Healthcare providers — even senior care providers, which often may be slow to adopt new technology — increasingly may be buying into the use of remote patient monitoring tools.

And the premise is a good one: Combined with artificial intelligence, wearables or passive sensors can collect health vitals, build a behavior pattern and then flag a concern before an older adult has a falling emergency or suffers a heart attack. 

Although the concept of RPM is gaining traction rapidly, the next step for healthcare organizations is to address more granular questions such as how long should individuals be continuously monitored and who gets to see the data.

Experts addressed “what happens next” for RPM in a new report from the Bipartisan Policy Center, “The Future of Remote Monitoring,” that was released this month.

“Underuse [of RPM] could limit access to beneficial care,” the report’s authors noted, “while overuse could unnecessarily increase spending in federal health care programs. Additionally, providers cite the need for tools — such as (AI) — to manage streams of data, otherwise the volume of patient-generated information can become overwhelming and unmanageable.”

Many providers are aware of the need to synthesize the data in something meaningful for both clinicians and patients; some RPM companies are creating “actionable information” in the form of weekly or even daily health reports, and are helping senior living and care staff members prioritize high-risk residents and patients, an executive with EchoCare recently told the McKnight’s Tech Daily.

As RPM becomes more extensive and is used to monitor a wider range of conditions, federal agencies and healthcare providers may need to update their coverage policies, the BPC report observed. In addition, the report recommends reviewing existing privacy protection laws to make sure they apply to RPM tools. 

One of the four case studies the report analyzed was on heart failure, a major concern among older adults; the researchers worked with the Department of Veteran Affairs and found monitoring symptoms via a wearable prevented emergency department visits and reduced costs. 

Older adults with heart failure, as a group, have been singled out as not using new monitoring devices as often as they could, according to one recent study.

David M. Levine, MD, MPH, from Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues report on the early national experience of the AHCaH waiver, issued in November 2020, creating a regulatory and payment pathway for hospitals to deliver AHCaH. A total of 5,132 patients with a medical diagnosis who received AHCaH between July 1, 2022, and June 30, 2023, were identified, representing 5,551 admissions.

The researchers found that patients receiving AHCaH were medically complex, with a mean hierarchical condition category score of 3.15; 42.5, 43.3, 22.1 and 16.1% had heart failure, chronic obstructive pulmonary disease, cancer and dementia, respectively. Heart failure, respiratory infection, sepsis, kidney or urinary tract infection, and cellulitis were the five most common discharge diagnoses. The mean length of stay was 6.3 days; the escalation rate was 6.2% and the mortality rate was 0.5% during hospitalization. At 30 days after discharge, the mortality, skilled nursing facility use, and readmission rates were 3.2, 2.6 and 15.6%, respectively.

“Our data provide preliminary evidence on national uptake and suggest that AHCaH is an important care model to manage acute illness, including among socially vulnerable and medically complex patients,” the authors write.

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Kayode O. Kuku, MD, from the National Institutes of Health in Bethesda, MD, and colleagues developed and validated a protein risk score for mortality in patients with heart failure in a community-based cohort study. A total of 7,289 plasma proteins were measured in 1,351 patients with heart failure. A protein risk score was derived for patients enrolled between 2003 and 2007 (development cohort; 855 patients) and 2008 and 2012 (validation cohort; 496 patients).

The researchers selected 38 unique proteins for the protein risk score in the development cohort. The protein risk score demonstrated good calibration independent of ejection fraction; reclassified mortality risk, especially at the extremes of risk distribution; and showed greater clinical utility compared with the clinical model.

“By illustrating the potential of high-throughput omics to improve the clinical management of the heart failure syndrome, our findings are directly relevant to clinical practice and strongly support the pursuit of the evaluation of proteomics for this purpose,” the authors write.

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Fumiki Yoshihara, from the National Cerebral and Cardiovascular Center in Osaka, Japan, and colleagues conducted a multicenter, randomized trial that enrolled patients at 18 medical facilities in Japan to examine the effects of dapagliflozin on UACR in patients with heart failure and T2D. Eligible participants were randomly assigned to a dapagliflozin or control group in a 1:1 ratio (146 and 148 patients, respectively).

At the end of the observation period, 107 patients (87.7%) were taking 5 mg dapagliflozin daily. The researchers observed no significant difference in the primary outcome of changes in UACR from baseline after a two-year observation between the dapagliflozin and control groups. Among the secondary end points, the dapagliflozin group had a larger mean decrease in left ventricular end-diastolic dimensions as one of the echocardiographic parameters. Compared with the control group, the dapagliflozin group had the composite end point less often, defined as cardiovascular death or hospitalization for cardiovascular events, hospitalization for heart failure events, hospitalization for all causes, and an additional change in prescriptions for heart failure in a two-year observation.

“The results obtained on the primary end point revealed no significant difference in renal dysfunction judged by UACR between the dapagliflozin and control groups, which is in contrast to previous findings from three randomized controlled trials,” the authors write.

Several authors disclosed ties to biopharmaceutical companies, including AstraZeneca and Ono Pharmaceuticals, which partially funded the study.

