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Informal caregivers of older adults provide critical support for their loved ones but are subject to negative health outcomes because of burden and stress. Interventions to provide information and resources as well as social and emotional support reduce burden. Mobile apps featuring access to information, assistance with scheduling, and other features can automate support functions inexpensively and conveniently and reach a greater proportion of caregivers than otherwise possible.
The aim of this study was to identify mobile apps geared towards caregivers of older adults, catalog features, and suggest best practices for adoption based on empirical findings of beneficial interventions in the caregiving literature.
Search for apps focused on ones catered for caregivers of older adults in Google Play and iTunes, compiling their features, and identifying features reflecting categories of support identified in successful intervention studies to negative caregiver outcomes. Intervention research indicates that provision of information and resources, assistance in practical problem solving, coordinating care among multiple caregivers, and emotional support reduce caregiver burden.
Despite approximately over 200,000 mobile health–related apps, the availability of mobile apps for caregivers is relatively sparse (n=44 apps) as of October 2017. Apps generally addressed specific categories of support, including information and resources, family communication, and caregiver-recipient interactions. Few apps were comprehensive. Only 8 out of 44 (18%) had features that addressed three or more categories. Few apps provided specific stress reduction exercises for caregivers, which is important for reducing burden.
Mobile apps have the potential to provide resources, just-in-time information for problem-solving, and stress reduction strategies for caregivers. Many apps offer functions that have been shown to reduce burden and improve health outcomes in caregivers, but few provide emotional support. Using an evidence-based practice approach, mobile apps for caregivers can provide multiple beneficial support functions. Apps can serve a much larger proportion of this highly underserved population in their mobile form than more traditional means, improving their health and quality of life.
The rapid increase in longevity and the post-World War II baby boom have produced major demographic changes in the United States. The number of adults over the age of 65 in the US is expected to be 89 million by 2050, more than double the number of older adults in the US in 2010 [
According to the National Alliance for Caregiving (NAC) and the American Association of Retired Persons (AARP) Caregiving in the US 2015 report [
Researchers have thoroughly documented that high demands of caregiving often lead caregivers to experience stress in physical, mental, and social health. This is a phenomenon commonly referred to as caregiver burden. Although there is no medical diagnosis code for caregiver burden, Zarit et al [
For those providing care for individuals with dementia, the risk of caregiver burden is especially high. Caregivers of individuals diagnosed with moderate to severe dementia, with the inability to perform most IADLs and the presence of behavioral disturbances, tend to experience higher levels of caregiver burden [
One theoretical framework that has played a particularly prominent role in shaping the development of interventions is the stress process framework [
Many intervention studies have focused on reducing caregiver burden among caregivers of older adults with dementia (ie, those with highest burden levels). Interventions that have been found to be most successful have provided them with information about dementia, trained practical problem-solving skills, improved family communication and other social support, and increased caregivers’ sense of self-efficacy [
Although there have been some mixed findings, Web-based caregiving programs have strong potential to increase access to social support from other caregivers and new social contacts, access to relevant information, and support from care professionals. These types of programs have also been shown to lead to improvements in coping skills, confidence, and self-efficacy and significant reductions in caregiver depression, anxiety, stress, and strain [
The ubiquity of mobile technology also has great potential for reducing caregiver burden. Technology already plays a pivotal role in many aspects of everyday life. According to Nielsen, 71.4% of adults living in the US own a mobile phone [
Mobile app programs are easily accessible, generally inexpensive, and provide a repository for information, which they can integrate from multiple sources [
In an online survey of 1000 technology using caregivers conducted by the NAC and United Healthcare [
It is estimated that the number of mobile health (mHealth) apps available to consumers exceeds 259,000 [
During October 2017, apps in English that self-identified or advertised themselves as tools or aids for caregiving were identified in the iTunes App Store and Google Play, the most prevalent operating systems in use by smartphones, by searching the keywords “caregiving,” “caregiver,” and “elder care.” The internet was also used to identify caregiving apps using the search phrase, “caregiving apps,” in Google Search. Only apps that specifically addressed family or informal caregivers of older adults were included.
Apps developed for professional caregiving provider organizations or apps that help locate professional caregiving services were excluded. Apps that were designed for those living with specific conditions or health issues (eg, stroke or cancer patients) were also excluded from this study, but it is important to acknowledge that these may also be used by caregivers. All apps were classified on their platform availability. This included the Apple iOS or Android and both phone and tablet, cost, and features as described on their iTunes App store or Google Play store page.
Relative to general mHealth apps, availability of mobile apps geared towards caregivers of older adults is relatively sparse with 44 apps as of October 2017. Nevertheless, this number has been steadily on the rise. Existing caregiving apps generally addressed specific aspects of the caregiving experience. Few apps were comprehensive, with only 7/44 (16%) apps with features that addressed 3 functions, and 1 (2%) app addressing 4 or more (
The 44 app programs (
Fifteen (34%) apps met criteria for providing caregivers with
A total of 21 app programs addressed practical problem-solving needs that many caregivers share. Practical problem solving was defined as addressing medication management, safety, personal health record tracking, or behavioral solutions. Three of the 21 (14%) apps contained tools for
One serious concern for caregivers of family members with Alzheimer disease or other types of dementia is wandering by the care recipient. For example, 60% of the individuals with dementia will wander, and this can lead to dangerous consequences [
Number of functions associated with caregiving apps (N=44).
