Using Smart Displays to Implement an Evidence-Based e-Health System for Older Adults with Multiple Chronic Conditions

This project will test the ability of voice-controlled “smart” technology to deliver an already proven electronic health system (Elder Tree, or ET) for older adults with multiple chronic conditions.

Multiple chronic conditions (MCCs) are a costly, pervasive problem for older adults, accounting for 90% of Medicare spending. Among Medicare beneficiaries, 65% have 3 or more chronic conditions, such as diabetes and hypertension, and 23% have 5 or more. MCCs are often addressed in primary care, where time pressures prevent focusing on self-management skills—although such skills are crucial for living successfully with MCCs.

An AHRQ-funded P50 supported the development and testing of Elder Tree (ET), an eHealth intervention designed for older adults. ET provides tools, motivation, and support on a laptop platform to help patients (and their clinical team) manage their health. The intention-to-treat RCT found that among patients with MCCs using higher levels of primary care, quality of life and symptom presence were significantly improved for those using ET versus a control group with general internet access. Moreover, our current and past research has found that the more ET (and related programs) are used, the more a patient benefits. Yet, despite ET’s benefits, many patients in the P50 RCT did not use it extensively. This is a common problem. Of more than 300,000 health apps on the market in 2017, only 40 were frequently downloaded, and of those the average retention was just 29% after 90 days. This engagement challenge is even greater for older adults, due in part to interface complexity, lack of device literacy, and physical limitations such as tremors and poor vision.

The central question of this proposal is whether adapting and delivering ET with voice-controlled technology can expand and sustain the use of the system by older adults with MCCs, improving quality of life and health outcomes even more than ET on a laptop.