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Jeremy Miles, MD, from the Montefiore Healthcare Network/Albert Einstein College of Medicine in New York City, and colleagues evaluated the predictors of long-term mortality in a large racially and ethnically diverse US patient cohort with low-density lipoprotein cholesterol ≥190 mg/dL. The analysis included 18,740 patients (2010 through 2020).

The researchers found that high-density lipoprotein cholesterol and body mass index extremes were associated with higher mortality. Higher low-density lipoprotein cholesterol and triglyceride levels were associated with an increased nine-year mortality risk in adjusted models. Higher mortality was associated with clinical factors such as male sex, older age, hypertension, chronic kidney disease, diabetes, heart failure, myocardial infarction and body mass index <20 kg/m². A significant survival benefit was seen with lipid-lowering therapy. High-density lipoprotein cholesterol <40 mg/dL was independently associated with higher mortality. Over time, there was a significant reduction noted in statin use: 56% of patients on primary prevention and 85% of those on secondary prevention were on statin therapy from 2019 to 2020.

“Our results support efforts geared toward early recognition and consistent treatment for patients with severe hypercholesterolemia,” the authors write.

Several authors disclosed ties to industry.

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Radiation therapy typically is used to help treat people who have cancer. But now it could be used to help treat people who have heart failure as well, new research shows.

Heart failure, which is when the heart muscle is too weak to generate proper blood flow, increasingly affects older adults. Approximately 10% of men and women aged more than 80 years have heart failure, according to the American Heart Association. 

In addition, just under half of those who are hospitalized for the condition end up needing rehab in a long-term care or skilled nursing facility, a Mayo Clinic report found.

A low dose of radiation helped improve heart function in both mice and human test participants with heart failure, according to new research out of the Washington University School of Medicine in St. Louis.

The radiation is targeted at a specific portion of the heart — every part of the heart muscle gets some low-level exposure — and works by reducing inflammatory immune cells, the researchers explained.

“There was concern that it could be harmful to overall heart function, even though it treats dangerous arrhythmia,” study co-author Ali Javaheri, MD, PhD, said in a statement. “We were surprised to find the opposite: Heart function appeared to be improved after radiation therapy, at least in the short term.”

In addition to new AI tools, another recent innovation for heart failure includes a potential drug delivery system that works like a modified insulin pump, the McKnight’s Tech Daily reported this week.

Before radiation treatment for heart failure could become common practice, more follow-up studies are needed on how people react to the treatment over time, and to get a more precise understanding of the process and its effects, the researchers said.

The findings on radiation and heart failure were published in the journal Med on Tuesday.

A new drug infusion device could allow seniors suffering from heart conditions to get treatment from a home or long-term care residence instead of a hospital setting.

The small device would work as a modified insulin pump, delivering medication via a needle automatically. 

The drug delivery system was safe and effective, researchers stated, with 95% of users reporting no discomfort.

Heart failure is a specific form of cardiovascular disease where the heart muscle becomes too weak to initiate proper blood flow, often resulting in fluid buildup in the lungs or legs, the researchers explained.

Older adults in whom heart failure has been diagnosed often will require a hospital stay, and 40% of patients with the condition are discharged to a skilled nursing facility, according to the Mayo Clinic. 

Even if older adults are then allowed to return home, 37% of heart failure patients end up returning to a skilled nursing facility at least two more times, the Mayo Clinic adds. 

A more effective treatment system could, at the very least, help shorten the costly cycle of moving through home, hospital and post-acute care facilities.

“We are pleased that our patients were impressed with how straightforward and intuitive the pump is,” study co-author Joanna Osmanska, MD, said in a statement. “This is a big step forward in our mission to improve life for patients with heart failure and this study demonstrates how effective this treatment can be.”

New artificial intelligence tools have been better able to predict heart failure risk, and point towards more accurate treatment methods, the McKnight’s Clinical Daily reported earlier this year.

The drug-and-device method was studied by experts at the University of Glasgow and the research was recently published in European Heart Journal: Cardiovascular Pharmacotherapy. 

The researchers indicated that there will be further studies conducted to further evaluate the efficacy of the drug delivery method.

A recent study from Mercy Health shows that having too much time on our hands can negatively affect us. Engaging in challenging and novel activities can significantly improve memory function in older adults.

It is more important than ever for senior living communities to embrace vibrant living and support their residents with interesting programming. By making it easy for them to take up new hobbies, we support residents’ experience and growth, which ultimately preserve and enhance their cognitive functions.

Supporting neuroplasticity

Neuroplasticity, the brain’s ability to adapt and form new neural connections throughout life, has immense potential to keep our minds sharp as we age. When older adults engage in hobbies, there is a positive response from the brain as it forms and strengthens new neural connections.

Research has shown that regularly partaking in mentally challenging activities, such as learning to play an instrument, joining an art class, exploring different cultures or picking up a new language, can lead to improved cognitive function, particularly memory recall. 

