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Telemonitoring in Older Adults: Does One Size Fit All?

Telemonitoring in Older Adults: Does One Size Fit All? The study by Takahashi et al1 provides useful information about the effectiveness of telemedicine. We believe that their negative results, although in line with others reported in the literature, should nonetheless be interpreted while taking into account some issues, the most evident being that the much higher mortality in the intervention group casts doubts on the real comparability of the study arms. Furthermore, the population studied was heterogeneous with respect to the main disease. The experience with comprehensive geriatric assessment, however, clearly demonstrates that elderly and frail patients benefit from a strategy of care tailored to individual needs.2 There is no reason for thinking that such a conclusion does not apply to telemonitoring. In addition, the efficacy of telemonitoring may change according to the main disease: despite some negative trials, a recent Cochrane review indicates that in patients with congestive heart failure, telemonitoring is effective in reducing the risk of all-cause mortality and congestive heart failure–related hospitalizations.3 The lack of focus on a specific disease may also reduce the capacity of the telemonitoring team of detecting changes in health status. For example, symptoms of chronic obstructive pulmonary disease exacerbation may be aspecific4 and may be missed by study personnel not specifically trained for (tele)assisting people with this disease. The lack of specificity of the study is also reflected in the top-down application of existing technologies to monitor patients regardless of their individual characteristics. A recent qualitative study shows that early detection of acute deterioration is not effectively achieved by current telemonitoring systems because telemonitoring is driven by available technology rather than by users' needs.5 In conclusion, this study adds to our knowledge on telemonitoring by indirectly suggesting that homogeneous populations, ie, sharing the main disease, should be the target of these interventions, or, otherwise, the protocol and the technology used should be sufficiently elastic to tailor the telemonitoring to highly different individual needs. Back to top Article Information Correspondence: Dr Pedone, Area di Geriatria, Università Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy (c.pedone@unicampus.it). Conflict of Interest Disclosures: None reported. References 1. Takahashi PY, Pecina JL, Upatising B, et al. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Arch Intern Med. 2012;172(10):773-77922507696PubMedGoogle ScholarCrossref 2. Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d655322034146PubMedGoogle ScholarCrossref 3. Inglis SC, Clark RA, McAlister FA, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010;(8):CD00722820687083PubMedGoogle Scholar 4. Incalzi RA, Fuso L, Serra M, et al. Exacerbated chronic obstructive pulmonary disease: a frequently unrecognized condition. J Intern Med. 2002;252(1):48-5512074738PubMedGoogle ScholarCrossref 5. Peirce SC, Hardisty AR, Preece AD, Elwyn G. Designing and implementing telemonitoring for early detection of deterioration in chronic disease: defining the requirements. Health Informatics J. 2011;17(3):173-19021937461PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Telemonitoring in Older Adults: Does One Size Fit All?

Telemonitoring in Older Adults: Does One Size Fit All?

Abstract

The study by Takahashi et al1 provides useful information about the effectiveness of telemedicine. We believe that their negative results, although in line with others reported in the literature, should nonetheless be interpreted while taking into account some issues, the most evident being that the much higher mortality in the intervention group casts doubts on the real comparability of the study arms. Furthermore, the population studied was heterogeneous with respect to the main disease....
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References (6)

Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2012.4415
Publisher site
See Article on Publisher Site

Abstract

The study by Takahashi et al1 provides useful information about the effectiveness of telemedicine. We believe that their negative results, although in line with others reported in the literature, should nonetheless be interpreted while taking into account some issues, the most evident being that the much higher mortality in the intervention group casts doubts on the real comparability of the study arms. Furthermore, the population studied was heterogeneous with respect to the main disease. The experience with comprehensive geriatric assessment, however, clearly demonstrates that elderly and frail patients benefit from a strategy of care tailored to individual needs.2 There is no reason for thinking that such a conclusion does not apply to telemonitoring. In addition, the efficacy of telemonitoring may change according to the main disease: despite some negative trials, a recent Cochrane review indicates that in patients with congestive heart failure, telemonitoring is effective in reducing the risk of all-cause mortality and congestive heart failure–related hospitalizations.3 The lack of focus on a specific disease may also reduce the capacity of the telemonitoring team of detecting changes in health status. For example, symptoms of chronic obstructive pulmonary disease exacerbation may be aspecific4 and may be missed by study personnel not specifically trained for (tele)assisting people with this disease. The lack of specificity of the study is also reflected in the top-down application of existing technologies to monitor patients regardless of their individual characteristics. A recent qualitative study shows that early detection of acute deterioration is not effectively achieved by current telemonitoring systems because telemonitoring is driven by available technology rather than by users' needs.5 In conclusion, this study adds to our knowledge on telemonitoring by indirectly suggesting that homogeneous populations, ie, sharing the main disease, should be the target of these interventions, or, otherwise, the protocol and the technology used should be sufficiently elastic to tailor the telemonitoring to highly different individual needs. Back to top Article Information Correspondence: Dr Pedone, Area di Geriatria, Università Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy (c.pedone@unicampus.it). Conflict of Interest Disclosures: None reported. References 1. Takahashi PY, Pecina JL, Upatising B, et al. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Arch Intern Med. 2012;172(10):773-77922507696PubMedGoogle ScholarCrossref 2. Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d655322034146PubMedGoogle ScholarCrossref 3. Inglis SC, Clark RA, McAlister FA, et al. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010;(8):CD00722820687083PubMedGoogle Scholar 4. Incalzi RA, Fuso L, Serra M, et al. Exacerbated chronic obstructive pulmonary disease: a frequently unrecognized condition. J Intern Med. 2002;252(1):48-5512074738PubMedGoogle ScholarCrossref 5. Peirce SC, Hardisty AR, Preece AD, Elwyn G. Designing and implementing telemonitoring for early detection of deterioration in chronic disease: defining the requirements. Health Informatics J. 2011;17(3):173-19021937461PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 12, 2012

Keywords: older adult

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