Gary Rothenberg, DPM

Living with diabetes is difficult for people in any stage of life, but it can get even tougher as patients get older and start to face the additional challenges brought on by aging. Poorly controlled diabetes can contribute to — and feed off of — other clinical and socioeconomic comorbidities, ultimately leading to lessened independence, worsening mental health and an overall decline in quality of life.

Staying ahead of diabetes and its complications is crucial for preventing this snowball effect in the older adult and geriatric populations. As more and more baby boomers enter these categories, remote patient monitoring (RPM) has quickly become a valuable solution for helping partner with older people in the management of diabetes.

RPM devices, such as wireless scales, connected blood pressure cuffs, continuous glucose monitors (CGMs) and temperature monitoring mats, have the potential to help people with diabetes improve their health while becoming more empowered and more connected to their care. But they are only effective when accessible to populations in need and deployed correctly as part of an innovative and comprehensive care ecosystem.

The key is architecting that ecosystem in a way that keeps patients at the center of their care by strategically incorporating the three “E’s” of successful diabetes care for older people: Education, Engagement and Empathy.

Education: A foundation of knowledge upon which to build long-term adherence

For people with chronic conditions, education has to go far beyond sending them home with a long-form, printed user manual for a new gadget. Patient education has to be delivered in a manner that accounts for each person’s health literacy level, self-care capacity, and complexity of their health status.

For example, many people with diabetes are unaware that approximately 20% of moderate or severe foot infections can lead to lower-limb amputations — and when that happens, their risk of five-year mortality increases by 250%. While one patient might find it motivating to hear this information point-blank, another may find it frightening, which could increase the risk of disengaging from further interactions.

The first patient might do well with a bulleted fact sheet and a check sheet of instructions, while the second is likely to benefit from time with an educator who can answer questions, provide reassurance, and guide them through optimizing their care routine. 

The same principles can be applied to the tech-savvy and the tech-averse when providing RPM devices. While not all older people fall into the second category, there are still many who will need robust, ongoing support through the phases of adoption if they are to see value and continued use of digital tools. 

Healthcare stakeholders need to start with devices that are user-friendly and offer reliable connectivity and meaningful data outputs. On top of that, RPM education should break down clinical and technical concepts into their simplest components, utilize strategies such as visualizations and video guides to encourage learning, and provide an appropriate degree of context so patients understand the “why” behind the reason they are using certain devices to support their health.

Engagement: Making tech matter for elderly individuals with diabetes

Comprehensive education can start people down the path to sustained engagement — as long as it doesn’t stop abruptly as soon as onboarding is complete. Clinicians and health plans need to foster continued relationships with patients, especially elderly people who are more likely to experience social isolation and frequently struggle with socioeconomic barriers to care

Engagement points should be built into the technology itself, such as giving the user a check mark or motivational message when they complete their care routine for the day. It can also take the form of regular outreach by diabetes coaches, digital delivery of weekly or monthly data reports, and patient-facing portals that use humans or chatbots to answer basic questions and triage more complex concerns to the right clinical or administrative contact.

Caregivers are also an underutilized point of engagement for the aging population. Oftentimes, both paid and unpaid caregivers have a deep understanding of the patient’s strengths, weaknesses, and communication style and can provide “interpretation” services that educate, motivate, and inspire patients to stay on track.

Empathy: Finding what truly makes a difference to each unique individual

Older adults may be hesitant to have RPM technology in their homes for a wide variety of reasons, including fear of the unknown, concerns over privacy and data security, or feelings of being overwhelmed or defeated by their poor health status.

Clinicians and health plans must make an effort to understand and validate each person’s feelings through strategies such as motivational interviewing. By focusing on working through fears and identifying goals, staff and patients can work together to achieve better outcomes through personalized motivators.

For example, a 92-year-old patient with multiple comorbidities wasn’t eligible for vascular surgery to get a limb-threatening infection under control. Many patients in that situation might accept the loss of mobility and decreased quality of life. But this patient was the water aerobics instructor at her senior village in Florida, and she was determined to get back to teaching. The thought of returning to the pool kept her committed to slow and steady treatment over the next nine months, using a patient portal between visits and a CGM device to help her providers work with her closely — and she proudly sent her providers pictures of herself with “the  girls” when she was finally cleared for swimming again.

By combining empathic relationships with personalized education and meaningful opportunities for engagement with RPM devices and the care continuum, providers and health plans can effectively collaborate with older adults to proactively manage diabetes. With the number of elderly people with diabetes set to grow significantly over the next decades, developing these strategies now can position providers, payors, and patients for success with achieving shared goals and creating the optimal conditions for even brighter golden years for aging patients living with diabetes.

Gary Rothenberg, DPM, is director of medical affairs for Podimetrics. He is a board-certified podiatrist with more than 20 years of experience that includes academia, clinical practice and research. He serves as an assistant professor of internal medicine in the Division of Metabolism, Endocrinology, and Diabetes at the University of Michigan.