Mobile Health Applications for Caring of Older People: Review and Comparison

Abstract

Background:
Mobile devices and applications (apps) that act as access tools for health care management aid in the improvement of clinical decision making and patient outcomes. However, the tremendous amount of mobile health (mHealth) apps available in commercial app stores makes it hard for the lay users as well as health care professionals to choose the right one for their individual needs. The contents and features of these apps have not been systematically reviewed and compared. This study aims to assess the contents and features of mHealth apps for caring of older people.

Methods:
A review and comparison of mHealth apps for caring of older people available in Google's Play Store (Android system) and Apple's App Store (iOS system) were performed. Systematic review of previous relevant literature were conducted. The assessment criteria used for comparison were requirement for Internet connection, information of disease, size of app, diagnostics and assessment tools, medical calculator, dosage recommendations and indications, clinical updates, drugs interaction checker, and information on disease management.

Results:
Twenty-five mHealth apps were assessed. Medscape and Skyscape Medical Library are the most comprehensive mHealth apps for general drug information, medical references, clinical score, and medical calculator. Alzheimer's Disease Pocketcard and Confusion: Delirium & Dementia: A Bedside Guide apps are recommended for clinical assessment, diagnosis, drug information, and management of geriatric patients with Alzheimer disease, delirium, and dementia.

Conclusions:
More studies about mHealth apps for caring of older people are warranted to ensure the quality and reliability of the mHealth apps.

Full text

Original Article
Mobile Health Applications for Caring of
Older People: Review and Comparison
Victoria Laput Anthony Berauk, BPharm(Hons)
1
,
Muthu Kumar Murugiah, BPharm(Hons), MBA, DBA
2
,
Yee Chang Soh, BPharm(Hons), MClinPharm
3
,
Yap Chuan Sheng, BPharm(Hons), MClinPharm
3
,
Tin Wui Wong, BPharm(Hons), PhD
1,4
,
Long Chiau Ming, BPharm(Hons) and MClinPharm, PhD
5,6
Abstract
Background: Mobile devices and applications (apps) that act as access tools for health care management aid in the improvement of
clinical decision making and patient outcomes. However, the tremendous amount of mobile health (mHealth) apps available in
commercial app stores makes it hard for the lay users as well as health care professionals to choose the right one for their
individual needs. The contents and features of these apps have not been systematically reviewed and compared. This study aims to
assess the contents and features of mHealth apps for caring of older people. Methods: A review and comparison of mHealth apps
for caring of older people available in Google’s Play Store (Android system) and Apple’s App Store (iOS system) were performed.
Systematic review of previous relevant literature were conducted. The assessment criteria used for comparison were require-
ment for Internet connection, information of disease, size of app, diagnostics and assessment tools, medical calculator, dosage
recommendations and indications, clinical updates, drugs interaction checker, and information on disease management. Results:
Twenty-five mHealth apps were assessed. Medscape and Skyscape Medical Library are the most comprehensive mHealth apps for
general drug information, medical references, clinical score, and medical calculator. Alzheimer’s Disease Pocketcard and Con-
fusion: Delirium & Dementia: A Bedside Guide apps are recommended for clinical assessment, diagnosis, drug information, and
management of geriatric patients with Alzheimer disease, delirium, and dementia. Conclusions: More studies about mHealth apps
for caring of older people are warranted to ensure the quality and reliability of the mHealth apps.
Keywords
mobile health applications, mHealth, getriatric care, drug information, disease diagnosis and management
Introduction
Mobile health (mHealth) is defined by the World Health
Organisation as a medical and public health practice using the
core utility of mobile and wireless devices, such as voice and
short messaging service and applications (apps).
1
mHealth has
transformed the conventional mode of health service delivery
globally in recent years.
Apps in mobile devices are handy and users including health
care professional (HCPs) can use it at anytime and everywhere
they are. One only needs to download the apps according to the
desired features of the apps. However, some of the apps are
paid apps for which subscription charges are applicable.
Some apps also need Internet connection in order for them
to operate and some do not. The presence of the highest data
transmission and life-critical apps is still doubtful if the con-
nection and availability of mobile broadband are uncertain.
Hence, users normally prefer those free apps that do not need
1
Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor,
Malaysia
2
Penang State Health Department, Pharmaceutical Services Division, Penang,
Malaysia
3
Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
4
Non-Destructive Biomedical and Pharmaceutical Research Centre,
iPROMISE, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
5
Unit for Medication Outcomes Research and Education (UMORE), Pharmacy,
School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
6
School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sem-
bilan, Malaysia
Submitted 5-May-2017; accepted 18-Jul-2017
Corresponding Author:
Yee Chang Soh, Faculty of Pharmaceutical Sciences, UCSI University, Jalan
Menara Gading 56000 Cheras, Kuala Lumpur, Malaysia.
Email: syc.chris@gmail.com
Therapeutic Innovation
& Regulatory Science
1-9
ªThe Author(s) 2017
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/2168479017725556
tirs.sagepub.com

