take advantage of the fitness equipment and programs. An additional 90 participants from Parker’s Adult Health Service programs and 115 community members use the fitness center, along with Parker employees.

The Nu-Step elliptical recumbent bicycle is a popular machine among senior members of the fitness center, as the seat swivels 360 degrees to accommodate mobility issues, while tracking steps and strengthening the upper and lower body simultaneously. Stonegate resident Janet Gaynor has used the Nu-Step for years to improve her balance, stating “I’m now able to walk the steps and curbs outside the facility.”

A recent addition to the fitness center was the Expresso Cybercycle, which challenges the mind and body concurrently. This virtual reality exercise bicycle allows one to navigate a chosen course or play a game, encouraging more stimulation and longer use. Virginia Dela Cruz, a community member, exclaimed “I lost over nine pounds in three months and have lowered my blood sugar and blood pressure from riding the Cybercycle!“ Parker won first place in last quarter’s Cybercycle mileage competition.

Just last month, the fitness center welcomed the Biodex System SD. This balance device allows our staff to assess physical impairments that cause functional limitation, then utilize and revise a prevention care/service plan for each resident. Members are thrilled to be proactive in their falls training. Currently, the Health and Wellness Team is studying the need, progress and outcome of several members over the course of three months. The various games and programs are physically and mentally challenging, but the rewards are fewer falls, fewer hip fractures and lower health costs.

Exercise has certainly evolved from the 1960’s Jack LaLanne Show, to a world of “what’s next?”

- Written by Lori Morell, health & wellness coordinator at The Francis E. Parker Memorial Home.

Not surprisingly, the Internet offers some of the simplest ways to further wellness. Just over half of Americans over age 65 use e-mail and the Internet, according to the Pew Research Center. This percentage is rising quickly as seniors seek easier ways not only to stay connected to far-flung relatives and friends, but also to be more engaged in their health care—e.g., e-mailing their doctors and refilling prescriptions online.

In the independent living section of The Mather, Evanston, Ill., residents’ average age is in their 70s, and “almost everyone there has a computer,” says Cate O’Brien, director of worker research. This makes it ideal for an online study pilot of The Spencer Powell Brain Fitness Program, an eight-week initiative to promote cognitive health. In it, participants engage in 30 to 60 minutes of online study per week, coupled with weekly activities, with the aim of boosting “brain healthy” activities and improving memory techniques and mindfulness.

Much older seniors are also riding the tech wave. The average age of participants in the ORCATECH study is 88, according to Zitzelberger. Besides using the Internet at home, many of them have smartphones “and quite a few have dropped their landlines.”

At Ecumen, which is implementing wi-fi throughout its assisted living facilities, Ecumen Connects can be likened to an extremely user-friendly version of Facebook (which all Ecumen communities also use, though mainly to connect with non-residents). “Its strength is that it is more accessible for people who aren’t necessarily comfortable with technology,” says Randee Hall, director of community services and marketing at Ecumen Bethany. Free to anyone who requests access, the network is also used by family and friends who connect with residents via e-mail, “virtual visits” and access to activity calendars, menus and photo albums.

What else resides on Ecumen Connects? A huge archive of movies and TV shows (including those from the 1950s and earlier), along with live webcams stationed all over the world, audio books and flip-page books, virtual museum “tours,” radio stations and more.

Regarding wellness specifically, Ecumen Connects has been especially helpful for memory care. Trivia games and other activities sharpen users’ memories, for instance. Old TV shows facilitate reminiscing, which can reduce blood pressure, among other therapeutic benefits. “If a resident wants, he can just turn on a webcam and watch birds or the ocean,” says Hall. “Instead of the busy-ness of the TV, this brings nature in. It is relaxing.”

Another technology that fosters reminiscing is LifeBio, an online system that uses prompting questions to create “life stories.” Christian Care Communities uses this as well as an application called MemoryBio, which provides a structure for reminiscing using pictures and objects. Residents access these tools independently or with the help of volunteers, “who find the stories fascinating,” Titsworth says. Loved ones can also upload images and memories remotely, if provided with the user’s password.

Often, creating a LifeBio can stir feelings of self-worth as well as happiness. Titsworth cites an assisted living resident who “loved talking about her job and how proud she was to help her family. She wanted to convey that she was a part of the family’s living too.”

Christian Care Communities also uses LinkedSenior, a web-based, touch-screen platform on kiosks in common areas, where residents, staff and visitors can interact with videos, games, brain fitness activities and more. “We have three and have only been using them for a couple of months, but our activity directors love them because they get higher participation in group activities,” Titsworth says. Residents can use the system alone or with others.

Echoing the sentiments of other providers, Christian Care Communities has a saying: “We want our residents to ‘wear out, not rust out,’” says Titsworth. “If our residents live fuller lives, they feel more fulfilled and happier.” Technology is proving a vital means to this end, and yet these are the early days. “Technology will be used in ways we can’t even imagine,” says ORCATECH’s Zitzelberger. “Ten years ago there was no Facebook.”

“I live alone but don't feel alone.”Shirley

“We've gotten to know each other and care about each other.” – Yetta

“I am still connected with my family … I chat with them anytime I want.” – William

Selfhelp Community Services, a 77-year-old not-for-profit that annually serves more than 20,000 elderly and vulnerable people in the New York City area, is committed to using groundbreaking technology to promote wellness and enrich lives.

Selfhelp’s Virtual Senior Center (VSC) is intended for homebound elderly. Many seniors living at home suffer from chronic conditions, have low income, and often do not receive any visitors for long periods. Through Selfhelp’s VSC, seniors like Shirley, Yetta, and William are reconnected with the outside world, and their overall sense of wellness improves dramatically.

The heart of the VSC is its interactive experience. Powered by a touchscreen computer interface, it is specially designed for elderly people. Through video technology, Selfhelp facilitates engaging activities like discussion groups, museum lectures, and music classes.

The array of VSC programming fosters a sense of community, social engagement, and well-being. Recreational, educational, and instructional classes provide participants with connections to peers who share and understand their experiences. In addition, Selfhelp developed programming to encourage deep discussion through the sharing of personal narratives. These classes are particularly helpful in forging meaningful relationships, giving homebound seniors an accessible space to share powerful, emotional, funny, or poignant discourse. Early research suggests that the approach reduces feelings of isolation, anxiety, and depression.

Since CEO Stuart C. Kaplan last reported on Selfhelp’s Virtual Senior Center expansion project, plans have begun to add hundreds of new homebound seniors to the VSC over the next two years. With the help of funders like the Consumer Electronics Association Foundation, the AARP Foundation, The Harry and Jeanette Weinberg Foundation, UJA-Federation of New York, and the Harriet & Robert H. Heilbrunn Fund, preparations are underway to add new “hubs”—local senior centers and other community partners from which VSC classes are broadcast. The VSC is now active in three Selfhelp senior centers, is coming online in three new hubs in New York City (The Carter Burden Center for the Aging, Educational Alliance’s Sirovich Senior Center, and the Jewish Community Center of Staten Island). It is also expanding nationally, partnering with CJE SeniorLife in Chicago and in discussion with potential collaborators in San Diego and Washington, DC.

Selfhelp’s VSC is truly growing by leaps and bounds, and its vibrant classes are enriching the lives of homebound seniors.

- Written by Laine Slatton, grants assistant, Selfhelp Community Services, Inc.