E-Health for Older Adults

Healthcare For Older Adults

As this section of the population is expanding rapidly, there is a pressing need to redesign service provision. In particular, physicians have recognised that there is a much greater role to be played by preventive medicine. Traditionally healthcare has been concerned with treatment of disease rather than prevention, but increasingly there is a need to focus on how we can promote greater periods of healthy active living. Figure 1 shows the most common disease trajectories. Where once seniors experienced a short period of accelerated decline in their health towards the end of their lives, it is now more common to see a slow deterioration in function over several years. The “compression of morbidity” scenario is now changing to a situation where better treatment options ensure that chronic disease has a less progressive course. Sometimes this is associated with intermittent episodes of reduced function for a short period of time, which may be reversible with brief hospitalisations or a period of rehabilitation in a multidisciplinary environment.

Figure 1.

Typical illness trajectories for people with progressive chronic illness. Adapted from Lynn and Adamson (2003). With permission from RAND Corporation, Santa Monica, California, USA.

Healthcare is not without its risks: in terms of encounters for each fatality it is more hazardous than driving, using a scheduled airline, or nuclear power (Commission on Systemic Interoperability, 2005). Typically 10% of inpatients are the victims of medical error (Leape, 1994). Hospitals harbour many pathogens and hospital-acquired infections are more common in older people. The development of specialty training for the care of older people is not widespread, and many older patients are treated by physicians without relevant specialist qualifications. This can lead to inappropriate interventions, or indeed under-treatment. Contact with physicians may in itself result in more prescriptions, and even community dwelling older adults take an average of 6 drugs (Barry, Gallagher, & Ryan, 2008). In short, healthcare does not always prioritise patient safety. It is this potential for adverse outcomes that has promoted the development of e-Health.