Internet connection and consist of all the desired features in one
single app. This is also due to the limited memory space of the
user’s smart device. Unsurprisingly, nowadays all HCPs hav-
ing smartphone and tablets expect consistency in downloaded
apps in all of their devices.
2
So it is important for the HCPs to
be able to distinguish which apps should be used in caring of
older people to obtain better outcomes.
The availability and quality of mobile health (mHealth)
apps have been increasing as a result of the high usage of
mobile devices in clinical practice.
3
Currently, more than
100,000 mHealth apps are available in commercial app
stores.
4
The tremendous amount of mHealth apps available
in commercial app stores has made HCPs wonder about the
quality of the apps available. Inexperienced HCPs might mis-
interpret the information available in the poor-quality
mHealth apps. Apps that are unnecessary may also take up
too much of the phone’s memory space.
This study was aimed to assess the contents and features of
mHealth apps for caring of older people. By comparing the
different features available among the relevant mHealth apps,
this study may guide the HCPs in choosing appropriate apps for
the delivery of geriatric care. Moreover, this study also pro-
vides background information for the developers of mHealth
apps in designing quality mHealth apps for HCPs.
Methodology
Study Design
Two approaches were adopted for the evaluation of mHealth
apps available for caring of older people. The first approach
was the systematic review of previous literature about mHealth
apps for caring of older people. The second approach was the
review and quality assessment of selected mHealth apps in
commercial app stores.
Literature Review About mHealth App in Caring of
Older People
The review was a search of previous literature related to
mHealth and caring of older people. The search was conducted
over 4 online databases: Google Scholar, PubMed, IEEE (Insti-
tute of Electrical and Electronics Engineers) Xplore Digital
Library, and Science Direct. The search terms used for all
databases were mobile health,mHealth,medical mobile appli-
cation,geriatric,elderly,older people. The literature in lan-
guages other than English were excluded for this review.
Feature Assessment of Selected mHealth App in
Commercial App Stores
The search was conducted with the two most common com-
mercial app stores for smartphone: iTunes Apple (Apple Inc,
Cupertino, CA, for iOS devices) app store and Google Play
(Google Inc, Mountain View, CA, for Android OS devices)
app store. The search terms used for both app stores were older
people,geriatric, and elderly. The exclusion criteria for this
review were apps not in English, paid apps, and games apps.
The iTunes Apple app store is available in all the Apple
mobile devices—iPhone, iPod, and iPad. In this study, mHealth
apps in the iPhone device were evaluated. The mHealth apps
that had matched the selection criteria were then sorted accord-
ing to their purposes, and descriptions provided by the app
stores. The number of downloads for each app was also
recorded and was used as the indicator of usage popularity.
Feature Assessment of Selected Mobile Health
Application Content
The selected mHealth apps were assessed according to the
following features:
1. Requirement of Internet connection for content access
2. Size of application less than 150 MB
3. Information on diseases
4. Diagnostic and assessment tools
5. Medical calculator
6. Dosage recommendations and indications
7. Clinical update and latest related issues and articles
8. Drugs interaction checker
9. Information on disease management (disease treatment
and/or prevention)
Criterion such as Internet connection requirement is
included because some of the apps might need Internet con-
nection for content access, and HCPs would require to establish
Internet connection before they are able to access the apps’
contents. As for the size of the apps, a smaller size would be
preferable to prevent interference in the apps’ installation rate
and the smartphone’s storage space. Apps with a size of 150
MB and more were found to have markedly reduced install
rate, by at least half the normal rate. Smartphones need 150
to 200 MB free space in their internal memory for smooth
functionality of their apps.
5
Research Instrument
For this study, we used two different models of smartphone:
Lenovo A369i (Lenovo Ltd, Haidian, China) and iPhone 5s
(Apple Inc, Cupertino, CA) with Android (Google Play) and
iOS (iTunes) platform software, respectively.
Results
Literature Review About mHealth Apps in Caring of
Older People
The key findings from the literature review about mHealth apps
for caring of older people are presented in Table 1.
2Therapeutic Innovation & Regulatory Science XX(X)

