The Apple Watch was recently cleared by the U.S. Food and Drug Administration (FDA) as a medical device, a landmark for a wearable device aimed at consumers. Able to monitor heart rates and perform electrocardiograms (EKG), the Apple Watch is the latest example of advances in the Internet of Things (IoT), Artificial Intelligence (AI), and mobile device technologies that are transforming care for both the elderly and the not so old.

Elderly people often have multiple health conditions that require intensive monitoring and care, yet they also lack mobility, making direct visits with healthcare providers difficult.

According to Jenny Chia-ling Yang, a researcher at Taiwan’s leading private/public research center, the Industrial Technology Research Institute (ITRI), as many as 98% of the elderly have at least two concurrent chronic diseases, and the prevalence of elderly with multi-morbidity is expected to increase, leading to functional decline, disability, and poor quality of life.

Yang noted in written correspondence that many age-dependent diseases, such as dementia, stroke, osteoarthritis, cancers, osteoporosis and fractures, and bedsores, “result in physical and mental decline, thus a continuous supervision and intensive contact with health and social care centers for the elderly is highly needed.”

Technological advances in communication technology are making it possible to provide “telehealth,” helping the elderly to connect to healthcare providers remotely for medication supervision and chronic-disease management. Those who don’t drive or have difficulty with mobility are thus freed from onerous visits to the doctor. At the same time, the more frequent contact with the healthcare provider raises “the chances that the patient will comply with the provider’s recommendations,” Yang says. Telehealth also decreases disparities in access to healthcare between urban and rural areas.

Mobile Health (mHealth) solutions deploy mobile devices such as smartphones as well as apps and services, opening up new opportunities for communicating with patients and monitoring their condition. Yang predicts that “the smart phone will become the preferred solution for collecting and analyzing health and lifestyle data, and for providing care support.” In fact, advances in body-sensor networks and AI/IoT devices bring the future prospect that remote monitoring could include connected implanted devices for monitoring vital signs.

Dr. Chen Liang-kung, head of geriatrics at the Taipei Veterans General Hospital, says that mHealth monitoring devices are spearheading a revolution in data collection that will lead to deep changes in how data is measured and analyzed – and to advances in health care.

For example, risks for hypertension and cardiovascular disease are assessed through multiple blood pressure readings throughout the day, resulting in an average blood pressure reading. Working with technology firm Acer, his research team has tracked 200 patients over the years using constant mobile monitoring of blood pressure. The results have enabled them to develop a far more precise assessment of the risks of cardiovascular disease, allowing them to create a risk profile of each individual patient, rather than relying on a single cutoff for high blood pressure.

Dr. Chen forecasts that the quantities of data that can be harvested through the use of mobile devices have the potential to greatly enhance research into disease and treatment. “In the past we had to frame our studies across decades,” he says. “With better devices and better algorithms, we can shorten the timeframe, and will probably need only three or four years to reach a conclusion that we might have needed 40 years to reach in the past.”

In addition, machine learning is enabling the development of better treatment of hearing impairment. Unlike traditional hearing aids that simply amplify sound, including background noises, this new technology employs an algorithm that can differentiate the voice of the speaker from the background noise.

Remaining challenges

Despite the promise, there is no assurance that the new technologies can reach their potential in helping with senior care. First, the elderly are less inclined to accept new technologies, and studies have shown that they can actually create anxiety. In addition, the difficulties that older people suffer –including cognitive impairment, vision and hearing loss, and motor function issues – can all obstruct elders from utilizing such technologies.

Also, ITRI’s Yang notes that the elderly “tend to have a strong need to establish a direct face-to-face relationship with the doctor,” tending to prefer “personal contact with health professionals, which means that telehealth services performed from a distance are often not perceived as relevant to them.” Yang also notes that removing the direct personal contact with the doctor reduces the patient’s overall level of social interaction.

The elderly might also be concerned about the confidentiality of virtual consultations. Remote monitoring of the elderly in their own homes also raises ethical issues over privacy, while the reliability of remote monitoring devices has also been questioned.

Yang notes that despite the evidence that technology can have a strong positive impact on the health of the elderly, “remote monitoring failed to reduce hospital admissions and emergency department visits.”

With 483 hospitals and over 20,000 clinics for a population of about 23 million, Taiwan already has one of the world’s most extensive and dense national healthcare systems, making it “relatively easy for people to access high quality and low cost medical care,” Yang wrote. She added that “in rural areas, where telehealth is needed the most by the poorest of the poor, it is least likely to be provided because of inadequate infrastructure and high connectivity costs.”

Despite the challenges, the increased use of technology in the healthcare system is expected to offer great potential for Taiwan’s IT sector. Taiwanese companies are already at the forefront in the development and manufacture of a number of types of medical devices, including digital blood pressure monitors, electric wheelchairs and scooters, and electronic thermometers.

“Based on these advantages and capabilities, Taiwan’s technology firms may further strengthen their cross-sector partnerships by establishing an ecosystem with innovative business models to capture the opportunities and gain profits,” said Yang.

Note: Due to a miscommunication with ITRI, in the printed version of this article in the October 2018 issue of Taiwan Business TOPICS, the information from ITRI was misattributed to Chang Tsz-yin of the institute’s Biomedical Technology and Device Research Lab.