Blog Series - Digital Health and Care Equality in ILD: Age

The impact of transformation on care equality is a key consideration for any planned change to a patient care pathway. 

As providers, we are clear that whilst digital health can be used by the majority, it isn’t suitable for every patient (at least not yet). Some patients cannot, or choose not, to use digital health for a variety of reasons, including device or internet access, willingness to self-monitor or just general healthcare engagement. But whether digital health solves or introduces healthcare inequality, impacting access or quality of care according to patients’ characteristics or demographics, is a different issue. 

In this blog-post series we will consider how digital health transformation impacts care access for ILD across key variables such as patients’ socio-economic group, ethnicity, geography and, for this first post in the series; age.

Age 

In our experience, age is raised as a potential limitation of digital health for ILD patient care far more often than for other respiratory indications, such as cystic fibrosis or lung transplantation. With almost 75% of UK ILD patients aged 70+ years (based on BTS ILD registry), such concerns are usually based on pre-conceptions regarding technology access, digital literacy and/or digital health acceptance in the older ILD patient cohort. An international survey of 207 ILD clinicians conducted in 2021 reported that clinicians perceived the main patient barriers to participation in telehealth for ILD were lack of awareness (76%), lack of knowledge of using smartphones (60%) and lack of confidence in telehealth (56%).

In reality, data shows technology access and acceptance among older people is changing rapidly, and in ILD patients specifically technology use and desire to access healthcare services through technology is high. Digital care has demonstrated feasibility and acceptability to patients with ILD, including those aged >75 years, and users of our own platform include ILD patients aged 90-plus. 

As we discuss below, evidence indicates that age in itself is not a barrier to accessing digital care for ILD. When planning the introduction of digital health technology for ILD, evidence indicates considerations around patients’ technology access or digital literacy should be addressed separately from patients’ age, and not as interrelated factors. Some researchers specialising in ageing and cognition have gone one step further, publishing a  commentary urging all healthcare disciplines to challenge outdated beliefs that digital health and older adults are incompatible, and to change practices that have led to older people being disproportionately excluded from digital health services and clinical trials. 

69% UK adults >65 years owned smartphone in 2021

Survey data from the UK’s Communications Regulator, Ofcom, shows smartphone ownership among adults aged >65 years grew from 39% in 2016 to 69% in 2021. Research on attitudes to digital health in the UK conducted by the Organisation for the Review of Care and Health Apps (ORCHA) found more than half (52%) of those aged 65+ years supported the move to digital health, and older people were most willing to use health apps for self-monitoring and tracking symptoms, or to  alert of a potential health condition.

80% Irish ILD patients owned smartphone in 2020

In Ireland, research conducted by the Irish Lung Fibrosis Association (ILFA) in 2020 showed that 80% of ILD patients surveyed owned a smartphone, and almost two-thirds (63%) of patients had used phone-based apps to help them in their daily life. A separate survey from the same group showed that when it came to accessing specialist services for multidisciplinary pulmonary fibrosis care, such as physiotherapy, dietetics, clinical psychology and occupational health, the majority of patients wanted to use  virtual care, in combination with face-to-face visits.  Feasibility of patientMpower demonstrated in ILD patients 

Clinical studies demonstrating feasibility and patient acceptability of remote monitoring of ILD using the patientMpower platform have enrolled patients across a wide age range, including patients over 75 years of age. For example, study NCT04850521  reported mean participant age of 68 years +/- SD of 11 years.

Increasing age can be associated with decreased manual dexterity, and 41% of ILD clinician participating in an international survey believed manual dexterity was a barrier to patient participation in telehealth. Research in patients with connective tissue disease ILD (CTD-ILD), which includes conditions which can impact hand function, such as rheumatoid arthritis and systemic lupus erythematosus, has shown that remote monitoring via the patientMpower platform and a handheld spirometer, and is feasible and acceptable to patients with CTD-ILD, despite impaired hand function.

patientMpower experience in ILD: Users aged >90 years

Our platform  supports the clinical care of patients with ILD across a wide age range. Age is not a mandatory data field for enrolment on to the pateintMpower platform, but majority of users do provide their demographic details and provide consent for secondary data use (e.g. research) . From this data, we can report that the median age of users of our ILD platform is 69, with a median of 70. Users range from patients in their mid-twenties all the way to users in their mid-nineties. 

Get in Touch

We have supported multiple ILD centres to deliver digitally-enabled care pathways and would be happy to share our experience and insights.  If you are considering a digital care approach and want to discuss issues like care equality and patient suitability further please get in touch at: info@patientMpower.com