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Market Overview for Technology for Aging in Place

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Living to 100 – will technology matter – and for whom?

What is the likelihood of living to 100 for older adults? Greater than you think – can you imagine that that by 2050, the number will grow from 72,000 to 1 million in the United States – in Canada, centenarians are the fastest-growing age group.  Today there are 450,000 centenarians worldwide – with the longest disability-free life expectancy found in Okinawa, Japan. Is society ready to accommodate double the number of seniors who will be living to 100 and beyond?  What will the experience be like – today’s centenarians offer a clue to how they came to live as long – genetics, healthy lifestyle, marital status. What these individuals were not, however, is socially isolated, as many of today’s boomers may be.

A conundrum – will less healthy baby boomers be among the centenarians?  Baby boomers may have a longer life expectancy at 65 than their parents – most likely due to availability of more sophisticated health care and medications. But for a disease free quality of life in their later years, they will they need to fix lifestyle and health issues that did not characterize their parents. For instance, boomers have shown themselves to be more likely to be obese, have poorer eating habits, have a greater prevalence of diabetes, and take more medications than the previous generation.  Ironically, almost all boomers want to lose weight, but when asked, ironically, they want to do so without exercise. And beyond age 80, most boomers will have some hearing loss.

Resource constraints may boost dependency on technology for seniors and caregivers.  But the benefits of technology may not just be related to disease management and lifestyle. As the population ages, will there be enough family member and professional caregivers to provide care? According to predictions, the ratio of available caregivers to potential care recipients is going to worsen. Better technology and more creative uses of it are likely opportunities to mitigate the growing caregiver gap.  These include making greater use of sensors in the home (the so-called Internet of Things) to detect issues with gait and falls. Population health data will help identify those at greatest risk of health issues and likely readmission to hospitals (see Figure 1 Table of Categories that may matter)

Making assumptions about care helps understand centenarian future needs.  How should society leverage available and future technology capabilities?  With lengthening life expectancy, poorer health and fewer available people to provide care, we can better understand the context for technology use and centenarians. The growing cost of providing in-person care will be an impetus for delivering more care remotely, including digital health technologies for diagnosis and remote monitoring, the use of wearables like smart watches or other jewelry to sense a problem like a fall and alert others.  (See Figure 2 Centenarian Morning in the Life)

Centenarians of the future will benefit from technology (r)evolution.  Eight years ago there were no commercially available consumer tablets. Five years ago there were no smart speakers on the market – today’s older adults have the benefit of access to large bright screens, devices they can speak to naturally and expect a response and widely available in-home WiFi and growing Internet use among older adults.  However, while Internet access is growing globally, the oldest old may still be non-participants in the benefits accrued with being online.  And non-participation may be as much due to the future cost of connection as due to lack of awareness.

Figure 1: Table of technology categories that may matter

Category

Examples

Implication/Benefit/risk

AI/Voice

Voice interfaces everywhere; increased engagement tools like Alexa, Google Assistant

Cost of higher speed Internet connection; privacy concerns

Social, Learning

Social networks, Online Learning

Maintain connection to family; learning in advanced old age; isolation of the offline

Digital health

Wearables, remote patient monitoring

More effective chronic disease management; alerting care providers;

Dementia care

Engagement, cognitive, wander management wearables

Improved cognitive function, lower risk of injury to wanderers

Hearing

Self-testing websites,

OTC hearing aids, amplifiers/hearables

Lower price and access, reduced stigma, enabling broader use; isolation, poorer health, dementia risk for non-users

Fall prevention

/detection

Weight-bearing exercise coaching, fall detection and gait analysis wearables

Reduction of hospitalizations due to falls, prediction of injury from gait analysis; risk of resistance from health professionals

Care Coordination

Tools for tracking care resources, tasks, milestones, care status

Family caregiver organization of tasks improves care quality; barriers of non-integration with health data remain

Internet of Things

/Smart systems

In-home security,

Individual motion/movement, cameras

Configured homes provide greater safety for very old; non-participation due to cost and lack of awareness

Predictive analytics

Identifying at risk population,

Predicting future individual incident

Health/insurer groups maintain contact with at risk groups; individual providers reach out to centenarians at risk

 

Figure 2: Centenarian morning-in-the-life scenario enabled by technology

At 101, Mrs. Johnson lives alone in an independent living community and walks without assistance.  Each day she wakes with an amplified voice-enabled alarm clock that tells her the time and offers a tip from its smart assistant on what to wear, given the weather. She views her activity schedule for the day – and sees that she is scheduled to attend lunch and a play with a grandson. She always wears her attractive smart watch which measures her heart rate and would warn if she fell. Her path to the bathroom is lit by motion-sensing lighting and alerts a caregiver that she is up. She glances at the voice-enabled display showing messages, news and fun facts for the day – spoken aloud and displayed. Her vital signs from the watch are regularly transmitted to a nurse -- Mrs. Johnson can expect a call from a nurse if vitals are out of range. Her daily stats are transmitted and aggregated because she is part of a study tracking wellbeing of Centenarians.  Mrs. Johnson speaks a request for a ride pickup for later that day. She receives a call from her grandson, then walks to the dining room to meet friends for breakfast.

Comments

We know that the probability of functional limitations increases with age.  From a low of 14% of people between the ages of 65-74 reporting difficulty with one or more activities of daily living, to more than 40% of those 85+, these limitations can be mitigated by the use of assistive devices.  Yet, basic HME/DME, so important to aging in place, are rarely mentioned in overviews of technology innovation.  

Vicki Freedman, via the National Health and Aging Trends Study (NHATS), has found that only one-third of adults reporting use of assistive devices are able to function independently. 

However, it is alarming that two-thirds either report difficulty with using the device, perform the task less often, or continue to need personal assistance - even with a device.  In some way, the design of the products is ill-suited to fully meeting their functional needs.  The result is that far too many people are unable to achieve their highest level of Functional Independence.

For too many years, restrictive coverage determinations perpetuated use of the cheapest devices, not the most effective.  The result is that the equipment doesn't have what it takes to promote self-care.  In fact, the design of the ubiquitous, commonly covered, slingseat wheelchair assumes that the wheelchair user is incapable of self-propelling and that a caregiver is always present to push them where they need to do.  

So let's include the need to improve the basic tools used by older adults to manage their self-care and mobility. Users of these devices want to be their healthiest self too!
 

The PERS/medical alarm (around-the-neck or watch/bracelet) is a great technology tool for any senior wanting to age in place and keep their independence in their own home.  www.334safe.com Around the Clock Medical Alarms offers added-touches of service that I've not come across in most of my research.  EMD-trained professionals in the call center (trained the same as 911 operators), monthly phone call reminders to test equipment, well-wishes cards, thank you vouchers, ect... are all things I know the older senior subscribers have expressed satisfaction with.  It's a sociable element that I've found lacking in many of the PERS devices available on the market in the USA today.   

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