Table 1. Key Findings from Literature Review About mHealth Applications in Caring of Older People.
Category mHealth Apps (Platform) Key Findings (Reference)
a. Applications for General Geriatric Care
Disease diagnosis or
management
iGeriatrics
(iOS and Android)
iGeriatrics app aimed at health care professionals (HCPs) especially
geriatricians as it covers a wide range of topics regarding geriatrics,
which include information on the titles of Beers Criteria, Geriatrics
Cultural Navigator, GeriPysch Consult, Guide to Common
Immunizations, Management of atrial Fibrillation, and lastly Prevention
of Falls Guidelines.
5
Treatment and
medication:
Drugs
information
Medical
references
Clinical score and
medical calculator
Monitoring tools
Micromedex
Medscape
MIMS Malaysia
Lexicomp
Epocrates
(iOS and Android)
According to Ming et al (2016)
6
, about (194 [86.6%]) of the pharmacists
justified the frequent usage of their mobile device as a reference of drug
information (DI), and the most commonly downloaded one is
Medscape, followed by Micromedex and MIMS Malaysia, followed by
Lexicomp and Epocrates.
Medscape, Micromedex, and Lexicomp does not need any access to the
Internet to be used, so this is more preferable among the pharmacists,
being easier to access information at any time and location.
7
As a dose calculator, the Lexicomp app was chosen as Medscape and
Micromedex lack this feature but have the general medical calculator.
7
b. Applications for Specific Geriatric Disease
Hearing loss uHear
(iOS)
uHear apps is a smartphone-based audiometric test app that can be
downloaded for free specifically for iOS mobile devices, and consists of
3 modules: sensitivity test, noise test, and screening questionnaires
(Abu-Ghanem et al, 2015).
8
This app can aid in detecting whether or not
the geriatric patient has loss of hearing.
hearScreen
(Android)
A study conducted by Yousuf Hussein et al (2015)
9
showed that use of the
hearScreen app, a user-friendly asynchronous smartphone-based
hearing screening, improved the early detection and prevention of
hearing loss among the elderly by HCPs at the undeveloped regions.
Dementia and
Alzheimer
diseases
iWander
(Android)
Dementia Screener
(Android)
MOBI-COG
(Android)
Mobile Cognitive Screening (MCS)
(Android)
There are some clinical monitoring and tracking apps based on mobile
devices’ GPS tool such as iWander that was invented for elderly patients
having Alzheimer disease who are likely to wander alone.
1
iWander is one of the apps for smartphones with an Android platform
that helps caregivers keep track of an elderly dementia patient from
even a far distance cost efficiently (Sposaro et al, 2009).
10
The Dementia Screener app asks questions based on the Hodkinson
and AD8 Dementia Screening Interview to complete the questionnaire-
based dementia screening.
11
MOBI-COG has a standardized cognitive test for dementia screening.
The elderly patient’s performance in the clock drawing and word recall
tests are assessed (Mandala et al, 2015).
12
The MOBI-COG App is a complete automation of the MiniCog
dementia screening test. It is a fast and effective tool for screening a
dementia or a cognitive disorder patient, where it performs all 3 steps
of the Mini-Cog test effectively and is capable of assessing the
correctness of a clock drawn on the mobile device touch screen with an
accuracy of 99.53%.
11
However, the most reliable app for screening dementia is the Mobile
Cognitive Screening (MCS), a neuropsychological battery app that can
be downloaded for Android smartphone users, having 14 tests with 33
questions to evaluate 8 diffrent cognitive functions.
12,13
Gait and balance
disorders
RollingBall
(Android)
iFall
(Android)
A recent study by Yamada and Aoyama
14
evaluated the ability of dual
tasking using a smartphone-based application, RollingBall apps as a
reference, and assessment of the risk of falls in elderly.
The iFall application is a simple app that has a low-powered fall monitor
that can send signals and also alert caretakers and HCPs in charge of the
elderly and reduce the false positives. It also has a falls detection
algorithm that is able to detect the possibility of falls in the elderly
patient. Hence, this app is highly reliable and trustwothly.
10
(continued)
Anthony Berauk et al 3

