Technology for Caregiving – we review the Apple Watch Series 4

Apple Watch 4 for Caregiving

Aiding Caregiving

Technology that benefits caregiving; the Apple Watch series 4 is a good example of technology for good.

The explosion in smart devices—phones, watches, fitness gadgets and the like—has unleashed a wave of apps designed to manage chronic illnesses, detect behavioral diseases and manage pain. Most recently, Apple announced that apps due later this year will allow its Series 4 watches to perform electrocardiogram readings or ECGs, and notify users of irregular heart rhythms.

The problem for consumers is knowing which apps—if any—actually work.

The Food and Drug Administration cleared the ECG app and irregular-rhythm notification feature on the Apple watch but noted that the apps aren’t intended to replace traditional diagnosis methods. The agency said the ECG data displayed on the Apple watch is for informational purposes only and isn’t intended to be interpreted by the user without consulting a health-care professional.

Most health apps on the market aren’t required to be reviewed by the FDA. That has raised concerns that some apps could expose consumers to harm.

The FDA last September started working with Apple and eight other tech and medical-device companies—including Fitbit , Samsung and Verily Life Sciences, a subsidiary of Google parent Alphabet —to streamline approval of mobile medical apps. In the meantime, here is a status check on some of the areas where health-monitoring tools might make the most difference.

Measuring Heart Health

Smartphones and watches can collect data on the heart continuously, which promises to improve the detection and treatment of heart disease.

For instance, devices that track heartbeat data can help doctors identify atrial fibrillation, a leading cause of heart failure and strokes. With a-fib, the upper two chambers of the heart beat erratically and at dangerously high speeds. Since symptoms come and go, it can be hard to detect, but watches worn for long periods have a chance of spotting it outside of a doctor’s office.

An ECG, the standard method of detecting a-fib, requires placing 12 electrodes on a patient’s body. The Apple Watch Series 4 will have electrodes built into the watch’s digital crown, which users touch for 30 seconds after opening the app to get an ECG reading, Apple says.

Another device, the KardiaBand watchband, also offers ECG capabilities and was cleared by the FDA in November. It was most effective in detecting a-fib when physicians looked at the results, rather than relying solely on the watch’s algorithms, according to a study by the Cleveland Clinic. The device’s instructions tell wearers to place their thumb over a spot on the watchband embedded with an electrocardiogram sensor, which records their heart rhythm.

But in the Cleveland Clinic study, about 35% of the recordings couldn’t be read by the watch’s algorithms, possibly because people didn’t press their thumbs down for the required 30 seconds. Electrophysiologists, however, looking at the same data, were able to accurately identify people with a-fib 100% of the time and people without a-fib 80% of the time. The electrophysiologists also beat the algorithm’s performance on recordings that it could read, correctly identifying people with a-fib 99% of the time, compared with the algorithm’s 93%.

Which is a reminder for all of us that patient compliance and adherence to protocol is the critical ingredient to determine the accuracy of these tests

With smartphone-based electrocardiogram monitors, clinics can access recordings of patients’ heart rhythms no matter where they are. Doctors can also use the monitors to diagnose patients with intermittent episodes of a-fib, which are hard to catch and follow up on patients who have had ablations, a procedure that removes diseased tissue from the heart to try to stop a-fib symptoms.

Family Caregivers are cued into technology

Family Caregiving

39% of U.S. adults are caregivers and many navigate health care with the help of technology

Four in ten adults in the U.S. are caring for an adult or child with significant health issues, up from 30% in 2010. Caring for a loved one is an activity that cuts across most demographic groups, but is especially prevalent among adults ages 30 to 64, a group traditionally still in the workforce.

Caregivers are highly engaged in the pursuit of health information, support, care, and advice, both online and offline, and do many health-related activities at higher levels than non-caregivers.

