There is no doubt that the global pandemic caused by COVID-19 has impacted all sectors of society and the whole population, especially citizens affected by chronic diseases. In this article we would like emphasise the impact that the pandemic had (and continues to have) on people affected by Parkinson’s, as well as on the opportunities provided by technology to help manage their disease and therapies remotely, and remarks that can be extrapolated to older people with chronic diseases.
The Digital health market
In 2020 the number of mobile devices in the world reached 7.94 billion, a number higher than the number of people living on this planet. In the EU-27 there were, on average, 1.220 mobile phone subscriptions per 1.000 inhabitants in 2018, indicating that in several countries some people had more than one mobile subscription in several connected devices. Consequently, the number of mobile applications available in the market has been increasing in recent years, with 2.56 million apps in Google Play Store and 1.85 million different apps in iOS App Store available for users to download.
In 2015, around 97,000 of those apps were focused on health and medicine issues and, statistics so far showed that the general public mostly downloaded apps including:
- Health information
- Physical activity recommendations
- Some types of diets
- Support on medication management.
Currently in the European region, digital health market is gaining momentum with mobile applications being widely used for improving health and lifestyle. mHealth apps for patients and doctors for the management of diseases are constantly being develop. High market penetration of technically advanced digital health devices and the existence of favourable government initiatives are expected to drive digital market, Europe digital health systems market accounting for 16.5 billion in 2018.
Mobile apps in Parkinson’s
Parkinson’s disease (PD) is the second most common neurodegenerative disease and, as symptoms and treatments responses can vary from one person to another, continuous monitoring is required for correct assessment. In this sense, mobile apps may be useful in the management of patients with PD.
The first bibliographic reference in literature research related to the development of a mobile app for PD was in 2011. Since then, several initiatives to promote research in Parkinson’s disease, including the use of mobile applications, have been launched.
Some of these were supported by European Commission under the 7th Framework Programme, as CuPid and REMPARK. Among the ongoing research that has been carried out within the Horizon 2020 framework are the development of a PD Manager Platform and the mPark Application, both led by Life Supporting Technologies Research Group (LifeSTech) from the Polytechnic University of Madrid. Recent European projects include ICT4Life (https://pae-eu.eu/ict-4-life/), PROCare4Life (procare4life.eu) and TeNDER (https://www.tender-health.eu/). Additionally, projects are being developed by companies such as Apple (mPower Application) and Roche Pharmaceuticals, including apps to assess PD.
For those who read this post and want to go deeper into the knowledge of potentially useful apps for PD patients (e.g. trade names, main features or prices) available in leading app stores, we strongly recommend reading the systematic review by Linares-del Rey M, et al.
Figure 1. Graphic representation of PD app. Source: Linares-del Rey M, et al (2017).
The article mentioned above reveals around 125 potentially useful applications for PD patients. Among these, 69 have been specifically designed for PD. According to the article, 23 apps provide information; 29 assess different aspects; 13 are focused on treatments; and 4 apps are intended for both assessment and treatment of PD patients.
A digital society to respond to demographic changes
It is undeniable that the internet has the potential to be highly useful to older people. For example, online shopping may free those with mobility issues from making difficult trips to the shops and in a similar vein, online banking can allow older people to manage their finances from home. The internet also provides numerous ways for older people to communicate with family and friends.
At the same time, Europe’s health and care systems face serious challenges, such as ageing, multi-morbidity; health workforce shortages; and the rising burden of preventable non-communicable diseases, and obesity, and other diseases including neuro-degenerative and rare diseases. Public spending on health and long-term care is steadily rising in EU Member States and is expected to continue to do so.
Digital solutions for health and care can increase the well-being of millions of citizens and radically change the way health and care services are delivered to patients, if designed purposefully and implemented in a cost-effective way.
Still, there is a digital divide between age groups in terms of their access to a use of modern Information and Communications Technologies (ICTs) and older people remain relatively slow to adopt new technologies, due in most cases to a lack of opportunity to learn. For that reason, older people during the general lockdown that countries in Europe experienced turned to their relatives, neighbors, and caregivers to overcome this difficulty and many learned to from them how to handle technology. Indeed, the statistics show that, once the elderly are confident enough to use technology, they start using the internet actively, just like younger generations.
Using existing technology combined with the necessary training to facilitate access would lead to this digital transformation. Reaching out digitally to those affected and offering them physiotherapy, speech therapy, occupational therapy, music therapy, cognitive stimulation and/or psychology sessions, as well as social workers support, would allow them to be accompanied throughout the whole process of the illness. And this is essential to maintain their quality of life as long as possible.
Although there are issues to improve, such as the interoperability of systems or the appropriate regulatory frameworks, the benefits of digital health are evident: personalized sessions tailored to people’s needs, access to a greater number of patients with far fewer resources and many other.
In the coming years, the Madrid Parkinson Association will continue to seek solutions and to bring its services closer to people in the situations described above, facilitating access to professionals and rehabilitation services, with new technologies being the ideal vehicle. In this way we will break or, at least, smooth out the barriers posed by distance, lack of mobility, dependence, and disability, thus allowing greater personal autonomy for people affected by Parkinson’s disease who cannot come to the center regularly.
 App Download and Usage Statistics (2020). Mansoor Iqbal, October 30, 2020: https://www.businessofapps.com/data/app-statistics/#:~:text=The%20iOS%20App%20Store%20launched,through%20the%20Google%20Play%20Store.
 The App Intelligence. Informe apps salud en espan˜ol. En: Mugarza F. Informe de las mejores 50 apps de salud en espan˜ol. Madrid: Zeltia; 2014.
 Doctoralia. Primer informe Doctoralia: salud e Inter- net 2015, 2015 [consultado 1 Ago 2016]. Disponible en: http://insights.doctoralia.es/informe-doctoralia-sobre-salud- e-internet-2015/
 Casamassima F, Ferrari A, Milosevic B, Ginis P, Farella E, Rocchi L. A wearable system for gait training in subjects with Parkin-son’s disease. Sensors (Basel). 2014; 14:6229—46.
 Sama A, Perez-Lopez C, Rodriguez-Martin D, Moreno-Arostegui JM, Rovira J, Ahlrichs C, et al. A double closed loop to enhance the quality of life of Parkinson’s Disease patients: REMPARK sys- tem. Stud Health Technol Inform. 2014; 207: 115—24.
 Project PD manager: http://www.parkinson-manager.eu/
 mPower. Mobile Parkinson: https://parkinsonmpower.org/
 pRed: http://www.roche.com/research and development/who we are how we work/our structure/pred.htm
 Linares-del Rey M, et al. Aplicaciones móviles en la enfermedad de Parkinson: una revisión sistemática. Neurología. 2017.http://dx.doi.org/10.1016/j.nrl.2017.03.006
 Joint Report by the Commission services and the Economic Policy Committee on Health Care and Long-term Care Systems and Fiscal Sustainability, European Commission and Economic Policy Committee, October 2016, https://ec.europa.eu/info/publications/economy-finance/joint-report-health-care-and-longterm-care-systems-fiscal-sustainability-0_en