On this episode of Digital Squared: From the Archives, Tom revisits his 2021 conversation with Dr. Heather Young, National Director for Betty Irene Moore Nurse Fellows in Leadership and Innovation Program and the Founding Dean Emerita for the School of Nursing at University of California Davis. Together they discuss new approaches to promote healthy aging, the changing interface between older adults and healthcare providers, and the challenges we face going forward ensuring healthcare equity in a world increasingly enabled through technology and data.
On this episode of Digital Squared: From the Archives, Tom revisits his 2021 conversation with Dr. Heather Young, National Director for Betty Irene Moore Nurse Fellows in Leadership and Innovation Program and the Founding Dean Emerita for the School of Nursing at University of California Davis. Together they discuss new approaches to promote healthy aging, the changing interface between older adults and healthcare providers, and the challenges we face going forward ensuring healthcare equity in a world increasingly enabled through technology and data.
Tom Andriola 00:07
My guest today is Dr. Heather Young, National Director for Betty Irene Moore Nurse Fellows Leadership and Innovation Program, and professor and founding dean emerita for Betty Irene Moore School of Nursing at University of California Davis. Dr. Young promotes healthy aging, focusing on the interface between older adults and family caregivers in the formal healthcare systems. Her research includes family caregiving, person centered and technology enabled care and chronic disease management. She is also a senior policy Fellow at AARP focusing on family caregiving. Dr. Young, thank you for joining us today.
Heather Young 01:03
What a pleasure. Thanks for having me.
Tom Andriola 01:06
Heather, you’ve been a part of looking at the challenges associated with aging and maintaining helping populations. There are a lot of changing demographics in our society that are coming at us. Can you tell us a little bit about those changing demographics?
Heather Young 01:22
Yes, you know, January 1st, this year, 2021, the first baby boomer turns 75. And every eight seconds for the next 30 years, we’re going to have a person celebrating a 75th birthday in this country. I find that to be staggering. It’s the population in California of the over-65 group is going from 14%, now to almost a quarter in 2030. So the population is also becoming more diverse. And societal changes are going to be happening in absolutely every sector with those kinds of changes. And the thing that’s interesting about that, to me is that with aging comes a whole different set of health kinds of issues. Health really happens everywhere. People who’ve survived into their eighth decade of life, have dodged many of the bullets that kill us when we’re younger, and can be solved by high-tech medicine and surgery. So with age and the prevalence of chronic conditions, we’re dealing much more with conditions that require lifestyle change, managing symptoms, such as fatigue, or pain. And the focus really shifts to optimizing function. How do you stay as active and as engaged as possible? And these are the two things that really improve health and wellbeing the most
Tom Andriola 02:37
Heather, you and I’ve talked in the past about what you call holistic care. Can you tell our audience how you define holistic care and how that’s changing in today’s society?
Heather Young 02:49
Yeah, I think of holistic cares as care along a couple of different dimensions. One is it’s really about the whole person is thinking about their physical, their mental, their social and financial wellbeing and taking into account their health needs as well as the social determinants of health. We’ve really seen during the COVID pandemic, a rapid increase of the use of telehealth, and it also highlighted health inequities, we could see with a pandemic, how much the access to things like affordable housing and food and technology affect outcomes in diverse communities. So it’s about seeing the person as a whole. It also is about not medicalizing life, it focuses on health behaviors that promote wellness – things like eating well being physically active, having meaningful connections with others. And in the technology world, there’s really a chasm between what we’re doing in healthcare, like with the electronic health record and medical devices, and what’s happening in the social world with mobile technology, with applications, with fitness trackers. And for the most part, these things are really polarized. And I think to provide more holistic care, we really have an opportunity to bring together the technology from these two worlds. For example, we just finished the project working with people who are living with diabetes, to promote their health. And we use nurse coaches that and mobile health technology activity trackers, for the person to set goals about their life, what they wanted to do to manage their life to improve their health while they’re living with diabetes. And this data that was collected in the social world, if you will, was then integrated into the electronic health record and visualized for the clinicians to see. So that instead of just saying ‘how are we going to manage your medications and change your dose?’ we could also say, ‘Well, how are you doing with your with the walking? how’s it going with your eating?’ And these are really important elements that actually need to change the conversation in our healthcare system, from more a disease focus to more of a wellness focus. And then finally, I think holistic care is inclusive. It’s not just thinking of the individual patient as an isolated entity but in the context of their family, because in our country, one in five households is engaged in family caregiving. And the family members are important members of the healthcare team as well. So if I’m going to really be able to help a person who’s older, I have to engage with their family caregivers as well.