Indeed, being a caregiver is independently associated with key health-related activities. When controlling for age, income, education, ethnicity, and good overall health, caregivers are more likely than other adults to:

  • Gather health information online, particularly about medical problems, treatments, and drugs.
  • Gather health information offline, from clinicians, friends, family, and others who share the same health condition.
  • Go online specifically to try to figure out what condition they or someone else might have.
  • Consult online reviews about drugs and other treatments.
  • Track their own weight, diet, exercise routine, or other health indicator.
  • Read online about someone else’s personal health experience (which, in the case of caregivers, could be related to their own or their loved one’s condition).
  • Go online to find others with similar health concerns (again, there may be dual motivations to connect — to find more information about handling caregiver stress, for example, or about their loved one’s health challenges).

In a previous study by the Pew Research Center, 47% of U.S. adults say it is likely that, at some point in their life, they will be responsible for caring for an aging parent or another elderly family member.1 Demographic patterns bear out this prediction: People ages 65 and older represented 12.4% of the U.S. population in the year 2000 but are expected to be 19% of the population by 2030.2

This survey finds that fully 75% of U.S. adults age 65 and older are living with a chronic condition such as high blood pressure, diabetes, or heart disease. Numerous studies have shown that the day to day management of these complex medical cases falls squarely on family members and friends who may not be trained. But, as this study shows, caregivers are turning to every resource available to get the information and support they need.

39% of caregivers manage medications for a loved one; few use tech to do so

Thirty-nine percent of caregivers manage medications for a loved one, such as checking to be sure pills are taken properly or refilling prescriptions. Just 7% of caregivers use online or mobile tools, such as websites or apps, to do so.

Nine in ten caregivers own a cell phone and one-third have used it to gather health information

Eighty-seven percent of caregivers in the U.S. own a cell phone and, of those, 37% say they have used their phone to look for health or medical information online. This is a significantly higher than the rate of mobile health search among non-caregivers at the time of the survey: 84% of non-caregivers own a cell phone and 27% have used their phone to look online for health information.

Most caregivers say the internet is helpful to them

When asked about the specific impact of the internet:

  • 59% of caregivers with internet access say that online resources have been helpful to their ability to provide care and support for the person in their care.
  • 52% of caregivers with internet access say that online resources have been helpful to their ability to cope with the stress of being a caregiver.
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Using Amazon Echo or Google Home for Caregiving

Amazon Echo for Caregiving

Caregiving can be a challenge, but with smart voice assistants like Google Home or Amazon Echo, you can make caregiving fun.

If you’re an Amazon Echo or Google Homeowner, you may only ask your device for the weather or to play music. That’s O.K., but these devices can do so much more — and they can offer more than a few useful tricks to make you feel as if you’re living in the future.

Some of these can make your mornings a little brighter, while others can make your evenings more relaxing. To get the most of these Alexa commands, you’ll need to enable the skills from the Alexa Skills store first, and the Google Home commands and settings have to be enabled in your Google Home mobile app.

Both the Google Assistant and Amazon Alexa offer a “routines” skill, which automates certain tasks based on a single command. For example, you can ask your Amazon Echo or Google Home to tell you the weather and what’s on your calendar for the day, after saying “Alexa, start my day” or “Hey Google, good morning.” With this particular routine, there are nine actions the Google Home can perform, including reading the day’s top stories or local news, and then transition into six other actions like playing your favorite music or a preferred podcast to finish up your “morning.” On the Echo, there are four basic options, but you can add eight more to lengthen the routine.

The Google Home has six ready-to-go routines that you can customize in the Google Home app, and the Amazon Echo has one. You can also create completely custom routines on both devices.

Parents, this one might be a lifesaver — for your voice: Both products let you broadcast an announcement across other devices in your home. So, if you have an Echo in the kitchen, living room and a child’s bedroom, you can say, “Alexa, announce that dinner is ready,” and Alexa will repeat the message on each device in your voice — no skill necessary.

