The Last Word: Digital Decision Making and Safety in the COVID World
A recent study in the American Journal of Geriatric Psychiatry found that more frequent late-life cognitive activity may maintain and improve decision making among older persons.1 These are helpful findings from a public health perspective. In this article, we extend the implications of this study by noting the ubiquity and complexity of digital decision making in a time of pandemic. We then consider the impacts of these digital services on late-life cognitive activity and propose digital safety strategies for clinicians, researchers, public health practitioners, and regulators.
Digital safety strategies are considered approaches to optimize digital decision making and protect late-life users of digital technologies. In the accompanying table online, we provide an overview of this topic.
We recently reviewed the effects of computers, the internet, and social media on the daily decision making of people living with brain health conditions.2 Teaching older adults to use social media has been found to significantly improve executive functioning as measured by their inhibitory control and overall cognition.3 Social media use among older adults may also positively boost health by increasing social connectedness, which is critical with social and physical distancing imposed by COVID-19.
Social media may also have adverse brain health affects for older adults. Loneliness and social isolation in older adults can dramatically alter cognitive performance, decision making, and emotional regulation.4 Lonely older adults have more difficulty maintaining vigilance and self-regulating, demonstrate a heightened awareness of social threats, and pay greater attention to negative social stimuli.2
Geriatric health care providers will have to increasingly contend with technology use in their day-to-day practice. For example, ubiquitous smartphones are being used to collect data that can be used in the clinic. Wearable technology has the benefit of capturing real-time biometric data on autonomic nervous system activity, voice analytics, sleep quality and quantity, physical activity, and social activity, all of which can assist in diagnosis.
Understanding the decision-making implications of cognitive decline, especially within the digital realm, and enacting subsequent clinical and policy measures is critical. Existing issues are likely to be amplified due to the current effects and long-term repercussions of COVID, making these measures an urgent global priority.
— Erin Smith is a brain health executive and an associate at The PRODEO Institute in Palo Alto, California.
— Malcolm P. Forbes, MBBS, MPM, is a principal psychiatry trainee at Royal Melbourne Hospital and a senior lecturer in the department of psychiatry at the University of Melbourne in Australia.
— Sandra B. Chapman, PhD, is a professor in and founder and chief director of the Center for BrainHealth, as well as the Dee Wyly Distinguished University Chair at The University of Texas at Dallas.
— Ian H. Robertson, PhD, is the T. Boone Pickens Distinguished Scientist at the Center for BrainHealth at The University of Texas at Dallas and codirector of the Global Brain Health Institute, a collaboration of Trinity College Dublin and the University of California, San Francisco.
— Harris A. Eyre, MBBS, PhD, is a brain health executive, cofounder of The PRODEO Institute, and President of PRODEO in San Francisco.
Digital Care in the COVID World
2. Ternes K, Iyengar V, Lavretsky H, et al. Brain health INnovation Diplomacy: a model binding diverse disciplines to manage the promise and perils of technological innovation. Int Psychogeriatr. 2020;32(8):955-979.
3. Quinn K. Cognitive effects of social media use: a case of older adults. Soc Media Soc. 2018;4(3):2056305118787203.
4. Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci. 2009;13(10):447-454.
5. Guess A, Nagler J, Tucker J. Less than you think: prevalence and predictors of fake news dissemination on Facebook. Sci Adv. 2019;5(1):eaau4586.