E4 EZ EE THE WASHINGTON POST.TUESDAY, NOVEMBER 23 , 2021
her mother’s movements.
“When I went to bed at night, I
didn't have to guess what she was
doing,” Weathers-Jablonski said.
“I was actually able to get some
sleep.”
New monitoring technology is
helping family caregivers manage
the relentless task of looking out
for older adults with cognitive
decline. Setting up an extensive
monitoring system can be expen-
sive — Weathers-Jablonski’s sys-
tem from People Power costs
$299 for the hardware and $40 a
month for use of the app. With
scores of companies selling such
gear, including SentryTell and
Caregiver Smart Solutions, they
are readily available to people
who can pay out-of-pocket.
But that’s not an option for
everyone. While the technology is
in line with President Biden’s
plan to direct billions of dollars
toward helping older and dis-
abled Americans live more inde-
pendently at home, the costs of
such systems aren’t always cov-
ered by private insurers and rare-
ly by Medicare or Medicaid.
Monitoring also raises ethical
questions about privacy and qual-
ity of care. Still, the systems make
it possible for many older people
to stay in their home, which can
cost them far less than institu-
tional care. Living at home is
what most people prefer, espe-
cially in light of the toll the
pandemic took on nursing
homes.
Technology could help fill a
much-needed gap in home care
for older people. Paid caregivers
are in short supply to meet the
needs of the aging population,
which is expected to more than
double in coming decades. The
shortage is fueled by low pay,
meager benefits and high rates of
burnout.
And for the nearly 1 in 5 U.S.
adults who is a caregiver to a
family member or friend over age
50, the gadgets have made a hard
job just a little easier.
Passive surveillance systems
are replacing the “I’ve fallen and I
can’t get up” medical alert but-
tons. Using artificial intelligence,
the new devices can automatical-
ly detect something is wrong and
make an emergency call unasked.
They also can monitor pill dis-
pensers and kitchen appliances
using motion sensors such as
EllieGrid and WallFlower. Some
systems include wearable watch-
es for fall detection, such
as QMedic, or can track GPS
location, such as SmartSole’s shoe
insoles. Others are video cameras
that record. People use surveil-
lance systems such as Ring inside
the home.
Some caregivers may be tempt-
ed to use technology to replace
care, as researchers in England
found in a recent study. A partici-
pant who had visited his father
every weekend began visiting less
often after his dad started wear-
ing a fall detector around his
wrist. Another participant be-
lieved her father was active
around the house, as evidenced
by activity sensor data. She later
realized the app was showing not
her father’s movement, but that
of his dog. The monitoring system
picked up the dog’s movements in
the living room and logged it as
activity.
Technology isn’t a substitute
for face-to-face interaction, said
Crista Barnett Nelson, executive
director of Senior Advocacy Ser-
vices, a nonprofit group that
helps older adults and their fami-
lies in the North Bay Area outside
San Francisco. “You can’t tell if
someone has soiled their briefs
with a camera, you can’t tell if
they’re in pain, or if they just need
an interaction,” she said.
In some instances, people be-
ing monitored changed their hab-
its in response to technology.
Clara Berridge, a professor of
social work at the University of
Washington who studies the use
of technology in elder care, inter-
viewed a woman who stopped her
CAREGIVERS FROM E1 usual practice of falling asleep on
the recliner because the technol-
ogy would falsely alert her family
that something was wrong based
on inactivity deemed abnormal
by the system. Another senior
reported rushing in the bathroom
for fear an alert would go out if
they took too long.
The technology presents an-
other worry for those being moni-
tored. “A caregiver is generally
going to be really concerned
about safety,” Berridge said. “Old-
er adults are often very con-
cerned about safety, too, but they
may also weigh privacy really
heavily, or their sense of identity
or dignity.”
Charles Vergos, 92 and living
in Las Vegas, is uncomfortable
with video cameras in his house
and wasn’t interested in wearing
gadgets. But he liked the idea
that someone would know if
something went wrong while he
was alone. His niece, who lives
in Palo Alto, Calif., suggested
Vergos install a home sensor
system so she could monitor him
from afar.