With the Google Home and Google Home Mini, you can do a similar command: “Hey Google, tell everyone it’s time to go.” If you’re an iOS user and want to do this but you’re away from home, you’ll have to separately download the Google Assistant app (Android users already have the Assistant enabled if they have the latest version of the operating system).

You might’ve heard of this but were dubious whether hands-free calling was actually possible, or easy. The good news: It is. The so-so news: There are a few steps you need to take before your hands-free calling dreams come true.

On Amazon Echo devices, you first have to sync your contacts in the Alexa app. Then, simply ask Alexa to call any of these people. A bonus feature on Echo devices is that you can call a friend or family member on their Echo device, like an Echo Spot or any device with Alexa installed. To enable this, both you and the person you’re trying to contact must have Alexa Calling and Messaging turned on. Then, you can call anyone from your mobile contacts. If that person has signed up, he or she will get a phone call on the Echo device or in the Amazon Alexa app.

With the Google Home, first link your Google account to your Google Home, turn on “personal results” and then sync your contacts. You’re ready to go, and you can ask Google to call anyone in your contacts list. You can also set hands-free callingto reveal your number when you call, so people can know it’s you and not an unfamiliar proxy number used to connect the call. (The Echo offers the same capability.)

For now, both devices don’t support calling emergency services, so no “Alexa, call 911” for you. Hands-free calling with Alexa works only in the United States, Canada and Mexico and only in the U.S., Canada and the U.K. for the Google Home.

Need a moment to yourself? Try meditating or relaxing with both devices with a few free, guided meditations from Headspace. On Google, you can say, “Hey Google, talk to Headspace”; on Alexa, request “Alexa, open Headspace.” If you’re a subscriber, you can continue a meditation from your phone onto your device. If you want general meditation content, you can say something along the lines of “Alexa, help me relax,” or “O.K. Google, help me meditate.”

Both devices can also help you calm down with commands like “O.K. Google, help me relax,” and sounds like rain falling will play — or white noise if you’re using it to go to sleep. The Echo is similar, but you can pick and choose what types of sounds you want to hear from the skills store. Google can also play “sleep sounds,” which are really lullabies meant for children, while the Echo offers white or ambient noise. Just say “Alexa, help me sleep” for options.

Sure, these devices can play music and add items to your cart, but it’s a little annoying to start every single request with “Alexa” or “O.K. Google.” Thankfully, Amazon and Google realized this. On the Google Home, the “Continued Conversation” feature allows you to ask your device a question, and the microphone stays on for eight additional seconds to see if you’ll ask a follow-up. (You do need to enable this in the settings of the Google Home app, as the feature is turned off by default.) The Amazon Echo also has the feature, except Amazon calls it “Follow-up mode” and you also have to turn it on in the app before using it.

Once it’s on, you can ask questions like “Who sang ‘In My Feelings?,’” and once your device responds with “Drake,” you can ask “How old is he?” and the device will not only know who “he” refers to but also answer without missing a beat. (Spoiler: Drake is 31.)

This feature has also paved the way to ask the device to do multiple things in one command. For example, with “multiple actions” on Google Home devices, you can say something like “Hey Google, turn up the thermostat and tell me the weather.” On the Echo, you can’t do it in a single sentence, but with follow-up mode you can just ask the two different commands one after the other.

Google’s later start in the smart home arena wasn’t necessarily a bad thing. The extra time allowed it to come up with some truly useful exclusive features. For example, if you download and use the Google Assistant app in addition to Google Home, you can ask Google to remind you to do something at a certain location. So, if you need to buy milk at the grocery store, you can say “Hey Google, remind me to buy milk at the grocery store,” and as soon as you’re near your preferred store (which Google will ask you to specify), your phone will let you know what you need.

And if you’re in the mood for a nice story at the end of a long workday, just say “Hey Google, tell me something good,” and Google Assistant will read some “feel-good” stories.

Amazon’s focus in the smart home space has long been less about automation or routines and more about who you are as a person. For example, the seven-minute workout skill will walk you through a quick, high-intensity workout just by saying, “Start seven-minute workout.” If you have an Echo Show or Spot, both of which have LCD displays, you’ll also see images walking you through some exercises.

Another example is “Alexa Donations,” where with an easy “Alexa, I want to make a donation,” you can donate $5 to $5,000 to the charity or cause of your choice. At the moment, 154 nonprofits work with Amazon and Alexa Donations to make it possible.

With these new commands, you and your home should be on the way to becoming smarter — and more useful. Sure, these devices can play music and set timers, but these tips can help you get even more of your money’s worth.

Caregiving; when seniors soon outnumber children

The future of caregiving

The population of the United States is not as young as it used to be, and the year 2035 represents a major demographic turning point.

According to a 2018 U.S. Census Bureau report, in 2035 “there will be 78.0 million people 65 years and older compared to 76.4 million under the age of 18.” In other words, the elderly population will outnumber children for the first time in the country’s history — a demographic shift that poses a unique set of public health challenges.

Los Angeles County will be especially impacted by the increasing ratio of non-working adults over 65 to working adults. In 2016, there were 5.2 working adults per retired person, but within 20 years, that number is expected to drop to 2.9.

Aging U.S. population: meeting mental health needs

When populations age, communities are tasked with supporting both the physical and mental health needs of older adults. California’s older adult population alone will increase by 64 percent by 2035 and with it the need for more services. Findings from a 2012 Institute of Medicine report highlight the growing crisis of dementia, substance abuse and mental illness, such as depression among America’s older adult population.

The conditions are often stigmatized, resulting in an absence of institutional support for services meant to address them.

Coupled with a lack of support and mentorship opportunities for students interested in working with older populations, this has led to a shortage of professionals with the necessary training to treat older patients struggling with these issues — as well as a dearth of crucial social services.

Yet, as the most recent census data indicates, there has never been a more important time for social workers to consider careers working with older adults. As the population of older adults with behavioral and psychological conditions increases, so too will the demand for related services and care.

The swelling of this demographic is owed, in part, to an influx of immigrants after World War II who now count themselves among baby boomers. The uptick in immigration also accounts for an increase in the ethnic and racial diversity of the aging adult population and their offspring. According to census data, “by 2020, less than half of children in the United States are projected to be non-Hispanic white alone.” This trend toward diversity is expected to continue among younger generations as well: Individuals who identify as “two or more races” make up the fastest-growing demographic in America.

Longer life expectancies among foreign-born minorities have also contributed to the growth of the older adult population. Because foreign-born minorities often live longer than their American-born counterparts, they spend more time in the category of “non-working older adult.” Asian populations, in particular, tend to live longer than populations of other ethnic backgrounds.

Cultural Barriers

The presence of so many different ethnicities across geographic diasporas, different languages, and different cultures creates great challenges for social work.

Current programs often do not account for differences in language and culture, creating a barrier to access for aging people in need. To compound these issues, doctors and social workers are not always trained to recognize medical and mental conditions that are most common among certain groups. Example; diabetes and high cholesterol are prevalent in Asian and Asian-American communities, but because that disease is often thought to be associated with obesity — which is not as prevalent in those communities — doctors often do not screen for it.

Finding new solutions

Addressing the needs of a large and diverse older adult population will require new and innovative solutions like integrating high-tech communication tools into caregiving processes. The most obvious benefit of this approach is the convenience factor these tools provide: Older adults with limited mobility may prefer a video conference call with their social worker or health care provider rather than an in-person visit, for example.

Equally important are the potential mental health benefits such tools would offer otherwise isolated older adults: ‘Teaching older Americans to use technology to communicate can improve cognition as well as feelings of connectedness, which could alleviate symptoms of depression and anxiety,’ becomes even more critical. Digital voice assistants like Amazon Alexa and Google Home with their smart sensors and conversational design can play a role in combating the challenges of living alone.