Preventing isolation

One of the many takeaways of the pandemic was the danger of isolation for the aging population. We learned that loneliness and isolation increase the risk for individuals to develop mental health challenges, as well as heart failure, cognitive decline and dementia/Alzheimer’s disease, according to the surgeon general and the US Centers for Disease Control and Prevention, respectively. When older adults participate in new hobbies, they spend more time with others and increase their chances for forming lasting friendships.

Inquire about their interests

When people of all ages try something new, it stimulates their attention and interest. It is crucial for senior living communities to ask residents what they are interested in, because one person’s idea of a fun activity could inspire others to join in.

For example, residents at Brightview Senior Living’s Shelton, CT, community recently went ziplining for the first time. One resident brought up the idea, and four others joined in on the adventure. Together, they had an exhilarating experience and made memories together — all because they wanted to try something they hadn’t tried before. 

Scientifically speaking, novel experiences such as ziplining trigger the release of dopamine, a neurotransmitter that plays a crucial role in memory consolidation. Ziplining is a unique example of this. Some others include learning chess and joining a tournament, taking pottery classes or trying new recipes.

A holistic approach

Vibrancy has become a buzzword in senior living, and for good reason. But beyond vibrancy, a holistic approach to overall wellness is a must.

SPICE in Motion, a proprietary program woven into every aspect of Brightview’s culture, is how we ensure that residents’ needs are met. SPICE stands for Spiritual, Physical, Intellectual, Cultural and Emotional health. Examples of those categories:

• Spiritual: Religion, meditation, positive affirmations, poetry and connecting with nature.
• Physical: Line dancing, drumming, fitness classes and walking clubs.
• Intellectual: Attending lectures, book clubs, current events and panel discussions that promote lifelong learning.
• Cultural: Learning about other cultures, trying new foods and learning a new language.
• Emotional: Grief support groups and comedy shows. 

Conclusion

It is the role of senior living communities to ensure that residents are constantly trying new things and to offer a holistic approach to health and wellness. At Brightview, the team of almost 50 vibrant living directors truly create custom, exciting experiences for their residents to support their quality of life and mental well-being. 

Dori Ray is corporate director of vibrant living at Brightview Senior Living 

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

When it comes to the importance of telehealth, for older adults and anyone else, the Senate Subcommittee on Health Care and healthcare organizations appear to be on the same page.

Both subcommittee members and outside experts weighed in on the value of telehealth during a hearing Tuesday afternoon, including the value of options for conditions that predominantly affect older adults, such as stroke and heart failure. 

Congress is considering making pandemic-era telehealth coverage permanent via the CONNECT for Health Act of 2023; currently, Medicare coverage of certain telehealth options is set to expire at the end of 2024.

“I’ve seen firsthand what telehealth means [for patients],” Committee Chairman Ben Cardin (D-MD) said to open the hearing. “It’s less costly for the consumer, that’s for sure. We have to underscore the importance of permanency: if you are a provider, you need to know a health plan won’t be disrupted because Congress is late in extending these rules.” 

Cardin offered an anecdote that he’d recently seen a veteran in western Maryland get “timely, quality telehealth care” from a clinician in Baltimore, 150 miles away.

Among those who submitted written testimony for the hearing were leaders with the American Hospital Association, which urged the committee to make the telehealth access permanent. 

“We strongly support the provision in the legislation which would permanently remove the geographic restrictions that currently limit where patients can access telehealth services,” AHA Executive Vice President Stacey Hughes said in a statement.  “We would encourage consideration of simply eliminating originating site restrictions altogether. Doing so would ensure that all Medicare beneficiaries can access services regardless of where they and their providers are physically located.”

Because the bill was reintroduced over the summer, there has been bipartisan support for its passing, with 60 senators and six bipartisan sponsors endorsing the legislation. 

President Biden also has made recent remarks about the importance of increasing healthcare access in underserved communities and training new healthcare workers. 

Yakubu Bene-Alhasan, MD, MPH, from Medstar Health in Baltimore, and colleagues used data from the National Institutes of Health “All of Us” Research Program to examine the association between the frequency of marijuana use and new-onset heart failure. The researchers found there were 2,958 events within a median follow-up of 45 months from a final population of 156,999 patients. Daily marijuana use was associated with an increased risk for incident heart failure compared with never use (adjusted hazard ratio, 1.34; 95 percent confidence interval, 1.04 to 1.72). After the addition of coronary artery disease diagnosis as a time-varying covariate in the main model, the association was attenuated and no longer significant (adjusted hazard ratio, 1.27; 95% confidence interval, 0.99 to 1.62).

Avilash Mondal, MD, from Nazareth Hospital in Philadelphia, and colleagues examined the association between CUD in elderly nonsmokers with established cardiovascular disease risk and MACCE. The researchers found that 13.9% of 28,535 elderly cannabis users reported MACCE episodes. Compared with the non-CUD cohort, the CUD cohort reported higher MACCE (odds ratio, 1.20), all-cause mortality, dysrhythmia, acute myocardial infarction, transfer to other facilities, and home health care. In CUD users, chronic lung disease, renal disease, hypertension and hyperlipidemia were predictors of MACCE episodes.

“The main public message is to be more aware of the increased risks and open the lines of communication so that cannabis use is acknowledged and considered,” Mondal said in a statement.

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