Feature Assessment of Selected mHealth Apps in
Commercial Applications Store
All the selected mHealth apps were reviewed according to the
criteria listed in Figure 1. One point was assigned for each
fulfilled criteria.
Based on the criteria listed, Medscape, Skyscape Medical
Library, and MyNAG apps scored the highest total score for
general geriatric care, which was then followed by Lexicomp,
Epocrates, MIMS, WebMD Health Tools, and Drugs.com.
Based on the criteria listed, Alzheimer’s Disease Pocketcard
and Confusion: Delirium & Dementia: A Bedside Guide apps
scored the highest total score for specific geriatric conditions or
diseases, which was followed by ConsultGeri: DementiaBSD:
Behavioral Symptoms of Dementia and BPSD Guide. Others
that had the lowest total scores were GDS: Geriatric Depression
Scale 15-Item, Dementia Screener, uHearTMePrognosis: Can-
cer Screening, Doctot Elderly Mobility Scales (7- item EMS),
The American Journal of Geriatric Psychiatric (AJGP), Alz-
heimer’s & Dementia: The Journal of the Alzheimer’s Associ-
ation, MCC GEMS, and iSeismometer. The feature assessment
results were tabulated in Table 2.
Discussion
Criteria for Feature Assessment
It is vital for the HCPs to have sufficient information about
various diseases for the provision of quality health care ser-
vices. Besides the disease information, the diagnostic/assess-
ment tools, and medical calculator regarding the elderly
conditions are very helpful to HCPs. Reliable apps tool could
assist HCPs to diagnose and assess the patients. As for the drug
references features such as dosage recommendations and indi-
cations, and also drugs interaction and drugs to avoid, it is
crucial for HCPs in the context of planning treatment and pre-
vention features for their patients.
In addition, to improve the quality of life of elderly patients,
HCPs would need to keep abreast with the current clinical
updates on the existing or emerging geriatric diseases and
health problems. The app features that were frequently visited
by HCPs and of most importance were general dosage recom-
mendations, adverse drug reactions (ADRs), and drug
interactions.
7
Table 1. (continued)
Category mHealth Apps (Platform) Key Findings (Reference)
Parkinson disease
(PD)
Parkinson’s Tracker Apps (PTA)
Self-Management and Adherence Tools to
Manage Parkinson’s disease (SMART-PD)
(Android)
iSeismometer
(iOS and Android)
A recent study conducted by Lakshminarayana and Wang
15
stated that
PTA and SMART-PD are aimed at the PD patient and carer who have
smartphones and/or devices with Internet access so that thay can have
access to the apps. The patient or carer can update their health
progress in the app, which then can be retrieved by the HCP in charge
through the SMART-PD web portal.
iSeismometer is a reliable app that is used to measure tremor frequency
and hence can identify any neuromuscular disease, as its analysis is as
precise as the usual electromyographic (EMG) analysis, other than being
the most affective app in measuring tremor frequency and EMG
analysis.
16
Cancer and life
expectancy
ePrognosis
(iOS)
The app asks patients 15 questions about their self, their health, and
whether or not certain activities are difficult for them. The app also
assesses the elderly based on 15 questions that are a combination of the
Lee and Schonberg mortality indices.
17
Multiple diseases MCC GEMS
(iOS and Android)
The MCC GEMS app guides HCPs on managing elderly needs and handling
the multiple chronic health problems in the right way and guidelines of
treating the conditions or diseases.
18
Review literatures on mHealth apps in 4 online
databases:Google Scholar®, PubMed®, IEEE
(Institute of Electrical and Electronics Engineers)
Xplore® Digital Library and Science Direct®
(Search terms used: mobile health, mHealth,
medical mobile application, geriatric, elderly, older
people)
Conduct mHealth apps search using smartphones
with 2 different commercial apps stores:
iTunes Apple® and Google Play®
320 mHealth apps found (Search terms used: older
people, geriatric and elderly)
Feature assessment on 25 selected mHealth apps
295 mHealth apps
excluded (Exclusion
criteria: apps not in
English, pay-for-use
apps, and games
apps)
Figure 1. Flow chart of the methods employed in the mHealth apps
review.
4Therapeutic Innovation & Regulatory Science XX(X)

