Technology and Aging

One of the most striking changes in the nature of medical care that has resulted from recent technological innovations has been the movement of medical treatment from predominantly hospital settings to physicians’ offices, freestanding specialty clinics, urgent care centers, and even the home. This transformation has resulted from the advent of minimally invasive surgery, new pharmaceutical treatments to replace surgery, and the development of increasingly sophisticated diagnostic and monitoring equipment for people to use in the home (Wilson; Stoeckle and Lorch). This movement might be even more pervasive but for the fact that many medical technologies are not designed for use by patients, but require trained professionals to operate them (Charness and Holley). As an increasing number of technologies are adapted for home use, the sophistication of community-based medical care should increase.

Another important innovation has been the development and use of biomaterials in medical treatment from gene therapy to prostheses to transplantation. Recent innovations in the use of biomaterials include the use of bioadhesive material to deliver drugs through the skin; the use of donor cornea cells as cornea replacements; and the application of bioengineered materials as bone grafts in hip replacement procedures or arterial replacements.

Now that technology has made it possible to map the human genome (or almost all of it), the understanding of the genetic, behavioral, and environmental origins of later life diseases is opening up rapidly. The potential of gene therapy to change the future of medicine has only begun to be perceived. Gene therapies are largely experimental, and testing and development of further therapies are presently complicated by scientific, legal, and ethical hurdles.

Advances in information technology are also helping to improve medical care for older persons in the community and in institutions. In general the use of computers and other communication equipment to connect patients and health care providers is referred to as telemedicine. There is relatively little evidence as yet to show whether telemedicine either improves or worsens health (Heathfield et al.), but the number of pilot programs is rapidly increasing. The use of telemedicine is generally thought to be effective for one-time emergency evaluations, follow-up contacts, medication checks, and primary care in isolated areas, but its usefulness for more extensive diagnostic applications or for long-term chronic disease management is not yet known. Telemedicine can improve patient access to physicians, improve communication among health care providers, reduce transportation costs, and eliminate some of the environmental barriers deterring patients from seeking care. In addition, access to computers and the Internet may make it possible for older persons to view their own medical records, may provide reminders for medication and other home treatments, and may distribute medical information that is individually tailored to the patient’s comorbidities and medications (Deatrick).

The adoption of new medical technologies by physicians, hospitals, and patients varies by patient and provider characteristics and across geographic regions. There is often a perception that older patients do not desire to receive aggressive or high-technology treatments for serious illnesses, but there is substantial evidence that the opposite is true (Mead et al., 1997). High-tech interventions also can be high-cost interventions, and thus will likely drive an increasing concentration of such interventions into a limited number of large medical institutions. Similarly, increasingly complex surgical procedures require investment in the training of physicians and other staff, and consequently are often concentrated in particular locations (Wilson). To some extent the problems engendered by the increasing localization of treatment options could be lessened by the growing use of telemedicine, leading eventually to savings. However, the acceptance of telemedicine faces hurdles related to patient privacy and confidentiality, liability, and licensure issues.