Number of functions | n (%) |
1 | 25 (57) |
2 | 11 (25) |
3 | 7 (16) |
4 | 1 (2) |
Apps meeting the criteria for each category of features (N=44). Note that some apps meet the criteria for more than one category.
Category | Examples and features | Platforms, n (%) | |||
iOS | Android | Both | Total | ||
Information and resources | Tips and advice; information about dementia, other diseases; searchable databases; videos; symptom tracking | 4 (9) | 3 (7) | 8 (18) | 15 (44) |
Family communication | Care coordination among family; instant messaging; calendar sharing; to-do lists | 3 (7) | 2 (5) | 10 (23) | 15 (44) |
Memory aids | Activities for care recipient; conversation starters; tools for memory support and reminiscence | 5 (11) | 4 (9) | 3 (7) | 12 (27) |
Care for caregiver | Support/chat groups |
2 (5) | 4 (9) | 4 (9) | 10 (23) |
Behavior solutions | Tips and information to manage problem behaviors (eg, agitation, wandering) | 3 (7) | 2 (5) | 3 (7) | 8 (18) |
Medication management | Medication reminders; dosage information; drug-interaction databases | — | — | 3 (7) | 3 (7) |
Safety | GPSa/motion sensor tracking; automated check-in calls; alarms and reminders | 1 (2) | 1 (2) | 3 (7) | 5 (11) |
Personal health record tracking | Doctors’ appointment reminders | 1 (2) | — | 4 (9) | 5 (11) |
aGPS: Global Positioning System.
In addition, 8 apps (38%) provided suggested solutions for dealing with behavioral problems that can arise in the care recipient. All of these apps were specifically designed for those caring for individuals with Alzheimer disease or other forms of dementia, as behavioral disturbances are often present in the middle and later stages of the disease and can be challenging for family members to handle. Examples of behavioral solutions or tips provided by these apps include how to address sleep disturbances, delusions, hallucinations, wandering, and catastrophic responses to stressors later in the day possibly associated with light changes towards sundown (“sundowning”).
Our search yielded 15 apps that facilitate better communication for coordinating care among family members. These apps were designed as communication tools to allow family, friends, neighbors, and colleagues to coordinate care needs for the care recipient. The apps allow caregivers to create profiles of their loved one containing health information pertinent to care, such as medical condition, medication list, and emergency contacts. An important feature of many of these apps is a shared calendar to coordinate the efforts of multiple family members or caregivers to assure recipient’s needs are addressed. With features such as instant messaging, sharing of photos and videos and other updates, they also provide a much-needed support network for caregivers. Only 2/15 (13%) of these apps were specifically designed for caregivers of persons with dementia, though the others were all designed for elder care.
Importantly, some apps aim to reduce caregiver burden by stimulating or supporting the needs of the care recipient. There has been a recent influx of care recipient focused
Caregivers are providing a significant service managing their loved ones’ health, but occasionally the stressful nature of this role can become detrimental to their own health. A total of 10/44 (23%) apps contained components to address caring for the caregiver, in the sense of providing emotional or social support or forms of stress relief, and respite. Apps in this category contain features such as chats or app-based support groups or social networks, assessments to track stress and burden level to be aware of one’s condition, suggestions for supporting one’s own health and quality of life and encouraging words, and advice from other caregivers.
The
The apps meeting our search criteria varied in cost and platform availability. Most were available for free, although some required or encouraged supplemental in-app purchases. Of those that did cost to download, the fee ranged from US $0.99 to US $29.99 making them relatively affordable. The only exceptions were the safety apps requiring additional GPS or sensor technologies. While the apps themselves were free, 2 required wearable sensors and hardware kits that start at US $249.99, and 1 offered home-based sensor technology at subscription rate ranging from approximately US $60 to US $170 per month, depending on the number of sensors needed.
Most apps (23/44, 52%) were available for both iOS and Android devices. However, of those available in only 1 platform, slightly more were available for download for iOS than for Android devices.