“The first question I asked is,
does it take pictures?” Vergos
recalled. Because the sensors
don’t have a video component, he
was fine with them. “Actually,
after you have them in the house
for a while, you don’t even think
about it,” Vergos said.
The sensors also have made
conversations with his niece
more convenient for him. She
knows he likes to talk on the
phone while he’s in his chair in
the den, so she’ll check his activi-
ty on her iPad to determine
whether it is a good time to call.
People making audio and video
recordings must abide by state
privacy laws, which typically re-
quire the consent of the person
being recorded. It’s not as clear,
however, if consent is needed to
collect the activity data that sen-
sors gather. That falls into a gray
area of the law, similar to data
collected through Internet
browsing.
Then there is the problem of
how to pay for it all. Medicaid, the
federal-state health program for
low-income people, does cover
some passive monitoring for
home care, but it’s not clear how
many states have opted to pay for
such service.
Some seniors also lack access
to robust Internet broadband,
putting much of the more sophis-
ticated technology out of reach,
said Karen Lincoln, founder of
Advocates for African American
Elders at the University of South-
ern California.
The relief monitoring devices
bring caregivers may be the most
compelling reason for their use.
Delaine Whitehead, who lives in
Orange County, Calif., started tak-
ing medication for anxiety about
a year after her husband, Walt,
was diagnosed with Alzheimer’s.
Like Weathers-Jablonski,
Whitehead sought technology to
help, finding peace of mind in
sensors installed on the toilets in
her home.
Her husband often flushed too
many times, causing the toilets to
overflow. Before Whitehead in-
stalled the sensors in 2019, Walt
had caused $8,000 worth of water
damage in their bathroom. With
the sensors, Whitehead received
an alert on her phone when the
water got too high.
“It did ease up a lot of my
stress,” she said.
— Kaiser Health News
Sofie Kodner is a writer with the
Investigative Reporting Program at
the University of California at
Berkeley Graduate School of
Journalism. The IRP reported this
story through a grant from the SCAN
Foundation. Email:
[email protected]
Twitter: @KodSofKaiser Health News, which produces
in-depth journalism about health, is a
program of the Kaiser Family
Foundation, an endowed nonprofit
organization providing information on
health issues to the nation.High-tech tools ease
caregivers’ stress but
can raise privacy issues
HANNAH NORMAN/KAISER HEALTH NEWS I LLUSTRATIONwell” and mental health apps,
some specifically targeted at
them, provide a peer community
and support in a setting that
provides both privacy and con-
venience. In interviews, men said
one of the biggest advantages
with these apps was anonymity.
The online help provides a
“less intimidating entry to men-
tal health,” says C. Vaile Wright, a
psychologist who is senior direc-
tor of health-care innovation for
the American Psychological Asso-
ciation. “They are an important
gateway to mental health for
many men who need help but
never considered reaching out for
it before.”
Research has show that men
often avoid seeking help because
of gender expectations that they
should not appear vulnerable or
unable to handle their own prob-
lems, according to one recent
study. They seek help for mental
health struggles at approximately
half the rate of women. Yet re-
search has also shown that men
are four times more likely to
commit suicide than women, are
more likely to abuse and die of
drugs, especially opiates, as well
as alcohol, and are at the fore-
front of the loneliness epidemic.
B ut it’s not fair, experts say, to
blame men exclusively for this
public health problem.
Men are far more likely to be
underdiagnosed for mental
health problems than are women,
research has found, because
many health-care practitioners
often misread men’s symptoms.
When metrics are used that more
accurately gauge their symptoms
— including irritability, aggres-
sion, risk-taking, substance and
alcohol abuse, somatic com-
plaints — men are nearly de-
pressed as women, according to a
2013 study. None of these symp-
toms are included in the bible for
mental health practitioners, the
Diagnostic and Statistical Manu-
al of Mental Disorders d iagnosis
criteria for Major Depressive Dis-
order, researchers reported.
The hope of those touting men-
tal health and well-being apps is
that the greater anonymity and
privacy they proffer will erode
men’s reticence about seeking
help. No large studies have been
conducted yet on men using
these apps, but a 2018 study by
researchers from Harvard Medi-
cal School and its T.H. Chan
School of Public Health found
that even before the pandemic
struck, more than 225 million
Americans had at least one of
these apps on their smartphones.
