Abstract
The Canadian College of Health Leaders and AGE-WELL are proud to present this special edition of Healthcare Management Forum focused on ageing, technology, and health in the post-COVID world. This collaboration with AGE-WELL began in November of 2020 when Forum’s Editor-in-Chief, Don Juzwishin, met with Andrew Sixsmith, Professor and Director of the Science and Technology for Ageing Research (STAR) Institute at Simon Fraser University and one of the founding Scientific Directors of AGE-WELL, to discuss the possibility of a special edition of the journal documenting lessons learned and challenges for older adults as we emerge from the pandemic.
AGE-WELL (www.agewell-nce.ca) is Canada’s technology and ageing network. The network was established by the Government of Canada in 2015 to respond to the challenges of an ageing population and to seize on the opportunities that digital technology offers to support the health and independence of older people. AGE-WELL is a pan-Canadian network that brings together researchers, academic institutions, non-profits, industry, government, future leaders, older adults, and caregivers to deliver technology-based solutions to support healthy ageing. The network includes over 250 researchers at 47 universities and research centres across Canada, and more than 420 industry, government and non-profit partners.
Nine months into the COVID-19 pandemic and the global response to it, there were clear signals that the role of digital technology would have an unalterable impact on healthcare delivery, particularly for older adults in the future. The lessons emerging from the COVID-19 response and recovery would be of significant interest to health leaders, providers, policy-makers and researchers.
In March of 2021, an invitation was distributed to the broad network of AGE-WELL researchers and collaborators to share their research findings. The response to the invitation was enthusiastic and the articles contained herein provide a select but wide cross section of the research and innovation that has taken place since the beginning of AGE-WELL. Preference was given to papers that address the policy and practice issues relating to innovation, adoption and implementation of technology-based services and products to improve the health of older adults.
The objective of the special edition was to provide health leaders with key lessons learned from the COVID-19 experience and specifically the following: • Bring attention to and offer solutions for health leaders to address the barriers to AgeTech innovation; • Identify means by which AgeTech can increase the autonomy, dignity and quality of life of ageing adults; • Identify sentinel projects that that have demonstrated to accelerate the effectiveness of remote care and telehealth; • Provide a prescriptive account of how health information and the digital determinants of health can be mobilized to improve healthcare delivery; • Offer a glimpse of emerging and promising technologies that are seeking partners and opportunities for implementation in the healthcare system; and • Identify and provide guidance to the ethical issues emerging with AgeTech and how to work with consumers to co-create solutions.
The articles can be classified into four broad themes. The first theme explores the relationship of Indigenous older adults with technology and how it may impact on their health and wellness. The second theme addresses the glaring challenges that the public and healthcare providers faced in the sudden accelerated digitization of healthcare and how the digital divide was or was not bridged through telehealth and virtual care. The third theme explores the challenges of respecting and facilitating the autonomy of older adults and how those can be reconciled with the challenges of social isolation. The fourth theme examines the question of how public expectations can be integrated in the introduction of digital technologies and how implementation can be best facilitated.
Indigenous older adults, technology, and health
McIlduff and colleagues write about engaging Indigenous older adults in technology use. They describe their mixed methods study and results which brought together the Model of Engaging Communities Collaboratively (MECC) along with the principles from the Ethical Engagement Training Module (EETM). The MECC originated from work with Indigenous communities in Australia to help inform the processes of implementing evidence-based practices within Indigenous communities. The EETM was developed within the Canadian Indigenous community to guide ethical and respectful engagement with Indigenous communities. The authors encourage Indigenous peoples, health leaders, researchers, and healthcare workers to take a strongly consultative, collaborative and community-led approach to the broader field of research and healthcare delivery to Indigenous peoples.
In the next article, Acharibasam and colleagues identify many of the barriers to good health of older Indigenous peoples being associated with the remnants of colonialism and racism. The compromised health status of Indigenous peoples can be attributed to impediments to access, ignoring Indigenous peoples’ voices and experiences, and the lack of health education. In their article, the authors describe how the Morning Star Lodge partnered with a diverse group of First Nations community members to learn about health practices and to engage in a dialogue on how to improve Indigenous peoples’ nutrition, exercise, and self-management of their health. The symposium assessed Indigenous older adults’ accessibility and readiness to adopt novel technologies in support the monitoring of their health status with a focus on dementia education. Health leaders are encouraged to work collaboratively with community members to establish culturally safe and relevant approaches to health education, monitoring of health status and providing access and tools for effective self-management.
The digital divide, digitization, and virtual care
Access to primary care services in Canada has been a serious impediment to the universality of healthcare services. Statistics Canada estimates that 14% of Canadians or 3.6 million people are without a family physician. Patterson and co-authors identify the potential for virtual care to improve access to primary care services. Despite the growing interest of the public, implementation of virtual care has been slow. Non-essential service lockdowns during the COVID-19 pandemic accelerated access to telehealth, however, the response was not equitable to all quarters of the population. The authors conducted a narrative scoping review to identify and understand the barriers to what has contributed to the suboptimal diffusion and implementation of technology. They identify policy shifts to increase virtual care provision by primary care physicians in response to the barriers and raise a concern as to whether health leaders and policy-makers can sustain the longer-term unfettered access for virtual care services.
