Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And we have an exciting thought leader panel for you today highlighting gerontechnology. In this panel, we have Dr. Lee Lindquist. She's the chief of geriatrics and will be moderating today's episode.

Joining Dr. Lindquist will be Alaine Murawski, she's a researcher; Dr. Alex Petrakos, she's an Assistant Professor of Geriatrics; and Dr. Jennifer Woodward, she's also an Assistant Professor of Geriatrics. Dr. Lindquist, I turn it over to you.

Lee Ann Lindquist, MD (Moderator): Thanks, Melanie. So, I'm Dr. Lindquist, and we represent Northwestern Geriatrics. And I just got to say, I am delighted to be around you guys. You guys are the best team.

Jennifer Woodward, MD: So excited to be here.

Alaine Murawski: Yeah. Thank you.

Lee Ann Lindquist, MD (Moderator): So today, we're going to be talking about gerontechnology, and that is a real word. Look it up. It's about geriatrics, gerontology, and how we can use technology to support our older adults.

So therefore, I'm surrounded by my favorite Northwestern geriatrics team. We have a social worker, Alaine Murawski. We have Dr. Alex Petrakos and Dr. Jen Woodward. So first off, I want to talk a little bit about the projects that we're doing, because we all are doing different technology to support older adults.

So, I'll start it off with Dr. Petrakos, and let's hear what you're doing for helping older adults.

Alexandra Petrakos, MD: Sure. I have had the pleasure or the honor of receiving a Bedside Scholars Award to learn how to use point-of-care ultrasound, which is bedside ultrasound, to help us basically augment our home care physical exam. And so, this has been really exciting. I had no experience with point-of-care ultrasound before this, so I was able to use my award to go get trained and learn how to do point-of-care ultrasound, and now introduce that into our home care program. So obviously, homebound older adults have limited access to care.

We can do some in-home testing, laboratory work, some imaging. But none of that can really be done in an expedited way. And so, having the point-of-care ultrasound allows us to check things kind of in the moment during the physical exam that we otherwise would either have to send out for and get results in several days, or if we're worried about the patient, send them to the emergency department, which is the place that nobody wants to be.

So, that's been exciting to even check for like bladder exam for urinary retention or check for pleural effusion on lung exam, pneumonia for lung consolidation. Obviously, you can slap the probe on the chest and do cardiac exam, which I'm still working on. And this is just like a drop in the bucket of what you can do with point-of-care ultrasound. So, that's been exciting to be learning how to do that and bringing that to our homebound patients in our program.

Lee Ann Lindquist, MD (Moderator): And then, also to be teaching it to the next generation of learners.

Alexandra Petrakos, MD: Well, yes. We're developing a whole—that is very exciting. You know, there's a lot of interest in point-of-care ultrasound because it's so easy to use. It's so small, you can carry it with you anywhere. Learners want to learn how to do point-of-care ultrasound. And so, that's been really wonderful. Also with this award funding, I've been able to develop a curriculum to teach our internal medicine residents basically how to do a best practice exam of patients with agitated dementia, and that includes using point-of-care ultrasound to augment the exam. So, the technology is sneaking in everywhere.

Lee Ann Lindquist, MD (Moderator): I love that. I just love your project. And to even help people that you can't get them to come in and maybe you can't get them or you can't get to their home. Dr. Woodward, you want to talk about how you use technology in your care of older adults?

Jennifer Woodward, MD: Yeah. So, technology's really beneficial in improving access to care. So especially for patients who live in underserved areas, or they can't get into the clinic or the city, we have started at Northwestern a geriatrics virtual memory clinic, where we will see patients who have cognitive issues or concerns, who need testing, who need diagnosis of dementia, management of dementia.

We have a social worker who helps with resources and support for their caregivers, and we do it all from the comfort of their home. So, we see the patients through telehealth, so they just pop us up on their smartphone or their tablet or their computer, and we can add in their family members from anywhere in the US or anywhere in the world actually, if they have a smartphone. And so, their family can be involved in the visits, and we kind of take the visits to them with technology.

Lee Ann Lindquist, MD (Moderator): That's fantastic. And it is serving so many people that might not want to come downtown Chicago or might not have access to a geriatrician to help them with their memory.