Table 2. Feature Assessment of Selected mHealth Applications in Caring of Older People.
a. General Geriatric Care
mHealth apps Medscape
Skyscape Medical
Library MyNAG Epocrates Lexicomp MIMS Malaysia
WebMD
Health Tools Drugs.com
My Blue
Book
Calculate
(Medical
Calculator)
Platform (app stores) iTunes and
Play Store
iTunes and Play Store Play Store iTunes and Play Store iTunes and
Play
Store
iTunes and
Play Store
iTunes iTunes Play Store iTunes and
Play Store
Apps version/date of last update 5.4/May 23,
2016
2.8/Apr 26, 2016 1.3/Mar 10, 2016 16.4/May 02, 2016 2.3.5/Apr
08, 2016
1.6.0/Jun 06,
2016
5.9.3/Jan 19,
2016
1.45/Apr 29, 2016 2.6.1/Jan
10,
2016
6.3/Apr 16,
2016
Requirement of Internet
connection for content access
Xpp p
XX pXpX
Size of app less than 150 MB pp p p pppppp
Information on diseases pp p Xpp p p XX
Diagnostics and assessment tools pp p XXX
pXpp
Medical calculator pp p p pp
XX
pp
Dosage recommendations and
indications
pp p p ppppp
X
Clinical update and latest related
issues and articles
pp Xppp
XpXX
Drugs interaction checker pXpppppp
XX
Information on disease
management (disease treatment
and/or prevention)
pp p p pp
XpXX
Total score 8 8 8 7 7 7 6 6 5 3
b. Specific Geriatric Disease
mHealth Apps
Alzheimer’s
Disease
Pocketcard
Confusion: Delirium &
Dementia: A bedside
guide
ConsultGeri:
Dementia
BSD: Behavioral
Symptoms of
Dementia
BPSD
Guide
GDS: Geriatric
Depression
Scale 15-Item
Dementia
Screener uHear
Platform (app stores) iTunes an Play
Store
iTunes iTunes iTunes iTunes and
Play
Store
iTunes and
Play Store
Play Store iTunes
Apps version/date of last update 2.6/Jun 04,
2016
1.2/Feb 23, 2016 1.0/Feb 27, 2015 1.3/Feb 07, 2013 2.0.5/Jan
23, 2015
1.02/May 31,
2011
1.5/May 20,
2012
2.0.2/Oct 13, 2015
Requirement of Internet
connection for content access
pp p p pppp
Size of application less than 150 MB pp p p pppp
Information on disease X X X X X X X X
Diagnostics and assessment tools pp p p pppp
Medical calculator X X X X pXX X
Dosage recommendations and
indications
pXX XXXXX
Clinical update and latest related
issues and articles
XX X X XXXX
Drugs interaction checker X pXXXXXX
(continued)
5