A 2019 meta-analysis found these
apps can be an effective tool for a
number of mental health condi-
tions.
Some such as Tethr offer men aMENTAL HEALTH FROM E1 space where they can privately
(or openly if they prefer) learn
how to discuss their mental
health and life struggles with
something many now under-
stand is crucial: emotional peer
support. Tethr also offers a daily
emotional “fitness” tracker, virtu-
al men’s groups or “pods,” as well
as videotaped podcast shows.
As with most apps, no licensed
mental health professional di-
rectly oversees the posts that men
share about their struggles or the
responses they receive (although
Tethr’s co-founders said they
have gotten guidance from re-
searchers with the Men’s Health
Research Program and the Uni-
versity of British Columbia).
Users’ posts resemble text mes-
sage exchanges about often
angst-ridden topics — the anni-
versary of a parent’s death, a
relationship ending, job loss, dai-
ly slogs with depression. Com-
miseration or empathy from peer
app users inevitably follows.
Members also are encouraged to
share daily one-word check-insaround their physical, mental
and emotional states. Both the
daily check-ins and more elabo-
rate postings are free. For an $8
fee per month, members can take
part in weekly support groups.
Before joining Tethr, Jason
Henderson was part of an in-per-
son men’s group. He often felt
unfulfilled by the group mem-
bers’ responses to his struggles
with depression and the resulting
shame.
“The solutions and advice
didn’t feel emotionally support-
ive at all,” he said. That changed,
he said, when he joined Tethr.
Fellow forum posters responded,
“That sounds really rough” and “I
can remember when I went
through the same thing,” Hender-
son recalled recently.
In addition to showing empa-
thy, it helped him “broaden my
emotional vocabulary so I could
talk about what my anxiety and
depression looked and felt like.”
This didn’t cure his depression,
but it decreased its intensity, he
said, and diminished his feeling
of shame.
Such peer-to-peer support net-
works with the growth of mental
health apps are what most exciteJohn Naslund, an instructor of
Global Health and Social Medi-
cine at Harvard Medical School
who specializes in mental health
epidemiology and digital mental
health.
Naslund said that the low-risk
of self-disclosure with the apps,
followed by emotional support
from other men, is a safe and
effective “gateway” to better men-
tal health. And it teaches men
how to create an emotional com-
munity in ways many of them
have not been able to do before.
These networks are virtual safety
nets, he said, that “connect indi-
viduals with others facing similar
challenges and offer commisera-
tion within a safe, nonjudgmen-
tal virtual environment.”
The majority of mental health
apps aren’t pegged to any specific
gender. Two meditation-focused
apps, Headspace and Calm, ac-
count for 90 percent of all active
mental health/well-being app us-
ers, according to a 2020 study in
the Journal of Consulting and
Clinical Psychology. A few such as
Tethr are designed for men, or
have men-specific sections.
The app HeadGear, for in-
stance, has a predominantly male
user group that is instructed to
spend five to 10 minutes a day, for
30 days, learning strategies for
relaxation and mindfulness, to
help them cope with stress and
develop stronger emotional ties
with other men. The app was
developed through a collabora-
tion among Australian nonprofit
organizations focused on mental
health at universities.
WellMind, an app endorsed by
Britain’s National Health Service,
offers a digital course that synthe-
sizes mindfulness and cognitive-
based therapy practices. Partici-
pants learn and practice tech-
niques for mindful eating and
breathing, body scanning for
greater stress awareness and
strategies for reacting to stress
differently.
Georgia Hanias, a spokesper-
son for WellMind, said psycholo-
gists at the University of Surrey
found that the app’s Be Mindful
course, produced reduced rates of
depression (63 percent), anxiety
(58 percent) and stress (40 per-
cent) in participants. While the
course is for everyone, some 40
percent of the 102,000 course
participants are men, Hanias said
in an email.
Stephen Hastie is one of them.