Jennifer Woodward, MD: Or patients who are sort of resistant to having the evaluation, right? So, maybe the families know something's going on, and they just can't convince them to come in for the visit, but they're much more likely to want to see somebody in their own homes.

Lee Ann Lindquist, MD (Moderator): So, let me follow up with how does a person get ahold of a virtual memory consult?

Jennifer Woodward, MD: So, they would just call our clinic, 312-695-4525, and we can get them scheduled.

Lee Ann Lindquist, MD (Moderator): And it's for anybody all over the state of Illinois?

Jennifer Woodward, MD: Anybody all over the state of Illinois.

Lee Ann Lindquist, MD (Moderator): That is fantastic. Yeah, we're reaching out everywhere with technology.

Jennifer Woodward, MD: Yeah, technology.

Lee Ann Lindquist, MD (Moderator): And I notice you talked about a social worker that you work with. One of my favorite social workers is Alaine Murawski, who is a social worker researcher. And I know we have NIH funding to help support older adults and their family caregivers using AI technology. Everyone loves AI.

Alaine Murawski: I know. It's a new thing.

Lee Ann Lindquist, MD (Moderator): So, tell us more about that.

Alaine Murawski: Yeah. So, this project that I'm working on is called NegotiAge. It's for family caregivers of older adults with dementia. So, we developed this AI-based training program for caregivers to go through so they can practice negotiations or conflict that they may experience when they're caring for an older adult. So, this could be conflict that they're having with the person they're caring for, conflict with other family members, or even discussions with a doctor that may have conflict.

So, we generated this with an interdisciplinary team, with computer scientists, AI experts, and we also had a family caregiver panel help us create this negotiation training that caregivers can use. So, we really designed it around caregivers. It's quick, easy. They can leave and come back if they wanted to. Really just set it up so that family caregivers can learn how to navigate different difficult things that they may experience while caring for an older adult.

Lee Ann Lindquist, MD (Moderator): And what's great about it is that we actually use artificial intelligence, so there's avatars that they can negotiate against.

Alaine Murawski: Yes. So, part of the training is they go through an AI program called IAGO. I won't get into the weeds on that, but it's a negotiation where they are practicing with an avatar. What I think is interesting about the AI program is that it factors emotions into it. I'm sure that you guys are all aware when dealing with people, sometimes when it involves care and decision-making, there's an emotional history there, so this IAGO factors that in so that they can practice and learn how to navigate the emotions that often occur with these conflicts.

Lee Ann Lindquist, MD (Moderator): And I know we've had heard some, like, early feedback from people that have used it, and I was hoping that you brought with some quotes.

Alaine Murawski: I did. I brought some quotes. So yeah, we had family caregivers go through this training program, and then we asked them for feedback. We had a lot of positive feedback. A lot of people said that it was easy to use. They felt the scenarios that they had were relevant to what they were actually experiencing as caregivers. It helped empower them.

One quote that really stood out to me, as I was preparing for this, is someone said, "This training made me understand the reasons for older adults' reluctance to accepting home-based care and how we can reach mutual beneficial decisions." Someone else said that, "Realizing that caregivers can utilize negotiation skills was novel and gave me a fresh perspective as my role as a caregiver." So positive feedback so far.

Lee Ann Lindquist, MD (Moderator): Yeah, that's fantastic. And especially when you see research be used in real world.

Alaine Murawski: Yes.

Lee Ann Lindquist, MD (Moderator): So, how do people get into this website or this NegotiAge?

Alaine Murawski: Yes. So, anyone can go to negotiage.com, N-E-G-O-T-I-A-G-E.com, and they have access to some resources that we have. We also created videos with Dr. Lindquist, and some business experts about how to plan for a negotiation and a planning document that they can utilize of how to plan for a negotiation as well. So, anyone can go to that website and access that information.

Lee Ann Lindquist, MD (Moderator): That's fantastic. I'm a little biased, though.

Alaine Murawski: Yeah.

Lee Ann Lindquist, MD (Moderator): And I will tell you the other project that we've been doing here at Northwestern that uses gerontechnology is our Oculus 3D for older adults. And Dr. Petrakos and I have been playing with the Oculus 3Ds until we're nauseated. But it's fantastic. I think it's really unique that we can use technology for older adults because many times we hear people saying older adults can't use technology, they don't use technology, and everyone at the table knows that's not true at all.