Tom Andriola 05:18
You know, it’s interesting, you bring up the family caregiving part. I was having a conversation with a colleague, and actually telling you a little bit about our conversation today. And he was talking about how, you know, in earlier generations, the concept of a family doctor coming to visit a patient at their home, and how they knew the whole family, right. And then we went to this hospital-centric model where then the patient had to go to the hospital, where it was only an interaction with the patient. And now with the whole movement of telehealth, we’re kind of moving back to more home-based interactions, but more digitally enabled. So it’s kind of an interesting ‘Back to the Future.’ But one where we have to really think about some of the disparities and inequities that are coming with technology.
Heather Young 06:05
Yeah, it’s amazing because as families, we share risk factors, and we share behaviors, as well as providing care for each other. So I really am in favor of thinking about the unit as a bit broader than the individual.
Tom Andriola 06:21
Well, Heather, you bring an interesting set of perspectives, right, because your career has spanned both the policy and the practice associated with health care, you know, family’s role and aging, that as we mentioned earlier, your senior policy fellow with AARP, you’ve been a geriatric nurse, you’ve also been a Chief Operating Officer at a company that ran retirement communities. When we think about technology and data in the future of healthcare and the future of aging, what are some of the positives and hopefulness that you have around the topic? And then what are some of the concerns that you have in terms of the risks of disconnecting patients from their health journey?
07:03
Well, enabling technology can do many things for us, it can foster connection, it can promote wellness, it can monitor chronic health conditions, it can help a person to continue to live longer at home, which is what most people really want to do – by making the environment smart, and it can also improve our systems of care. Currently, I’m co-directing the Healthy Aging in a Digital World Initiative at UC Davis with Tom Nesbitt. And we have a large collaborative group thinking about many levels of technology and data, particularly as it pertains to healthy aging. And there are four main areas. The first is around technologies that we have on our person, such as apps that can record a sleep or heart rate. The second is technologies that are passive in our homes, such as medication reminders, those that can adjust the temperature and security of our home, or monitors to track routine behavior, and provide reminders or alerts when a person falls or doesn’t open their refrigerator to have breakfast. The third area are those technologies that connects us with others, tele and video conferencing, engagement and social media, the internet, the ability to seek information on the internet. And then finally, technologies that produce information to drive decisions. And the population over 65 actually includes three generations with great diversity of backgrounds, current function, health challenges, strength. And there’s so much data and electronic health records that could be used to drive both personal and programmatic decisions. Figuring out what’s the best choice for me, given who I am using data of people who are like me, in other words, precision health, or data to guide program leaders to know what works best for whom and under what conditions. So this converts data into wisdom that actually enables us to get the best outcomes and the most efficiency, adding value to healthcare. So those are the positives. And I think that those really, you know, have a huge amount of potential.
Tom Andriola 09:13
Because I have to ask a question, those four areas are just they’re fascinating, right? The information that we’re collecting there is far beyond what the health system really ever envisioned collecting. How are we going to kind of collect that information and make it personalized for for me as an individual, to help me manage my health going forward?