The course helped him deal bet-
ter with stress and anxiety and
“slow down and find more mo-
ments of stillness in my life,” he
wrote in an email. “It hasn’t made
[stress and anxiety] go away, but
it has enabled me to... respond,
rather than react, to situations.”
W hile praising the apps,
Wright also cautioned that they
aren’t a replacement for conven-tional in-person therapy. What’s
more, some researchers worry
that there’s a gap between the
metrics that apps use and that
clinical mental health profession-
als use to gauge their efficacy.
Wright said that perhaps the
largest challenge for those want-
ing to try or use a mental health
app is that no regulatory body
oversees them. And the claims
made by many of them often lack
evidence-based research, she
said.
“They’re coming out faster
than the research can keep up
with,” she said.
So how can someone needing
help wade though the thicket of
apps? (Or websites that focus on
men, such as Evryman, HeadsUp-
Guys and Man Therapy?)
Stephen Schueller, associate
professor of psychological scienc-
es and informatics at the Univer-
sity of California at Irvine, recom-
mended looking for ones de-
signed with some degree of hu-
man interaction. That means
they should provide feedback or
support from, ideally, mental
health professionals or, at least,
trained peers who can commiser-
ate.
Self-guided apps without di-
rect human feedback can be ef-
fective with “small-to-moderate
impacts on things like stress,
anxiety and depression,” said
Schueller, who is also executive
director of One Mind Psyber
Guide, which vets and rates digi-
tal mental health tools. “But apps
with human support have been
found to be as effective as tradi-
tional face-to-face treatments.”
Naslund suggested reading re-
views of apps online to see wheth-
er research-based evidence exists
to gauge the effectiveness and
safety. Also, all the experts said it
helps to try out the app with a free
trial to see whether it’s easy to
navigate.
Finally, since none of these
apps are required to be compli-
ant with the rules of the Health
Insurance Portability and Ac-
countability Act (i.e., patient pri-
vacy), little transparency exists,
and they can sell users’ personal
information without your knowl-
edge. Consumers should find out
where their data is going when
they use an app and how it’s
going to be used (for research?
marketing?).
“If you at least know this,”
Naslund said, “then you can make
an informed decision about
whether or not to use the app.”
Even with mental health care,
caveat emptor — let the buyer
beware — matters.
[email protected]Andrew Reiner is the author of
“Better Boys, Better Men: The New
Masculinity That Creates Greater
Courage and Emotional Resiliency.”Just for men: Mental health appsConsumers shouldfind out where theirdata is going whenthey use an appand how it’s goingto be used.American cereal maker and food
manufacturer C.W. Post elevated
breakfast’s status with advertis-
ing that hawked the ability of
Grape-Nuts to do everything
from helping children grow to
boosting adults’ brain power.
“Because of his innovative
promotional techniques, Post’s
influence on the morning meal... was profound,” writes food
historian Abigail Carroll in her
book “Three Squares: The Inven-
tion of the American Meal.”
Post’s advertising shaped not
only what people ate but also
what they expected breakfast to
do for their health.
By the 1950s, ads for Grape-
Nuts were touting its alleged im-
pact on weight. One ad, for exam-
ple, showed a smiling young
woman holding a sexy dress
against her thin body as a heavier
woman glared jealously at her.
Another proclaimed that the
“trimmest weight watchers just
happen to eat Post Grape-Nuts.”
The theme continued in a
1960s Grape-Nuts ad campaign
featuring a mom named Caroline
Burke and her look-alike teenage
daughter, Dale. The iconic TV
commercial showed a young man
mistakenly grabbing Caroline in
the swimming pool and then ex-
claiming, “Oh no, Mrs. Burke. I
thought you were Dale!” Her se-
cret to staying so slim? Exercise
and Grape-Nuts for breakfast.
In the decades that followed,
Kellogg’s reinforced the message
about breakfast and weight
through ads for Special K. People
old enough may remember the
“pinch an inch” commercials.
Said one: “If you can pinch an
inch” on your waist — and who
can’t?—“the Kellogg’s Special K
breakfast may help you lose
weight.”