Alaine Murawski: Not true.

Lee Ann Lindquist, MD (Moderator): No. We see older adults using more and more technology. So, what we decided to do is we convened a group of people and, you know, some older adults, some youngsters that were computer, you know, experts, as well as geriatricians and geriatric nurse practitioners. And we all asked, you know, here's an Oculus 3D, which is a virtual reality headset, and we said, "Which of these programs that are out there would actually be best for geriatrics or help people who have different geriatric syndromes?"

And so, we published an article on it, and we're going to be looking at how we can test it in people who are homebound or maybe don't get out as much. But it's really cool to see how you can have somebody be in their home, but then also experience, you know, a walk in Paris or a walk through the Art Institute, which is using technology to really help support older adults.

So, we have a bunch of questions here. And so, one of the fun questions is, what role does technology play in preventing hospitalizations? So, what do you think about that?

Alexandra Petrakos, MD: Yeah, I can talk about that. I think that's part of what we're most excited about using point-of-care ultrasound in the home, is to have kind of in-the-moment testing to help us come up with a accurate diagnosis and guide clinical decision-making and minimize the need to send patients to the emergency department or to seek hospitalization. Because if we can get information in real time using technology, we can come up with a plan that prevents patients from having to go to the hospital.

Lee Ann Lindquist, MD (Moderator): No, I love it. I love it. So, here's another fun one. How are you seeing older adults currently use technology?

Jennifer Woodward, MD: Oh, I can take this one. So, I think there are lots of ways that technology can help us age in place and to be more independent, which I think is what everybody really is interested in. So, this comes along with having automatic pill dispensers, ones that now can connect via technology with your pharmacy and can dispense medications. We can have AI companionship, so they'll do calls to check in on you. You can have AI that looks in your refrigerator to make sure the food is not spoiling.

So, there are so many adaptive devices that happen from technology. We have fall prevention devices. So if you're living by yourself, instead of the old, like, "I've pushed the button because I've fallen and I can't get up," now it will detect the fall if you're unconscious and call for you. So, I think AI and technology is helping older adults stay in their homes longer and stay safer and more independent.

Lee Ann Lindquist, MD (Moderator): Yeah. And I do think that it's also helping their family members feel more comfortable about their remaining the same.

Jennifer Woodward, MD: Absolutely. Yeah.

Lee Ann Lindquist, MD (Moderator): And I love it when my seniors are wearing, you know, their wearable device. You can take your pick of your favorite. And people will say, "Hey, you haven't moved as much. Why are you only on 3,000 steps? You should be at 5,000." Or, you know, "I got an alert that you're here. Are you okay?" So, I love how it supports seniors as well as supporting family members who, let's be honest, we all have somebody we worry about at some point, you know?

Jennifer Woodward, MD: Yeah, we want to keep them safe and keep tabs on them.

Lee Ann Lindquist, MD (Moderator): So, one of the fun questions that got posed is where do you see the biggest barriers to adoption among older adults of technology? And what makes me laugh a little bit is that it's not so much the seniors don't want the technology. I see oftentimes that the younger population says, "Oh, seniors won't be able to handle it" or "Let's not do it with seniors." Because I know even in our Oculus project, there were some people that said, "Oh, if you put a headset on them, they'll get confused or they'll fall down." And you're like, "We've shown that people can use VR." Same with like, you know, should we use different apps for people? And we know that seniors can use appS.

One of the fun things I see is that most of our technology is built for the younger audience, so everything is in small print, it's got small fonts. And even the instructions are not really made or tailored for older adults. So, a project we did a while ago was looking at how we could make Amazon Alexa, and I'm sure all of us have seen the SNL cartoon about that. But how we can make it actually more accessible to older adults. And so, that was a fun project that we did a while back with Dr. Katie O'Brien.

So looking ahead five to 10 years from now, what innovation do you believe will transform the way we care for older adults, and what should health systems be doing now to prepare and support healthy aging, healthy living, both of those? We all kind of joked at this.

Jennifer Woodward, MD: We did kind of joke, because I said, "I think it's going to be like robots and flying cars and The Jetsons." But really, I do think we are probably moving more towards, like, automatic companions, and, you know, we have the little dementia puppy dogs that move and talk because they're little robotic.

