Envisioning digital health for older adults: a polychronic disease approach

To the Editor, The healthcare landscape for digital health and wellness programs has seen an explosion of interest over the last decade. Remote and virtual programs for wellness and health offer numerous psychological and physical health benefits1,2, yet to date, most programs have largely targeted a younger, healthy demographic. Older individuals and individuals with chronic medical diseases such as diabetes and high blood pressure (HTN) may also benefit significantly from such novel holistic digital interventions. Early digital health programs aimed at improving patient outcomes for specific conditions such as diabetes, weight loss, and fall prevention amongst older adults have had encouraging early results, with participants reporting increases in mobility and glycemic control3,4. However, this past work has largely focused on single solutions aimed at a sole physical or medical complaint (e.g. weight loss, fall prevention), where the challenge is that many older adults suffer from multiple comorbidities5, with upwards of 70% of adults aged 65 and over having at least two or more chronic diseases6. An additional challenge is that the possibility of multiple digital solutions for each concern may create a disruptive user environment and confusion and adversely affect sustained engagement across all the programs7. Creating a digital platform aimed at a diverse range of middle-aged and older adults, while focusing on overall health (e.g. nutrition, physical activity, balance, mental health), may offer numerous health benefits to participants, particularly those with polychronic disease. With the rise of mobile and digital programs for health and lifestyle change, alongside the growth in the aging population, creating digital health programs that consider not just a single disease entity, but rather a polychronic approach may better operationalize the complexities and complex interrelationships in patients with multiple comorbidities. Such programs targeting older adults with polychronic disease may yield positive health outcomes in this growing and vulnerable population. A polychronic digital lifestyle change program approach may play a positive complement to traditional medical care and primary care management with regard to primary and secondary prevention of chronic diseases ranging from cardiovascular to orthopedic8. An emphasis on digital programs for older adults should consider accessibility, as well as a multi-pronged approach to individuals with polychronic disease that considers the encouragement of lifestyle/behavior change, alongside collaboration with their healthcare providers and medical management. For example, our program, Mighty Health is a novel app and web-based program with a target demographic of older adults, integrating physical and psychological lifestyle goals, including guided lesson goals and plans on nutrition, physical exercise, and mental health, alongside live coaching for encouragement and motivation. Engagement is both asynchronous and contains several synchronous features including live workout sessions and a virtual coach to help with accountability and motivation. Initial retrospective data from a sample of 166 active Mighty Health users (average age 61.2) have found that amongst individuals using the program for 12 weeks, participants on average reported a weight loss of 11.2 lbs (SD 12.7), with 77.7% of the participant's improvement in mobility. Participants with diabetes mellitus reported an average decrease of HgB A1C by 0.7 (SD: 0.8), while those with Hypertension reported an improvement of 12 mmHg (SD 12) in their systolic blood pressure, and individuals with hyperlipidemia reported an average improvement in their LDL by 12 mg/dl (SD 16). Finally, 14.5% endorsed a decrease in unscheduled healthcare visits since starting Mighty Health. This descriptive sample of 166 Mighty Health participants was retrospective and self-reported, without a comparison group of matched participants not using such a digital program, thus weakening our ability to draw any strong conclusions on the efficacy of such a digital program. However, these preliminary findings suggest initial promising results pointing to the potential utility and positive impact of a digital program that envisions a holistic polychronic angle for older adults. Future work focused on rigorous prospective observational and randomized control trials may clarify any short-term and long-term impact that such interventions may have on patients. This future work examining the clinical efficacy of such interventions will ideally continue to focus on a diverse range of patients across the age spectrum. Older adults represent a vital and growing segment of the general and clinical population. In the wake of the recent technological revolution impacting all of healthcare, programs dedicated to patients at risk, or with polychronic disease, may lead to significant improvements in the well-being of these patients and may have powerful downstream positive effects on resource utilization and the broader healthcare ecosystem at large. Ethical approval The deidentified data and proposal to include in this correspondence were reviewed by an outside Institutional Review Board and determined as exempt (Pearl IRB). Sources of funding Self-funded (Mighty Health). Author contribution B.P.C.: conceptualization, supervision, and writing – original draft; E.T.: writing – original draft, review, and editing; P.K.V.B.: provision of data/evidence collection, writing, review, and editing; L.T., F.L., and J.L.: writing – original draft, review, and editing. Conflicts of interest disclosure Bernard P. Chang, MD, PhD: has received equity shares from Mighty Health as an advisor and consultant; Eric Tam, MD: has received financial support from Mighty Health as a consultant; Pedro K. Villas Boas, Lindsay Tullis, Felipe Lopes, and James Li: is a paid employee of Mighty Health. Research registration unique identifying number (UIN) Not applicable. Guarantor Not applicable.