Likewise, the Special K Chal-
lenge ad campaign promised that
consuming the cereal for break-
BREAKFAST FROM E1fast and one other meal every day
could lead to the loss of up to six
pounds or a jeans size in two
weeks. Kellogg’s could point to
published research supporting
the claim — which the company
helped to fund.
Financial support for break-
fast-related studies by cereal
makers has also probably helped
shaped our perceptions of the
morning meal. In most cases,
such research has found that
breakfast eaters tend to weigh
less than breakfast skippers.
Some studies without industry
funding have yielded similar re-
sults. The problem is that many of
these studies tend to show only
associations, not cause and effect.
It could be that breakfast eaters
are thinner because of other life-
style habits or traits that research
didn’t account for.
Sorting this out requires ran-
domized trials, the kind of studies
that can show cause and effect.
And in such research, which ran-domly assigns participants to ei-
ther eat or skip the morning meal,
breakfast tends to come up short.
Pooling results from seven tri-
als — a type of study known as a
meta-analysis — in 2019, Austral-
ian researchers found that partic-
ipants assigned to eat breakfast
did not lose more weight. Nor did
they consume fewer calories.
Breakfast eaters on average took
in 260 more calories per day than
breakfast skippers.
A separate meta-analysis in
2020 by Harvard researchers con-
cluded that people who skipped
breakfast lost slightly more
weight than those who ate break-
fast.
“Still, the evidence is not
strong enough to recommend eat-
ing or skipping breakfast,” says
Marta Guasch-Ferré, senior au-
thor of the Harvard study.
One limitation of all this re-
search is that it focuses just on
whether people ate breakfast —
not what or how much they con-
sumed. Starting your day with,
say, a giant stack of chocolate-
chip pancakes is not the same as
eating steel-cut oats with berries.
“It is likely not a good strategy
for overall health and weight
management to consume a break-
fast full of sugars, refined carbo-
hydrates, and processed meat,
and may be better to skip break-
fast than to eat low quality foods,”
Guasch-Ferré says. But she adds
that a healthful breakfast is “to-
tally fine.”
Registered dietitian and au-
thor Carolyn O’Neil advises peo-
ple not to force themselves to eat
in the morning if they aren’t
hungry.
But if you do eat breakfast, she
says it should consist of “a combi-
nation of foods that will help
nourish you and also give you
staying power.”
That means including protein,
fiber and fat to help fill you up.
One of O’Neil’s favorites is sliced
tomatoes and cheese on a whole-grain English muffin. Foods such
as whole-wheat toast with peanut
butter or scrambled eggs with lots
of vegetables can also fit the bill.
The morning meal doesn’t
have to consist of conventional
breakfast foods, O’Neil says. It
can include leftovers from dinner.
If you opt for sweet breakfast
treats such as doughnuts or pas-
tries, she recommends limiting
portions and combining them
with foods high in fiber and pro-
tein to prevent a spike in blood
sugar that will be followed by a
crash.
When it comes to cereal, look
for brands that are relatively high
in fiber and low in sugar. If your
favorite cereal isn’t so healthful,
try mixing it with one that is.
“Think of it as a tossed salad,”
O’Neil says.
As for coffee with your break-
fast, research shows that it can be
part of a healthy breakfast (and
protective against many diseases)
as long as you don’t overdo it or
load it up with cream and sugar.
Whatever you eat, O’Neil sug-
gests avoiding a large breakfast,
which can make you feel sluggish.
Instead, keep a healthful snack
such as plain yogurt and nuts on
hand to tide you over until lunch
if necessary.
Allison says it’s possible that
eating breakfast may have other
benefits such as increasing alert-
ness, boosting mood and improv-
ing metabolic health, although
like weight control, these effects
are “not truly well proven.”
In the end, whether to eat
breakfast is an individual deci-
sion based on your preferences
and goals.
“Try different things and see
what works for you,” Allison says.
[email protected]Robert J. Davis is the author of
“Supersized Lies: How Myths about
Weight Loss Are Keeping Us Fat —
and the Tr uth about What Really
Works.”With breakfast, don’t expect to lose pounds“The evidence is notstrong enough torecommend eating orskipping breakfast.”
Marta Guasch-Ferré,
senior author of the Harvard studyISTOCK