In summary, over the last few years, there has been growth in the number of mobile apps targeted at caregivers of older adults and designed to help them manage caregiving responsibilities and reduce levels of burden. However, in comparison to the large number of mHealth apps and caregiving apps available more generally, there are still relatively few apps catering specifically to the unique needs of caregivers of older adults. As the baby boomer generation is aging, this country is bracing to deal with the largest proportion of older adults our population has ever seen. For the first time in the US and globally, adults 60 years of age and older will soon outnumber children aged 5 years and under. [
Alzheimer disease and other types of dementia are projected to increase drastically with the aging of the population. Currently, Alzheimer disease affects over 5 million Americans, and it is projected that this number will triple by 2050 [
Another finding revealed by this study is that caregiving apps still have room for improvement regarding their comprehensiveness. For instance, 25/44 (57%) of the apps surveyed provided only 1 service to caregivers. Only 8 (17%) of the 44 apps provided 3 or more services. Caregivers are already balancing various daily tasks, medical appointments, jobs, and more. Thus, it might be ideal to combine as many useful features as possible into 1 easy-to-use app. The goal of mobile apps to support caregivers should be to reduce their load to help their productivity rather than hinder it. Also, as mentioned previously, the stress process framework suggests that caregivers experience stress in a larger context and targeting just one problem or fulfilling a single need will likely be less effective than an intervention targeting multiple needs [
In addition, most of the caregiving apps currently on the market do not seem to have been developed with the guidance of caregiving researchers. Therefore, there may be gaps between app features and empirical findings regarding caregiver burden and effective means of intervention. Future developers should collaborate with academic researchers to ensure that their apps are designed with the current empirical evidence in mind. For example, one crucial area particularly overlooked by most existing apps is caring for the caregiver. While 10 (23%) apps provided some form of limited caregiver support, most of the apps focused on providing solutions to concrete problems (eg, tracking a wandering loved one, dealing with problematic behaviors, communicating with other family members, or keeping a health record). Though these are pressing needs, there is still an imperative demand for resources focusing on supporting the caregiver’s emotional well-being, including coping with stress, anxiety, and depression. Our search yielded many general meditation and stress relief apps, but none were found to be directed toward caregivers of older adults and their unique stressors and experiences.
Family caregivers are providing an indispensable service to society, saving the health care system billions of dollars annually. Often, they do so to the detriment of their health and well-being. Furthermore, studies suggest that when the caregivers’ mental health is strained, their care recipients may suffer as well, regarding worsened health and shortened longevity [
Importantly, though they may be the ones who have the most to gain from this technology, family caregivers have been found to be less likely to use mobile apps than the general public [
Models of technology acceptance suggest that users, including older adults, are willing to invest in new technologies if they perceive enough usefulness and ease of use [
For reasons such as these, user experience studies are needed to customize apps to the needs, desires, and abilities of the targeted users. For instance, it may prove useful to develop adaptive material for caregivers whose care recipients are experiencing different stages of dementia. A strategy that works to calm or stir memories in a person with dementia may work well initially but lose its effectiveness as the disease progresses. Dementia is a progressive disease, meaning that symptoms will change and worsen over time. Therefore, a one-size-fits-all approach may not be appropriate for dementia caregivers, at least not without addressing the diversity of caregivers and the evolving needs of their care recipients. Additionally, many caregivers of older adults are over 65 years of age themselves, caring for a spouse or other loved one. As such, app designers should involve older adults in the design process as much as possible, as opposed to simply testing with younger demographics. Apps that are user-friendly for younger adults may not be user-friendly for older users.
Another consideration that will be important as the field of mHealth continues to move forward is that of security and privacy, for example with video monitoring of care recipients. Of course, with the advent of these new technologies comes the great potential for increased supervision, safety, and support. However, these developments also give rise to important questions regarding the invasion of privacy and security of information [
Another question worth considering is whether 1 app can, or should, actually “do it all.” While it is our opinion that simplicity, by way of fewer apps, will be preferred by caregivers, we must recognize that this may not be the case. Perhaps well-developed apps, each with a different focus, will be equally useful and preferred for the sake of compartmentalization. However, during our review, 6 caregiving apps that were included in an early count in December 2016 disappeared by October 2017, each of which had provided a singular service. This turnover pattern might provide support for the futility and limited appeal of single function apps for caregivers. Lastly, it is essential to take into account the frequency and duration of app use. If an app’s sole purpose is to provide information and resources, will caregivers continue usage after they have acquired the specific information they sought? For this reason, an app offering multiple features may be favored by caregivers and used more regularly.
In conclusion, the findings discussed in this paper should inform future work to develop more evidence-based, comprehensive apps to support caregivers’ needs and reduce caregiver burden. Apps may be an easy, accessible, and relatively inexpensive way to help this population manage and navigate the day-to-day challenges of the caregiving role, especially for those who do not have the time or means to seek out in-person support. More research is needed on effective mobile app interventions and resources for caregivers, including piloting with and surveying caregivers themselves to see how this technology can best suit their needs and preferences. It is extremely encouraging to see the number of relatively new apps supporting family caregivers of older adults. However, taking into account the input of caregivers themselves and incorporating the most up-to-date evidence emerging from research will likely be critical to the success and effectiveness of these apps. With the rapid growth of mobile phone use in our population and the simultaneous growing number of older adults, a golden opportunity exists to utilize mobile phone technologies to help manage their caregiving needs.
Catalog of caregiving apps and their features.
American Association of Retired Persons
Activities of Daily Living
Global Positioning System
Instrumental Activities of Daily Living
mobile health
National Alliance for Caregiving
We would like to thank the National Institutes on Aging Multidisciplinary Training Grant (T32 AG000037), the University of Southern California Graduate Provost Fellowship, and the Partners in Care Foundation for their support.
None declared.