LAUSR

Population ageing, combined with an increased use of health technologies to manage co-morbidities, is driving an increased demand for health and aged care services. High usage of these services is particularly common in older adults with the geriatric condition of frailty [1]. This vulnerable population group often faces a mismatch between their care needs and access to health care services due to impairments in physical functioning and/or dependence on other people for assistance [2]. Frailty is clinically recognised as reduced strength and a lack of physiological functioning, with a concomitant high risk of disability, vulnerability, falls, and death [1]. Survival of co-morbidities, such as cancer, chronic kidney disease, cardiovascular disease and HIV, often lead to frailty [1]. Delaying or preventing frailty progression by improving access to relevant health care services is a well-recognised priority for health systems. To identify which older adults access health care services, why they access these services, and where these services are located, the use of Geographical Information System (GIS) technologies is invaluable [3]. GIS and related spatial analysis methods can show the geographical distribution of health care services, which in turn, can be overlaid on the same map as population health data [3]. Thus, GIS technologies enable us to identify ‘hotspot’ areas of high frailty prevalence which need improvements in health care provision. A promising area of future research is for GIS monitoring to capitalise on advancements in wearable devices which monitor an individual’s long-term health, physical activity, sedentary time, and their physical location [4]. Such devices include: accelerometers that can measure walking distance and detect risk of falls; and computerised watches which detect physiological measures such as heart rate and blood pressure. These wearable devices can be connected with the ‘Internet of Things’ (IoT), which is a network of physical devices (including smart phones) supported with data transition features [4]. More specifically, spatial energetics is an emerging field of research in GIS monitoring that can be used to inform health care accessibility. Spatial energetics examines the interaction between an individual’s pattern of activityrelated behaviours (such as walking/sitting) and the time of day, space, and environmental location [5]. To achieve this, Global Positioning (GPS) locational data are paired with GIS data to from high-spatial resolution data on location, which is then time-matched with data on energetics from wearable devices and smart phones [5]. The data extrapolated from these devices can inform how to optimise health services to make them more accessible and efficient when catering for older adults with frailty. For example, extrapolated data can inform on ‘walkability’ to commonly used health care services, including proximity to local public transport services, and whether the distance needed to walk is physically achievable. Overall, very little research to date has used GIS technology in health systems planning for older adults with frailty. Future research should therefore consider using advances in GIS technologies to monitor health service accessibility for this vulnerable and rapidly expanding population group. This valuable knowledge will enable health service planners to ensure that older adults with frailty have equivalent access to health care services compared with any other person without frailty. Such knowledge will also play a fundamental * Elsa Dent [email protected]