Table 2. (continued)
b. Specific Geriatric Disease
mHealth Apps
Alzheimer’s
Disease
Pocketcard
Confusion: Delirium &
Dementia: A bedside
guide
ConsultGeri:
Dementia
BSD: Behavioral
Symptoms of
Dementia
BPSD
Guide
GDS: Geriatric
Depression
Scale 15-Item
Dementia
Screener uHear
Information on disease
management (disease treatment
and/or prevention)
pp p p XX X X
Total score 5 5 4 4 4 3 3 3
mHealth Apps ePrognosis:
Cancer
Screening
Doctot Elderly Mobility
Scales (7- item EMS)
The American Journal of
Geriatric Psychiatry
(AJGP)
Alzheimer’s & Dementia: The
Journal of the Alzheimer’s
Association
MCC
GEMS
iSeismometer iSeismometer
Platform (app stores) iTunes iTunes iTunes and Play Store iTunes and Play Store iTunes and
Play
Store
iTunes Play Store
Apps version/date of last update 2.1/Apr 06,
2015
1.1.1/Dec 06, 2014 5.6.1/Mar 20, 2016 5.6.1/Mar 19, 2016 1.2.0.113/
Sep 24,
2015
1.3/Mar 21,
2011
1.3/Mar 10,
2016
Requirement of Internet
connection for content access
pp XXX
pp
Size of application less than 150 MB pp p p ppp
Information on disease X X pp
XX X
Diagnostics and assessment tools pp XX
pXX
Medical calculator X X X X X X X
Dosage recommendations and
indications
XX X X XXX
Clinical update and latest related
issues and articles
XX pp
XX X
Drugs interaction checker X X X X X X X
Information on disease
management (disease treatment
and/or prevention)
XX X X pXX
Total score 3 3 3 3 3 2 2
6

mHealth Applications for General Geriatric Care
The Medscape app has a few features that require Internet
connection for access. It contains drugs information (dosage
and indications, interaction, adverse effects, warnings, preg-
nancy, pharmacology, administration, images, and formulary);
disease and conditions (Internet connection required); proce-
dures for a treatment; drug interactions that can be checked
without connecting to the Internet; pill identifiers such as
shape, color, form, and scoring (Internet connection required);
medical calculator for any diseases, conditions, and diagnoses
involving, for example, the brain and spinal cord; critical care;
diagnostic criteria; diagnostic imaging; ear, nose, throat, and
dental; examination protocols; fluids; gastrointestinal; heart
and chest; hematology; laboratory; lung and respiratory; med-
ication protocols; musculoskeletal; obstetric and gynecologic;
oncology; pediatric and neonatal; psychiatric; renal; skin and
soft tissue; statistics and toxicology; and formulary (Internet
connection required). This app also contains top news from the
Medline website, but Internet connection is required for access.
Skyscape Medical Library app contains the free drug guide
that could be used as drug references, medical calculator, dis-
ease management, and the latest news about various diseases.
MyNAG app is only available for the Android platform.
This app contains the national antibiotic guideline (second edi-
tion), which served as a guide for HCPs practicing in Malaysia
for the treatment of infectious diseases. This app also contains
medical calculator and assessment tools for the dosage recom-
mendation purpose.
The Epocrates app includes a few guidelines regarding dis-
eases and treatment. One of the guidelines is about geriatric
medicine such as hip fracture treatment, opioids for chronic
pain, and overactive bladder. Like other general health care
apps, it contains drug information and clinical updates.
The Lexicomp app provides drug information such as drug
dosage and drug interactions. However, this app does not pro-
vide information about disease management, such as treatment
and prevention of diseases or health complications.
The MIMS Malaysia app requires one to sign up first, and
this app also needs Internet connection for content access. It
contains drug information; medical calculators; medical news