But I think hopefully in the next five to 10 years where we're really moving is for more innovation and more devices that just help people age better and stay safe and stay independent and stay in their home.

Lee Ann Lindquist, MD (Moderator): Absolutely.

Jennifer Woodward, MD: Yeah.

Lee Ann Lindquist, MD (Moderator): The other thing I think about is when you think about health systems, and a health system like Northwestern, you know, we've got Epic. It's a large EHR, or electronic health resource, and I love it when their seniors are out there, and I have a couple who are in their hundreds, who are actually messaging me through my chart. And you're smiling, because you get those too.

Yeah. So, I love it when health systems are being built and having services that are offered universally. So, people are not saying, "Oh, my 99-year-olds wouldn't be able to handle this technology. Let's, you know, not give it to them." Give it to them. Let's see if they can use it. I don't think we should exclude older adults from using technology. Thoughts on what we'll be doing in five to 10 years?

Alexandra Petrakos, MD: I think, to your point, the technology has to be developed in a way that it is accessible and user-friendly, and are there going to be kind of systems in place to help teach how to use that technology, right? To anybody. Everyone. You know, there's a learning curve for everyone who's going to try to use any kind of new technology. And so, that's something, I don't know, that I've kind of run into with patients in clinic, for example, who are very eager to learn how to use, butthey aren't going to be able to teach themselves. And, you know, there are some supports in the community that can help guide that, but I would like to see more of that, and maybe developed by Northwestern, right?

Lee Ann Lindquist, MD (Moderator): Absolutely. So, Northwestern Geriatrics, super strong program, and we do a lot with gerontechnology. One of the best stories that I've heard from you was when we were doing the Oculus project, and one of your relatives who's a little bit, you know, older, started going wild.

Alexandra Petrakos, MD: My sweet mother-in-law, Cynthia. She loved the Oculus. She was all over the different games. And, you know, she's an embracer of technology, and it's wonderful. And she put it on, and she loved it, you know? It was entertaining. It was fun. It gave her an opportunity to try something different. And for me, that was, like, eye-opening, right? People can do this. People can do it.

Lee Ann Lindquist, MD (Moderator): And for those that always have a little bit of problem with technology, or maybe they don't feel the most comfortable, I love recruiting the grandkids. And I have two teenagers that love Oculus, that, you know, play different things, and they always kind of share it with their grandparents and say, "Look what we're doing." And both of them are, like, in their 70s and 80s. And so, it's kind of fun to see this intergenerational play where people that are younger, that have had technology their entire life are engaging older adults. And so, there's a good socialization there. So, I don't necessarily think that AI is going to completely replace human contact. As much as I think it would support it, I don't think the next podcast of geriatricians will be four robots.

Alaine Murawski: I do not.

Lee Ann Lindquist, MD (Moderator): But what do you think about technology in the home?

Alaine Murawski: I think technology is obviously where everything is headed, and so we have to acknowledge it. And I also think, going back to a point that, Dr. Petrakos mentioned earlier, I think we also have to, when we create programs for older adults, have accessibility in mind. I mean, that's what we did with NegotiAge, is really try to lay it out so that someone older could navigate through it. Instead of just making technology, making sure that we have older adults in mind when we're making it.

Lee Ann Lindquist, MD (Moderator): There's family caregivers who are spouses who might also be in their 70s or 80s.

Alaine Murawski: Yes.

Lee Ann Lindquist, MD (Moderator): And what I love about NegotiAge is that the AI avatars will give you emotion, will say you don't know anything. So, they mimic so much the daily conversations, and we heard that so many times during the study.

Alaine Murawski: Yes. And so when you're talking about technology in the home, I think that's kind of where it's going, is making sure that we're making things in the home for older adults.

Lee Ann Lindquist, MD (Moderator): That's fantastic. That's fantastic. So, I want to thank all four of us, including myself, all three of you guys for coming and discussing gerontechnology. Look it up. It's a real word. And thank you for listening. And feel free to visit us at Northwestern Geriatrics. Our phone number is 312-695-4525. Thank you very much.

Melanie Cole, MS (Host): Thank you all so much for such a lively discussion. To refer your patient, or for more information, please visit our website at breakthroughsforphysicians.nm.org/geriatrics to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole.