Self-Tracking Technology for Older Adults: Not Ready for Prime Time

3/31/13 By Suneel Ratan

A recent Pew survey indicating that 69 percent of US adults track a health-related measure casts a new light on a rapidly proliferating set of consumer-oriented, Internet-connected, self-tracking technologies with names like FitBit, UP, and FuelBand. The survey indicates that older adults are the biggest self-trackers, but are doing so mainly in their heads or on paper. So are these products ready for prime time with older adults?

The short answer is: Not yet. As to when they will be, the answer depends, at least in part, on how quickly the usability of self-tracking products and ‘smart’ mobile technologies intersect with the needs and adoption curve of older adults. Companies simply need to start designing products with older adults in mind if they’re to really serve and penetrate this huge market.

The new wave of self-tracking products can be seen as the consumer-oriented younger sibling of the telehealth technologies that first arose in the late 1990s for the monitoring and care management of individuals with chronic disease.

There are different flavors of telehealth. The most basic involves simple gathering and clinical monitoring of vital signs such as weight and blood pressure. Other approaches build upon that foundation and add a component that connects tracking physiological measures to monitoring behaviors such as diet and medication compliance – and rolling all of that into activating individuals in self-management to prevent crises from occurring.

Consumer-oriented self-tracking products build upon this approach by connecting the measurement of one or more parameters to the setting and accomplishment of a personalized set of goals. This typically involves a connected device such as an activity monitor or weight scale whose data can then be uploaded to the ‘cloud’ so that progress toward daily goals like activity and more overarching goals like weight can be viewed and trends can be analyzed. This in turn can either be done via the Web or via an app for a mobile device such as a smart phone, tablet.

(A key distinction between the consumer-oriented technologies detailed in this post and telehealth – which is now morphing into ‘medical-grade’ mobile health or mHealth – is that telehealth has typically been associated with medical-grade applications that involve the use of a medical device such as a blood-glucose meter or with using data for diagnosis, clinical decision support, or treatment recommendations.)

The Pew survey, Tracking for Health found that “ … 69% of U.S. adults track a health indicator like weight, diet, exercise routine, or symptom. Of those, half track “in their heads,” one-third keeps notes on paper, and one in five uses technology to keep tabs on their health status.”

Digging deeper, the report notes that:

... (P)eople living with one or more chronic conditions are no more likely than other U.S. adults to track their weight, diet, or exercise routine. They are, however, significantly more likely to track other health indicators or symptoms and this likelihood increases among those living with more than one condition …

Nearly half (45%) of U.S. adults are dealing with at least one chronic condition. Of those who are living with two or more conditions, 78% have high blood pressure and 45% have diabetes — two health conditions more effectively managed when people track their own data.”

Even more interesting insights emerge from this Q&A with the Pew report’s author, Susannah Fox, from the Quantified Self blog. Distinguishing between individuals who track in their head vs. those who use formal methods ranging from pen and paper to products like Jawbone’s UP, she notes:

“The “formal” trackers are more likely to report that this activity has had an impact on their health:

  • 54% of trackers who record their notes say it has changed their overall approach to health, compared with 39% of informal, “in their heads” trackers.
  • 48% of trackers who record their notes say it has led them to ask a doctor new questions, compared with 33% of informal trackers.
  • 42% of trackers who record their notes say it has affected a health decision, compared with 26% of informal trackers.”

One can always question the relationship between cause and effect. Still, beyond that, Fox indicated that she was surprised that older adults are “… much more likely than younger adults to be trackers, particularly in the ‘health indicators or symptoms’ category. I had thought of tracking as a younger person’s pursuit, probably because I focus on the tech and gadgetry that I see associated with tracking. Broadening our questions to include all adults and all forms of tracking educated me about the reality of people’s lives.”

AARP notes that 70 percent of Americans above the age of 50 have one or more chronic conditions. So put it all together and it’s clear that older adults are a prime market for self-tracking technologies that can make it easier and more effective for them to track their health, and to set goals in concert with their doctors and achieve them.

Still, there are a lot of reasons why self-trackers haven’t caught fire with older adults, let alone the mass market. First and foremost, the products just aren’t that easy to use unless you’re a dedicated fitness freak or tech head. The Nike FuelBand, for instance, requires a USB connection to a power supply to be charged every four to six days, as well as the installation of an application on a computer for set up (which then includes setting up an account, and so on, and so forth – see next bullet point). The wrist band also can be paired with a smart phone for tracking progress against goals on the go, which requires having a smart phone (which, per Pew, only 12 percent of Americans 65 and over do), and downloading and installing an app.

While older adults are typically last adopters of many technologies, companies that want to serve older adults again need to more explicitly design for them or support by a caregiver, rather than wait for them to grow more sophisticated. Shantanu Nundy, a Chicago-based physician and innovator, says, “You need to meet folks where they are,” Nundy says, “so the best way is to piggyback on the technology they already use. Older adults are less likely to use apps so this requires either making the solution available for lower-tech devices or having an education and training component specifically for them.” In his own case, Nundy has successfully used text-messaging as a care-management tool for individuals, including older adults, with diabetes.

Beyond that, many older adults have multiple conditions and require being monitored for a range of measures, which puts a premium on having integrated ‘dashboards’ of tracker-generated data that can in turn draw from a wide range of potential tracking devices. Including ones from different companies. Such dashboards currently largely don’t exist because of a lack of openness within the ‘digital health ecosystem.’ For the past seven years, the Continua Health Alliance has been pushing for interoperability and made progress. But a recent PriceWaterhouseCoopers paper notes that we aren’t there yet: "For a change in the status quo, buyers of the market i.e., providers, payers and regulators must impose pressure on their incumbent vendors to enable interoperability as part of their value proposition," states the article. "In the end, interoperability across diverse systems and vendors is essential to create truly scalable mHealth solutions."

Older adults are also more likely to begin adopting such technologies if their doctors ‘prescribe’ them for them – and certainly there is a large amount of anecdotal evidence of rapid uptake of smart phones and tablets by physicians themselves. But the PriceWaterhouseCoopers paper similarly notes that the lack of connectivity between mobile health technologies and clinical systems such as EMRs is impeding the rapid diffusion of the wide range of mHealth technologies. (One interesting side note: It will be interesting to see whether physicians and other clinicians start using consumer self-tracking technologies themselves, which in turn would influence how they would view such technologies for their patients.)

Older adults may not be the sexiest targets for product designers, but the Pew self-tracking study reaffirms that they are the part of the population for whom such technologies remain most urgent. For instance, take a consumer-oriented wrist-based activity monitor, have it connect in real time, add in the right analytics – and you’d have a product that could both support older adults in remaining more active and in potentially predicting falls. So here’s a parting thought and hope: That those designers will keep older adults more in mind as they design the next waves of cool new self-tracking hardware and apps.

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