Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults

Enhancing an evidence-based electronic health intervention, Elder Tree, with voice-controlled technology can broaden its use, leading to improved overall health and reduced hospital readmission for older adults with multiple chronic conditions.

Project Details -
Ongoing

Multiple chronic conditions (MCCs) are a significant issue among older adults, posing a costly and time-consuming burden on the U.S. healthcare system. For example, 65 percent of Medicare beneficiaries have three or more chronic conditions, accounting for 90 percent of Medicare spending. Healthcare management is crucial for those with MCCs, though adherence can often be complex and overwhelming for patients. While MCCs are usually addressed with a patient’s primary care provider, time constraints during visits may prevent dissemination of self-management tools and resources for patients to gain proper management skills. Technological interventions for the delivery of motivation and support have proven to help older adult patients manage their health.

The evidence-based electronic health intervention Elder Tree (ET) is a laptop application that provides coping tools, motivation, and social support to help patients with MCCs to manage their health. Previous AHRQ-funded research found the application to be successful among users; however, there is the barrier of technology literacy among the older adult population. This research will investigate whether voice-controlled technology can broaden and sustain the use of ET more effectively than the laptop platform. In addition to audio-activation software, the enhanced ET system includes a smart display to add a visual component so a voice command response can be heard and read. The goal of the system enhancement is to increase the impact for older adults with MCCs.

The specific aims of the project are as follows:

  • Develop, with user-centered design, the smart system platform to deliver the evidence-based ET. 
  • Conduct a randomized clinical trial to test patient outcomes such as medication adherence, depression symptoms, quality of life, and compare improvements among men versus women. 

The research team will conduct a two-arm randomized clinical trial comparing the laptop platform of ET to the enhanced “smart system” version of it using a smart device. This enhanced version includes a smart screen display as a visual component, which is integrated with a speaker for volume to extend to a large area of the home. The trial will involve 220 participants over the age of 65 with four or more MCCs recruited from primary care clinics in Madison, Wisconsin.

The overall goal of this research is to deliver healthcare self-management tools for skill development to older adults with MCCs in a way that is accessible and encouraging to the patient. The expectation of this study will be to show smart devices can enhance the sustainability of programs such as ET, and in turn will significantly increase the impact of it among older adults. This advancement aims to increase quality of life, improve overall health, and reduce hospital readmission among older patients with MCCs.

The Virtual Smart Assistant: How Voice-Controlled Technology Can Support Self-Management of Healthcare in Older Adults

The Virtual Smart Assistant: How Voice-Controlled Technology Can Support Self-Management of Healthcare in Older Adults

Enhancing an evidence-based electronic health intervention, Elder Tree, with voice-controlled technology can broaden its use, leading to improved overall health and reduced hospital readmission for older adults with multiple chronic conditions.

Principal Investigator: Gustafson, David H., Mares, Marie-Louise
Organization: University of Wisconsin - Madison
Research Profile: Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults
Funded Amount: $1,987,467

How can we bridge the digital divide for older adults?

As people get older, they need more support for management of their health, especially those who are living with multiple chronic conditions (MCCs), including pain, that can make adherence complex and overwhelming. Although MCCs are usually addressed with a patient’s primary care provider (PCP) during visits, time constraints can hinder PCPs’ ability to share and explain self-management tools and resources.

As he has aged himself, Dr. Dave Gustafson from the University of Madison–Wisconsin has wanted to understand how technology can support older adults in managing their health. In previous AHRQ-funded research, Drs. Gustafson and Marie-Louise Mares and their team developed an evidence-based electronic health intervention called Elder Tree: a laptop application that provides coping tools, motivation, and social support to help patients with MCCs to better manage their health. They found that, while the tool was successful, the impact was only for those who were high users of primary care (i.e., seemed to have more complex health needs). Moreover, followup conversations with study participants suggested that there was often a large barrier of technology literacy among older adults who weren’t connected to other online health and social support systems, and who seemed to need and want Elder Tree the most.

How can we make it easier for people who are in their later years to benefit from the technologies that are out there? We have been studying this for a number of years now, but we have always used a laptop. Some of the feedback that we've gotten is that using the laptop can be difficult or confusing. You have to log on to a laptop, and you might forget the password and then never sign back in. You might not remember how to scroll down, or if there was something interesting, you can't find it again. Or your hands tremble, and so it’s difficult to use a laptop.”
– Dr. Gustafson

Cue your personal smart assistant

Drs. Gustafson and Mares thought that one way to address this challenge would be to use voice-controlled technology, like a health management “Hey Google” or “Hey Alexa.” They are studying whether this technology can broaden and sustain the use of Elder Tree more effectively than the laptop platform. In addition to audio-activation software, the enhanced Elder Tree system includes a smart display to add a visual component, so a voice command response can be heard and read. The goal of the system enhancement is to increase the impact for older adults with MCCs and chronic pain, in particular. The research team will conduct a three-arm randomized clinical trial comparing treatment as usual to the laptop platform of Elder Tree and to the enhanced “smart system” version of it using a smart device. The team is making a concerted effort to recruit a diverse group of participants to help address racial health inequities. Research has shown that Black Americans may have distrust in the healthcare system and are often undertreated by providers.

Technology to support older adults

The research team believes this voice-controlled technology may be an effective, accessible, encouraging way to deliver healthcare self-management tools to older adults with MCCs. The central question of this study is whether smart devices can enhance the sustainability of programs such as Elder Tree and, in turn, will significantly increase its impact among older adults. This advancement aims to increase quality of life, improve overall health, and reduce hospital readmission among older patients with MCCs.