and continuing medical education; multimedia such as videos
of the latest medical news; disease resources where HCPs can
obtain treatment guidelines as well as drug information; special
reports on any news, diseases and treatments, and medical
events; and QR code scanner. The medical calculators are cate-
gorized into specific classes; for example, for geriatric care, it
has the abbreviated mental score.
The WebMD Health Tools app has all of the features eval-
uated in this study except for the medical calculator, updates in
clinical news, and also the management regarding the treatment
and prevention of the health complication. However, it could
be used as drug references and diagnostic and assessment tools.
The Drugs.com app has organized the drugs according to the
diseases or health conditions and also by the pharmacologic
classes. This app contains drug information, including drug
side effect and drug interactions. Additionally, this app con-
tains the symptom checkers that might be useful for HCPs in
the diagnosis and management of diseases.
My Blue Book provides drug information such as the pre-
scriber category of drugs and drug indication where one can
search using the generic/brand name of a drug.
Calculate (Medical Calculator) is a medical calculator app
created by the QxMD Software team that consists of medical
professionals. The app’s contents are grouped into general
calculators and few specific health calculators, including for
geriatrics. It will give health results according to the
answered questions.
In addition, Medscape, Micromedex, and Lexicomp do not
require Internet access; therefore, they are more preferable
among the pharmacists’ information access at any time and
location. Nevertheless, users of Lexicomp, which has features
identical to those of Micromedex, still need to subscribe after
30 days of the trial period.
7
mHealth Applications for Specific Geriatric Disease
The Alzheimer’s Disease Pocketcard app has tools for diag-
nosis and assessment to enable HCPs to identify and assess
the elderly with Alzheimer disease besides having info about
Alzheimer treatment. However, it does not provide informa-
tion on drugs interaction; instead, it has drugs recommenda-
tions and indications.
Similarly, Confusion: Delirium & Dementia: A Bedside
Guide also enables the HCPs to detect delirium and dementia
as Alzheimer’s Disease Pocketcard app does. The app provides
info on the types of dementia and delirium. This app contains
few assessment methods to identify delirium by using the Con-
fusion Assessment Method (CAM) and cognitive impairment
screening by using the Six-Item Screener (SIS), Abbreviated
Mental Test (AMT), Montreal Cognitive Assessment (MOCA),
and Mini Mental State Examination (MMSE). In addition, a
few assessment methods to identify the risk factors of dementia
or delirium are also available. Lastly, it includes drugs formul-
aries regarding sedating drugs and their dosages, and drugs to
avoid in elderly patients with delirium and dementia.
The ConsultGeri: Dementia and BSD: Behavioral Symp-
toms of Dementia apps have information on diagnosis, assess-
ment tools, and management of dementia patients. The BPSD
Guide app also enables HCPs to diagnose and assess the
symptoms regarding elderly dementia. It has behavior man-
agement and medical calculator but there is no management
of the treatment and prevention. The GDS app has a geriatric
depression scale that is used to calculate the level of elderly
depression. Patients are assessed according to their score in
the total 15 questions. The Dementia Screener app has assess-
ment tools for progression of dementia based on the questions
of the AD8 Dementia Screening Interview and the screening
of dementia symptoms.
Anthony Berauk et al 7

