Abstract
There is a great anxiety among social planners about the aging population. Indeed, in 2010 Americans over 65 years of age represented 13% of the population, and those over 85 years of age are the fastest growing segment of the population. These numbers are reflected not only in the developed world, but to a striking degree in the developing world as well. And they are sick! In the United States their rate of hospitalization is three times that of the general population, and their health expenditures are spent out of pocket 13.2% of their total expenditures on health, whereas the general population spent 6.6% (
Well, there is a strong prejudice that says older people are not comfortable with computer technology, and therefore telemedicine is just not going to work for them. Here are a few facts. Between 1970 and 2010, the percentage of older Americans with a high school diploma increased from 28% to 79.5%. About a quarter have bachelor degrees. They are also the generation that created the digital age!! This group in America and the developed world created the demand for the Internet, the World Wide Web, the cell phone (1973), the iPhone (2007), the personal computer, the iPod, the iPad, the digital this and the digital that. The world did not become digital because of some brain eruption in Generation X! Grandma is not out there knitting. She is out there texting and using social media to keep up with those much younger offspring who seem to think she is out of touch!!
The fact is that we are getting ready to care for the first generation of elderly who are completely in tune and iTuned for digital interaction. This communication and information revolution is something they created and demanded. So, why is there a problem with planning their telemedicine needs? Let us consider a few misconceptions and realities.
The elderly do indeed have certain disabilities and mobility issues that make the rapid fire thumb pump a problem. They do not hear too well. They get frustrated with constant change and frequent upgrades. OK, they also forget things, like why did I go to this side of the house to get what? They tend to use the same password all the time and really do not like to invent new ones with regularity that require more than 8 characters, including some uppercase and some lowercase letters and some numbers and/or symbols. They embrace an entire life of memories and do not like constant innovation. BUT, they are the digital generation, and they have done as much technical adapting as any generation in history. Older people just need to do things on something resembling their own terms.
Martin Cooper, the developer of the cell phone, made a presentation to the American Telemedicine Association's (ATA's) annual meeting several years ago in which he told wonderful anecdotes about this technology that is so pervasive in our lives. He described his newest innovation: a simple cell phone with large numbers that only made and received calls!! O, yes, that is something you now see on the market. He thought older people would like that!! Probably right.
The Baby Boomers are just hitting 65. The bulk of the demographic surge is in the 55–64-year bracket now. The current model of incident healthcare is not going to be affordable for their real needs. This group had trouble saying no to open relationships and drugs. They have no capacity perhaps to say no to disease!! But they are readily studied, and it is incumbent upon the telemedicine community to look not with dismay at their qualities but to study their ability to adapt and their neural plasticity. What technology do they need in their great capacity for technology that will work and last? There was a spoof news report on radio recently that claimed a judge had used alternative sentencing on a mischievous and felonious teenager. The miscreant was sentenced to teach Internet at a nursing home. Well, it might have been a short sentence if the population was the Boomers in 20 years.
We hope to see a flood of research on the coming Boomer glut to make it entirely feasible to make telemedicine work for this fabulous generation. Think about it!! What are the barriers? What has worked? How do they work? Is it really necessary for the simplest telemedicine network to have a bedside information technology person to punch the keys? Could we not move those arthritic hands off the too small keyboards and use voice? How much can we do in monitoring that is truly passive with interventions that are at least semiautonomous? What are the engineering and architectural qualities of the elder environment that make chronic care facile and cheap? And, after all, where is my robot? At least he will talk to me!! Then with the best appropriate technology we can move on to validation studies of new delivery systems that will make this matter of caring for the elderly pretty painless and affordable. Also, if things look too gloomy, remember that the Baby Boom is not like a sea change. The Boom is set to fade about 2050 when those Nexters get older but in smaller numbers!!
A Word About This Issue
This issue contains a special grouping of articles on the use of telemedicine and mental health—telemental health. Although we see significant increases in mental health issues in our communities, the use of telemedicine across all age groups can be a significant tool. Each of the four articles highlights key issues that can impact wider adoption, including barriers, obstacles, effectiveness of available services, and a report on an ATA meeting held during the mid-year meeting in New Orleans in the fall of 2012. Although this is not intended to cover all aspects of telemental health, this collection can serve as a ready reference for the telemedicine practitioner.