En español | Sally Balch Hurme’s 75-year-old husband, Arthur, has dementia. Every day she struggles to keep him safe in a world full of digital threats.
Hundreds of emails pour into Arthur’s smartphone from telemarketers with hard-to-resist offers. His Facebook account is peopled with “friends” from foreign countries — all strangers.
“He has no idea who they are,” says Hurme, an elder law lawyer and author. “Some of them are wearing bandoliers of ammunition, holding their guns. It is horrific.”
Then, there’s Amazon, a never-ending source of shopping temptation. Recently, Arthur ordered four pocket translators, several watches and a large quantity of maple sugar candies for $1,000. Though the items can be returned, Hurme doesn’t always know where Arthur has stored items he’s bought.
Many families are encountering similar concerns. As cognitive impairment increases among older adults, devices like computers, smartphones and tablets become difficult to use and, in some cases, problematic.
Most adults 65 and older go online
The emergence of this issue tracks with the growing popularity of devices that let older adults communicate with friends and family via email, join interest groups on Facebook, visit virtually via Skype or FaceTime, and bank, shop, take courses or read publications online.
According to the Pew Research Center, 73 percent of adults 65 and older used the internet in 2019, up from 43 percent in 2010. And 42 percent of older adults owned smartphones in 2017, the latest year for which data is available, up from 18 percent in 2013.
Already, some physicians are adapting to this new digital reality. At Johns Hopkins Medicine, Halima Amjad, an assistant professor of medicine, now asks older patients if they’re using a computer or a smartphone and having trouble such as forgetting passwords or getting locked out of accounts.
“If there’s a notable change in how someone is using technology, we would proceed with a more in-depth cognitive evaluation,” she says.
At Rush University’s Alzheimer’s Disease Center in Chicago, neurologist Neelum Aggarwal finds that older adults are bringing up problems with technology as a “nonthreatening way to talk about trouble with thinking.
“Instead of saying: ‘I have issues with my memory,’ people will say: ‘I just can’t figure out my smartphone’ or ‘I was trying to start that computer program and it took forever to get that done,’” Aggarwal says.
If his patient had been using digital devices with difficulty, Aggarwal will try to identify the underlying issue:
• Does the older adult have vision issues or problems with coordination?
• Is she having trouble understanding language? Is memory becoming compromised?
• Is it hard for her to follow the steps needed to complete a transaction?
If using technology has become frustrating, Aggarwal recommends deleting apps on smartphones and programs on computers.
“The anxiety associated with ‘Oh my God, I have to use this and I don’t know how’ totally sets people back and undoes any gains that technology might offer,” she says. “It’s similar to what I do with medications: I’ll help someone get rid of what’s not needed and keep only what’s really essential.”
First, delete some apps
In these circumstances, Aggarwal recommends that the patient use no more than five to 10 cellphone apps.
When safety becomes an issue — say, for an older adult with dementia who’s being approached by scammers on email ― family members should first try counseling the person against giving out their Social Security or credit card information, says Cynthia Clyburn, a social worker in the neurology division at Penn Medicine in Philadelphia.
If that doesn’t work, try to spend time together at the computer so you can monitor what’s going on.
“Make it a group activity,” Clyburn says. If possible, create shared passwords so you have shared access.
But beware of appropriating someone’s passwords and using them to check email or online bank or brokerage accounts.
“Without consent, it’s a federal crime to use an individual’s password to access their accounts,” says Catherine Seal, an elder-law attorney in Colorado Springs, Colorado. Ideally, consent should be granted in writing.
Consider 'parental' controls
Older adults with Alzheimer’s disease commonly turn away from digital devices as they forget how to use them, says Lon Schneider, a professor of psychiatry and neurology at the University of Southern California.
With her husband’s permission, Hurme unsubscribes him from accounts that send him emails and removes friends from his Facebook account.
On his cellphone, she has installed a “parental control” app that blocks him from using it between midnight and 6 a.m. ― hours when he was most likely to engage in online activities. The TV also has a “parental control” setting to prevent access to “adult” channels.
Instead of an open-ended credit card, Hurme gives Arthur a “stored value” card with a limited amount of money. She manages household finances, and he doesn’t have access to the couple’s online banking account. Credit bureaus have been told not to open any account in Arthur’s name.
If Hurme had her way, she says she would get rid of Arthur’s cellphone — his primary form of communication. (He has stopped using the computer.)
But “I’m very sensitive to respecting his dignity and letting him be as independent and autonomous as possible,” she says. For all the dangers that it presents, “his phone is his connection with the outside world, and I can’t take that away from him.”
Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.