The iSeismometer app can assess the tremor frequency of
patients for early detection of Parkinson disease. Through this
app, we can conveniently assess the elderly where there is an
absence of suitable analytical equipment at hand. ePrognosis:
Cancer Screening is an app that guides the screening of cancer
for high-risk patients.
The Doctot Elderly Mobility Scales (7-item EMS) app pro-
vides physiotherapists with a standardized validated scale for
the assessment of mobility function in more frail elderly
patients. The scale has good validity and interrater reliability.
This scale assesses 7 dimensions of functional performance
including locomotion, balance, and key position changes, all
of which are intrinsic skills that permit performance of com-
plex activities of daily living. The performance is assessed
through the scores obtained by the elderly.
There are mHealth apps that contain the updated and latest
related issues and articles regarding elderly diseases. Among
them, the Alz & Dementia app consists of collections of latest
journal issues and the results of studies regarding Alzheimer
diseases and dementia. The journal publishes reviews, preven-
tion, risk factors, interventions, and early detection of dementia
and its application in new technologies. HCPs can download
the journals for free or paid.
Same holds for the American Journal of Geriatric Psy-
chiatry (AJGP) app, which consists of a collection of latest
issues of journals regarding geriatric psychiatry on the diag-
nosis and classification of psychiatric disorders and mental
health of older adults. The features are the same as the Alz &
Dementia app.
Multiple Chronic Conditions: Geriatrics Evaluation and
Management Strategies (MCC GEMS) app has assessment
tools such as the Mini-Cog Screen For Dementia, Montreal
Cognitive Assessment (MOCA), Vulnerable Elders Assess-
ment (VES-13), Patient Health Questionnaire (PHQ-2), and
Patient Health Questionnaire (PHQ-9). It contains the manage-
ment guideline to help HCPs in managing patients with multi-
morbidity. The Geriatrics Evaluation and Management
Strategies (MCC GEMS) app provides treatment plans for the
elderly. It enables HCPs to identify which medication should
be discontinued or dosage reduced.
There are few features that commonly present in mHealth
apps. In general geriatric care apps, features such as diseases,
medical calculator, dosage recommendation and indications,
drugs interaction, and management (prevention and treatment)
are mostly present and useful to the HCPs.
16
While for specific
geriatrics apps, features like diagnostic and assessment tools
are most commonly included in the apps. Important informa-
tion including dosage recommendation and indications, drugs
interaction, and management (prevention and treatment) are
not found in most of the mHealth apps assessed. Apps that have
the most criteria are the most advantageous. However, we still
need to consider the app size. Bigger app size may interfere
with the storage of smartphone devices.
The present study assesses only the free mHealth apps that
are more accessible to the users; however, paid apps probably
provide more content and/or features that are demanded by the
HCPs. HCPs tend to refer to more than a single app to obtain
more medical information as the free mHealth app does not
offer the complete medical and drug information needed during
their clinical clerkship.
19
Paid mHealth apps are penny-wise if
they cover any updates.
1
Feature Assessment Scores
Based on the quality assessment criteria scored in this study,
the Confusion: Delirium & Dementia: A Bedside Guide and
Alzheimer’s Disease Pocketcard apps scored the highest total
score of 5 for the specific care of older people, which was then
followed by BPSD Guide, BSD: Behavioral Symptoms of
Dementia, ConsultGeri: Dementia, ePrognosis: Cancer Screen-
ing, MCC GEMS, Doctot Elderly Mobility Scales (7-item
EMS), The American Journal of Geriatric Psychiatric (AJGP),
GDS, Dementia Screener, iSeismometer, HeartRateFree, and
Alz & Dementia. As for specific geriatric apps, Confusion:
Delirium & Dementia: A bedside guide, Alzheimer’s Disease
Pocketcard, and ConsultGeri: Dementia apps are recommended
for elderly management, and diagnostic and assessment tools
and methods for elderly patients.
For drug references, Confusion: Delirium & Dementia: A
Bedside Guide, and Alzheimer’s Disease Pocketcard would be
the best options. Most apps have criteria such as drugs infor-
mation and medical references. For simple screening of demen-
tia, we can use the Dementia Screener. Both iOS and Android
platforms do not necessarily have the same apps. Some of the
apps are available in either of the platforms, as it depends on
the app’s availability in the stores, that is, in the Apple iTunes
or Google Play app store. Medscape and Skyscape Medical
Library apps are the most comprehensive mHealth apps for
general drug information, medical references, clinical score,
and medical calculator. Alzheimer’s Disease Pocketcard and
Confusion: Delirium & Dementia: A Bedside Guide apps are
recommended for clinical assessment, diagnosis, drug informa-
tion, and management of geriatric patients with Alzheimer dis-
ease, delirium, and dementia.
Conclusions
It is useful for the HCPs to have at least a few mHealth apps in
their smart mobile devices. They need information and updates
regarding elderly health problems. The top downloaded apps
for general geriatric care are Medscape, MIMS Malaysia, Lex-
icomp, and Epocrates. Based on the feature assessment criteria
scored in this study, Medscape, Skyscape Medical Library, and
MyNAG apps scored the highest followed by Lexicomp, Epo-
crates, MIMS Malaysia, WebMD Health Tools, My Blue Book,
Drugs.com, and Calculate(Medical Calculator). Therefore, for
general geriatric care, Medscape, Skyscape Medical Library,
and MyNAG apps are recommended as they provide the most
comprehensive medical information and have user-friendly
features that might aid HCPs in their patient care process. For
information on diagnosis, diseases, and management such as
8Therapeutic Innovation & Regulatory Science XX(X)

prevention and treatment, and dosage recommendation and
indications, the Lexicomp, Epocrates, MIMS Malaysia, and
Skyscape apps could be good choices among the mHealth apps
assessed. Nonetheless, more studies about mHealth apps for
caring of older people are warranted to ensure the quality and
reliability of the mHealth apps.
Acknowledgment
The authors would like to express their gratitude to the Ministry of
Higher Education, and Universiti Teknologi MARA, Malaysia, for
financial support for this research. We wish to thank Richard Thrift
(English Editing Netherlands) for reviewing and editing the manuscript.
Declaration of Conflicting Interests
No potential conflicts were declared.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This work
was supported by LESTARI grants: 600-IRMI/DANA 5/3/LESTARI
(0006/2016) of Ministry of Higher Education, and Universiti Tekno-
logi MARA, Malaysia.
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