Fang and co-authors tackle the future of digital health as a human rights issue in the context of health and community care facilitated through technology. Concerned with negative and positive consequences of digital technology, the authors delve into two case studies one in Scotland and the other from British Columbia, to identify the factors that will have the most appreciable impact on access. From their cross-case analysis, the authors identify five areas for health providers and leaders to consider for improving equity in access to the challenges of an increasing ageing population. The authors highlight that policy and practice solutions must consider access to digital technologies, cognitive and physical limitations, issues of cyber security, address financial and social challenges and ensure rural and remote access. On the negative side, the authors are concerned that policy solutions that do not take structural impediments into account will further marginalize individuals or groups.
Freeman and colleagues remind the reader that rapid diffusion of technology during the pandemic, although beneficial to many, widened the digital divide for many others. Mindful of this emerging disparity, the authors make a series of recommendations for policy-makers to consider as they attempt to bridge the digital divide.
Autonomy versus social isolation
The COVID-19 pandemic had a devastating impact on the social connectiveness of many people, but it hit older adults particularly hard. Clayton and his co-author tackle social isolation and the role of AgeTech in a post-COVID world. They begin by describing the difference between social isolation and loneliness. This is supplanted with data to provide an appreciation of the severity and scope of the problem. The authors go on to describe several initiatives in the form of case studies that AGE-WELL has supported to tackle social isolation and promote social connectedness. Key lessons and recommendations for health leaders to consider are identified.
Autonomy and independence of older adults were also severely impacted by the COVID-19 pandemic. Liu and her co-authors identify and analyze the factors that compromised autonomy and independence of older adults. Liu highlights the wide array of AgeTech, also known as gerontechnology, that have emerged in the last several years, but she reminds us that older adults were particularly susceptible to the digital divide. In addition, Liu points out that the Western worldview of autonomy and independence of older adults has had a negative impact by amplifying ageism through the intersection of identities with race, gender, and culture. To counter this phenomenon, Liu proposes a non-binary framework that promotes relational autonomy which assumes that relationships form a person’s identity, therefore, no one is autonomous to the exclusion of others. Liu and co-authors encourage an interdependence; a person’s lifestyle choice is supported by interreliance within the context of one’s environment. Health leaders are encouraged to apply the inclusive framework to ensure that services to older adults do not perpetuate ageism.
Getson and her co-author address the challenges and opportunities of socially assistive robots in long-term care. They describe their specific interactive study and the staff response to the use of a socially assistive robot, Pepper, who was used to screen staff coming into a facility. The authors go on to describe the results of the human-robot interaction and the lessons learned. Staff acceptance was analyzed as were other perceptions of the robot. Staff were generally positive about the screening robot which raises the opportunity for further exploring opportunities and challenges for the use of socially assistive robots.
What do older adults want and need and how can implementation be successful?
The final two papers examine how to seek advice of what older adults want and need in the form of digital technologies and how they can be effectively implemented. Wilson and his co-authors take on the big challenge of reimagining the long-term care sector using technological innovation. To fully understand what it is older adults want from digital technologies, Wilson undertook to develop an approach, prepare evidence briefs to inform citizens and convene citizen panels to engage in a national stakeholder dialogue of what the future using technology should look like. The deliberations arrived at actions to develop an innovation roadmap/agenda (including national standards and guidelines); using co-design approaches for the strengthening the long-term care sector and for technological innovation; identifying and coordinating existing innovation projects to support scale and spread; enabling rapid-learning and improvement cycles to support the development, evaluation, and implementation of new technologies; and using funding models that enable the flexibility needed for such rapid-learning cycles.
The final paper by Knoefel and co-authors describes the implementation of smart supportive dementia technology in a hospital transitional care setting. Still at a developmental stage, the authors describe this technology for older adults living with dementia and their informal care partners. Preliminary results demonstrate some benefits in private homes. The case report provides health leaders with examples of how a team of researchers and health managers are navigating the complexities of a hospital setting, using human-centred design and implementation strategies, to facilitate the implementation and adoption of the technology.
Concluding remarks
The ageing of Canada's population coupled with the sharp focus that COVID-19 has brought to the risks and challenges associated with the elderly ageing in residential, community or home care settings, creates an opportunity for health leaders, providers, innovators, and developers to double their efforts to identify how AgeTech can be mobilized to improve the quality of life of ageing Canadians. We are pleased to share this collection of articles that highlight the program that AGE-WELL has undertaken to bring older adults, researchers, innovators, providers, policy-makers and health leaders together to advance Canada’s AgeTech sector to deliver technology-based solutions that support older adults and caregivers, and those who support them. AGE-WELL is also training the next generation of innovators in this field and the beneficiaries will be older adults.
This special edition is being made available to all AGE-WELL network members and College members.
Footnotes
Don Juzwishin, BA, MHSA, PhD, FCCHL, is the former director of Health Technology Assessment and Innovation for Alberta Health Services. He holds adjunct associate professor positions at the Universities of Alberta, Calgary, and Victoria. He is a co-lead of the Networks of Centres of Excellence AGE-WELL initiative which strives to create real-world solutions that will make a meaningful impact on the lives of older Canadians and their caregivers.
Andrew Sixsmith, PhD, is a Professor and Director of the Science and Technology for Ageing Research (STAR) Institute at Simon Fraser University and one of the founding Scientific Directors of AGE-WELL.