Home > RNJ > 2007 > July/August > Editorial: Transcending Dependence with Technology

Editorial: Transcending Dependence with Technology
Elaine Tilka Miller, DNS RN CRRN FAHA FAAN Editor

More than 100 million Americans experience one or more chronic illnesses. Of these, approximately 30 million residing at home experience some degree of dependency on others for basic activities of daily living (ADLs) (Wolff, Boult, Boyd, & Anderson, 2005). Plus, as the severity of chronic conditions increases, the necessity for closer monitoring and dependency on others generally grows. A careful examination of costs associated with chronic illness further reveals that these costs account for greater than 75% of total healthcare costs and affect seniors more than any other age group (Wolff, Starfield, & Anderson, 2002).

For those living at home, one partial solution to the need for consistent monitoring and healthcare provider (HCP) intervention rests with recent technology advances such as telemedicine and other home-based communication systems. Research is expanding in the area of home-based technological systems that will enable patients and their families to maintain meaningful lives despite the challenges posed by chronic illness and increased rates of survival from formally deadly diagnoses such as HIV, heart disease, cancer, and stroke. In addition, home based technologies that focus on prevention and early detection of problems have improved patient adherence to discharge plans of care, monitoring patients in homes (e.g., vital signs, glucose levels), and emergency response, when older adults fall or have other healthcare crises.

Today, more and more companies are exploring ways that technology may assist those who are aging and those with chronic illnesses. For instance, Intel’s Proactive Health Research Group is exploring devices that will help with medication compliance, smart furniture that can recognize and record human activities, sensor networks to monitor falls and accidents, and smart appliances that will help encourage proper diet. These systems will assist caregivers and families to know when medications are missed, when there is little to no activity in the home, and for adult children to monitor from afar. The ultimate goal is to “develop proactive systems that can anticipate a patient’s needs and improve the quality of life for both patient and caregiver” (www.intel.com/research/prohealth/ cs-aging _in_place.htm, p.2).

Increasingly home-based systems are being designed to assist individuals with mild cognitive losses to remember names, past conversations with family members, and maintain social contact through telephone visual displays, personal computers, PDAs, or other home network systems. However, an awareness and openness by HCPs to new advancements and additional collaboration with major stakeholders such as patients/families, developing communication technology companies, governmental agencies, and healthcare insurers is crucial if they are to be fully prepared for the future. By forming these collaborative partnerships, a more comprehensive understanding can be obtained regarding how technology can help prevent falls, identify signs/symptoms of worsening conditions, foster greater independence related to ADLs and instrumental ADLs, and improve overall quality of life.

What is the role of rehabilitation nurses in this process?

  1. We must open our eyes to what is possible with the technological aids we now have and will have in the near future. That means keeping abreast of new communication technologies and monitoring systems, reading journals and publications outside our field, and familiarizing ourselves with some of the pilot work that has already begun.
  2. We need to be early adopters of these technologies, because our patients are often those with the greatest need for “connection” to their families, friends, and healthcare providers. Consider the articles in this issue of RNJ. For example, how might new technologies assist with monitoring and maintaining connectivity to patients following hip fractures, stroke, cardiac rehabilitation, and the loneliness associated with multiple sclerosis? Rehabilitation nurses should be knowledgeable regarding the evaluation of the applicability and efficacy of new technologies for our home-based patients.
  3. We should realize that in-home communication technologies will make our jobs easier, will make us more productive, and make us more effective with patients, families, and other practice disciplines. As a professional group, we need to be proactive, rather than reactive, to what is occurring.

Nurses, by the nature and scope of our practice, frequently obtain the most holistic view of our patients and their families as we prepare them for discharge. Being in tune with technological advances that will facilitate independence in a safe environment is an important and exciting aspect of our professional role.


Health research and innovation. Retrieved March 27, 2007from www.intel.com/research/prohealth/cs-aging _in_place.htm.

Wolff, J. L., Boult, C., Boyd, C., & Anderson, G. (2005). Newly reported chronic conditions and onset of functional dependency. Journal of American Geriatric Society, 53, 851–855.

Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162, 1211–1221.