Heather Young 09:33
This, I think, is one of the most important challenges we have in technology at this point, which is how do you integrate disparate sources of data that there are so many sources that I’ve mentioned above, and if we really actually turn it into improving health for an older person living in their home, informing their caregivers and engaging their health care providers, there has to be more integration. So that involves both standardization and figuring out how do we create the architecture to enable these different data sets to talk to one another in a meaningful way, and then synthesis of the data so that it gets synthesized in a way that can be turned back to the different users in ways that makes sense to them and are usable for them. And I think these are kind of ubiquitous technology challenges, actually. They go beyond aging, they go beyond healthcare. I think out in the general community, these are the kinds of grand challenges that I think are viable to be addressed, to really optimize technology. And when you think about the older adults, there’s another dimension, which is how to create accessibility based on their function. So vision and hearing and those kinds of changes that might occur with aging, and also the ease of use. And that’s a literacy issue, really, across the lifespan. How do we create technology that users can use and get and can actually make sense of?
Tom Andriola 11:01
Okay, now, you’re gonna tell us about kind of the downfalls, pitfalls, risks that we run with all this new technology in our world?
Heather Young 11:10
Yeah, so this, this is an area that I think is very important. So I think my first concern would be around technology, not replacing human connection. That it’s something that can facilitate and augment care and connection, but we really should be as we’re developing and deploying technology, attending to both the importance of human connection and the ethics on many levels. So there’s privacy, security, appropriate use of data and many other ethical issues. So those are areas of vital importance. Secondly, older adults are the fastest growing group of technology adopters. People in this – it totally makes sense – because those who are over 65, many of them actually worked in environments where they use computers, and they socially been using media. So we’re going to see an incredible increase in older adults using technology in the coming decades. But access is not equitable. There’s a digital divide that relates to technology, literacy, affordability, and connectivity. And many communities, especially rural communities don’t have broadband, technology can be expensive. And if we’re really going to adopt technology as a major tool in healthcare delivery, the costs need to be addressed at some level. So you and I were talking the other day about sending someone home with a monitor to watch their oxygen level with alert. If someone comes in during the pandemic, and they say ‘go home, you can be more comfortable there. Your your monitor will signal you if you need to come back to us,’ which is a great idea that much cheaper than being last but not. But if the older adult has to pay for their technology, there will be inequitable use of this option. So we do have to think about those issues as well.
Tom Andriola 12:55
Yeah, I think we’re seeing already that, you know, the pandemic has accentuated and brought in a much more transparent way the digital divide and inequities that we still have. I’d have to say my experiences today in the pandemic is government is responding to the educational aspects of trying to close that digital divide gap. I haven’t seen it in healthcare yet. But we really need to double down on the voices there, because as you said, the the demographics are such that this is just going to become a larger problem. In your years at Davis and especially in being the founding dean of the nursing school, you were very focused on education, you know, changes in the workforce needed for the healthcare system, training and education program development. What does that look like, from your perspective, looking forward into the further into the 21st century? I mean, what are we looking at from the standpoint of a healthcare workforce? 2030? And how do our environments need to evolve to to deliver those types of professionals into the environment?
Heather Young 14:01
So the workforce for the future, particularly with the demands from an aging population is not a matter of simply adding numbers. We don’t have enough numbers, we, I don’t think we can even produce enough people to meet the need adequately. So that says that we need to transform the way we do it, that we’ve got to really think about our models of care, we’ve got to think about who does walk where to make sure that the right person is the right place at the right time. And we also need to think about both technology and teamwork differently – organizing people in such a way that we can optimize the contribution of each person who’s on the team and using technology to the extent that we can, both to deliver care and to prepare people to be able to work in the in the future. I’ll give you an example around tech and education around simulation. When we designed Betty Irene Moore Hall at UC Davis, the home of the Betty Irene Moore School of Nursing, we created a similar lab that’s actually an apartment, full on everything in an apartment, a kitchen, bathroom, living room, and a bedroom. And this was designed because so much care is moving to the home. And this is a big shift for us to go from hospitals to home care. And what it enables us to do is to give students the opportunity to learn to handle high-impact and high-risk situations in a low-risk way. So they can practice when it isn’t actually going to have a negative effect on the family or the person that you’re caring for. And this is very important for everybody. So for example, managing comfort care at the end of life in the home. And having difficult conversations with family about the death takes considerable skill and confidence. And using simulations, students can practice the skills perhaps with standardized actors who come in there and are playing the role of the person who’s dying and the family members. They can be recorded and then debrief with their peers and with faculty to reflect on what they could do better and learn from each other. So when they’re really in a situation of being in a home with a family, with someone dying thy’re prepared to be able to manage the complexity of that situation. So I think we can really increase the precision with which we educate people, the ability to give feedback, and the ability to practice over and over those kinds of skills in healthcare, that you don’t want to be the one that’s just being practiced upon, you really need to have the person who’s working with you, as a clinician have the competence to do so. So I’m really excited about simulation is that providing that opportunity.
