Involving artificial intelligence technologies in the care of older people: the future of healthcare

Posted on 14th October 2022 by Jehath Syed

In 2020, it was estimated that globally, 727 million people were aged 65 or over. This is expected to reach 1.5 billion by 2050, with a projection of a 250% increase in the underdeveloped or developing countries, with India’s older persons population projected to exceed 227 million. (1,2)

The increase in the number of older people may be due to demographic transition meaning a reduction in mortality and a reduction in fertility. This demographic transition not only results in disproportionality across all age groups, but also adds burden to the society as it would cause relative reduction in the proportion of children and an increase in the share of people in the main working age and older person’s groups. Also, this disproportionality may be the result of advanced healthcare and its access, and reduction in the rate of death and illness from parasitic and other microbial infections. (2,3)

Why are we concerned about an ageing population?

Most of the older population live with multiple chronic conditions as a part of ageing and the lifestyle adopted. Furthermore, there is a consequent increase in the prevalence of ‘geriatric syndromes,’ which has resulted in poor health outcomes, disabilities, mortality, and hospitalization/ institutionalization rates. (4)

The gradual decline in activities of daily living (ADL) among almost 30% of older patients with an acute medical condition worsens the pre-existing condition. The limited cognitive or physical ability among the older population causes failure in their ability to present their illness and symptoms. Often these patients experience deterioration of mental or physical health during their hospital stay. An estimated 60-fold increased risk is identified among  hospitalized older patients to develop permanent disabilities, which may make them more predisposed to other adverse outcomes. (4) The changes due to the normal ageing process impacts both the pharmacokinetic and pharmacodynamic parameters of the drugs making the older person more vulnerable and susceptible to adverse drug reactions (ADR) with the use of potentially inappropriate medications (PIMs), (5) with its prevalence being around 11.5 to 62.5%. (6)

The estimated percentage of ADR-related hospital admission in older patients is approximately 11%, with one in ten hospitalized patients experiencing an ADR during their hospital stay. (7)

Causes of medication misadventures in the healthcare setting

Medication misadventures are usually the consequence of a lack of communication and loss of information at the point of transition of care during hospital stay. (8,9) It is noted that around 27% of medication misadventures occur during admission in hospitals due to incomplete medical records. (8)

The three factors identified as hindrances during transition of care are:

1. Frequent changes in medications,
2. Poor health literacy,
3. Poor transmission of information among healthcare providers.

These factors may give rise to medication discrepancies or prescription errors, leading to patient harm and increased medication related hospitalizations. (10)

Medication reconciliation

Medication reconciliation is effective in reducing medication irregularities and errors, and reducing and correcting clinically relevant medication errors, thereby promoting and improving patient safety. Study results have shown more than 25% of the identified medication errors had potential clinical impact which could have been reduced by a reconciliation process. (11)

Medication non-adherence

Another cause of approximately 10% of the hospitalizations is medication non-adherence, which contributes to an estimated avoidable healthcare cost of 300 billion USD in the United States alone. With the increase in age, chronic diseases become more prevalent, and the increased volume and complexity of medication regimens leads to an increased risk of medication non-adherence. Among older people, other factors also play a role in increasing the likelihood of medication non-adherence, which includes polypharmacy, decreased visibility, motor dexterity, and decreased autonomy. (12)

Medication non-adherence may be associated with poor therapeutic outcomes, disease progression, increased healthcare utilization and an estimated burden of billion dollars per year in avoidable direct healthcare costs. (13)

Non-adherence may be attributed to a set of behaviours including both intentional and unintentional causes. Unintentional nonadherence refers to a non-deliberate alteration in treatment which could be due to forgetfulness, poor manual dexterity, losing medication or economic reasons. On the other hand, intentional non-adherence is the deliberate alteration in treatment which is largely associated with lack of patient motivation. (14)

Belief about the medicines

Two possible factors that may predict medication non-adherence are patient’s belief about their medicines coupled with their health literacy. The patient’s belief about the necessity of taking their medicines, and concerns regarding their medicines, have shown to predict the patient’s adherence to medicines. A stronger belief in the necessity or concern regarding the medicines is significantly associated with high adherence. Therefore, it is essential to assess the medication belief to understand the adherence behaviour among chronic medication users. (15)

Health Literacy

Similarly, adequate health literacy is associated with high medication adherence in older people with chronic diseases. Health literacy is an individual’s ability to obtain and understand the basic health information and services needed to make appropriate decisions regarding their health. (16) According to reports published in ‘The Tribune India’ (17):

In India, at least 9 out of 10 adults suffer from low health literacy. It is reported that even in the US and the UK, more than 50% of the people have low health literacy and the ‘cost of ignorance’ is about 200 billion USD in the US alone.

Advances in older person healthcare

The advancements in healthcare involve artificial intelligence (AI) to promote better patient safety. AI in healthcare is utilized for better prevention, diagnosis, and treatment of disease. AI is also incorporated in cancer detection, disease management, other patient safety factors, and clinical decision support (CDS) alerting systems. These assist the clinicians in making decisions, improving patient-care monitoring and, ultimately, improving the clinical outcomes. ^[4,18]

Examples of these are:

• Early screening of dementia to identify early cognitive impairments (4)
• Early screening of other geriatric health problems, such as fall risk, (19) frailty index, (20) and urinary tract infection (UTI) in patients with dementia (21)
• Early identification of ADR occurrence during hospitalization (7)
• Creating medication reconciliation lists faster and preventing any discrepancies, thereby, reducing the burden on clinicians. (22)

In conclusion, exploring AI in healthcare for the older person that involves the multidisciplinary healthcare team and AI technologies will not just aid in improving patient safety but also reduce the medication misadventures and promote better ageing.

References (pdf)

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