Tom Andriola 16:38
Heather, we’ve been talking at our university in terms of future education, around data literacy amongst medical professionals, and how do we enhance data literacy? Have you given much thought to that? And was that part of the program that you evolved at Davis?
Heather Young 16:55
Absolutely, Tom. I mean, I think that it’s such an important part, that it’s been a core value, and an element of the curriculum from the outset, for all the students in the program. So for clinicians, they need to understand how to work in a world where they need to be digitally literate, they need to be able to be comfortable with technology – not only using it themselves, but they’ve also got to be able to help patients and families use it. So we have to educate others about technology. So there’s that practical hands on experience with technology that’s vital. But there’s the informatics side as well, where our clinicians of today and the future, really need to understand the power of data and understand how to collect it in a meaningful and standardized way so we can use it. And then actually how to do the analytics on the back end of it to be able to modify programs to be able to modify approaches of care based on the data that’s being generated. So it’s an absolutely important piece, and it used to be relegated more to the researchers. But I believe that it’s something that’s a core competency across all.
Tom Andriola 18:04
So here’s the last question Heather, and every one of our interviewees gets this question. And it’s because we have such amazing and accomplished individuals who join us on this podcast. We ask you to share two or three pieces of actionable advice or up and coming leaders in their organizations. What are the two or three lessons you’ve learned over the course of your career on how to create positive change in the environment that you work in?
Heather Young 18:31
Thanks for that question. I think the one that really comes to my mind mostly right now, because of the pandemic and racism awareness, that has so many tragic elements, is that we should never miss a good opportunity. Right now we’re in a situation where assumptions we hold dear and barriers we’ve defended, have flown out the window. And innovations have accelerated at an incredible pace. So for example, the adoption of telehealth and I think we must not lose this opportunity for creative thoughts and for deliberation about how to sustain meaningful changes that ultimately will serve communities better. So taking the opportunity, seeing those moments and really capitalizing on them, it’s my first piece of advice. The second would be that the complex problems we need to solve in health and society require really different kinds of collaboration. And we have to look more broadly for those who can inform both our understanding of the problem and generate the solution. And I think it takes this interdisciplinary work to a whole new level. In our work at UC Davis., in the Healthy Aging the Digital World, our collaborators include scientists from the entire university. It’s not just the white coats of health care and the engineering people. It’s also social science and humanities, the arts, law – all of those people have to have a voice in us and help shape the future. So I am a real advocate for opening our minds to who else could inform us and help us with with solutions. And then the final thing that I that has been a hallmark of my career and it’s so important, I think is listening to the people we’re designing for. And they’re often too often silenced by the isms: ageism, ableism, racism, sexism, and the intersectionality of these elements, marginalizes people even further. And the demographics of our society is changing, our thinking about inclusion has to change. And if we’re really going to do human- centered design and come up with solutions that fit the people we’re trying to design for no matter what it is, whether it’s education or practice, or community work. We have to partner in new and creative ways.
Tom Andriola 20:48
Heather, that’s awesome. Thank you so much, Dr. Young, our guest today. Thank you for joining us very much.
Heather Young 20:55
My pleasure. Thank you so much.