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When markets don't intersect - xHealth and tech for aging

 The xHealths prefer to ignore the elephant in the room.  Every day I am treated to a plethora of updates (remember my 24 LinkedIn Groups) about this conference and that event for Health 451.0, Connected YouKnowWhat, Wireless WhatsUp, and Mobile Name-that-disease. The very word ‘health’ connotes opportunity (avoid 30-day hospital readmissions!), visions of reimbursement, and smiling clinicians on the far side of webcams.  After all, shouldn’t the xHealths target employer-funded health insurance programs, monitoring ailments among employees and their kids’ childhood diseases? And doesn’t the ‘m’ in mHealth mean mobile, mean smart phone, always-on, on-the-go and on-the-run?  Tweet your stats to your friends and get a friendly e-mail from your doctor’s iPad.

Aging patients just don’t make for snazzy demos, I guess.  But the gleaming gold in them thar hills fades into the distance, along with the gleams in their eyes when the words ‘aging’ or ‘elderly’ or ‘old’ enter the discussion. Only 11 percent of the 65+ have smart phones (not even the wealthy love them, heads-up carriers!). I dunno, maybe that’s because they are irritatingly small-screened, small-keyed, flickering images requiring sure-handed swipes and pinches. So all of these fab health startups have to find relatively well constituents among the young and middle-aged smart app store junkies, pushing free and/or low cost apps. Maybe you’re walking around after leaving your Foursquare social living restaurant, but you ate too much, and you just forgot where your doctor was?  Not to worry -- help is available from DocGPS, “no matter where you are…”

There are parallel market lines – who will have the guts to cross this chasm?  Of course, we all know that the 65+ comprise the majority of chronic disease sufferers, with 2 or more diseases on average. But if you are waiting for the young-old to take their phones with them into their older age cohort range, and your investors are optimistic and have patience, life is good -- the patients will age unto you. No need to figure out how to push the telehealth in-home market past its tipping point. No need to find the doctors who serve an aging population -- gee, maybe they’re in Florida or Arizona? No need to invite those doctors into free pilots of all types of monitoring tech, including wander detection for those 400,000 Floridians living alone at home with dementia.  Meanwhile, small companies that target the aging sector plod uphill with little online fanfare -- with an angel investor here, a grant there, an occasional VC -- who try to fill gaps with a bit of technology. These vendors and their investors worry about the elderly home alone, not the mobile always-on-the-phone. Doesn't this seem just like a chicken-egg problem – whoever crosses this chasm will push vendors to move from their xHealth side of the house to seeing the need on the other, helping to pave the path, perhaps, to the nirvana of Medicare reimbursement.


As someone who cared at home for two parents dying simultaneously from cancer and Alzheimer's disease, respectively, while working and raising children, your post resonates completely! Unlike those young entrepreneurs with a gleam in their eyes at the market potential for eHealth solutions, they're missing the target audience completely. It's not the 65+ year olds, rather, it's their adult children who wind up being the caregivers. I wrote a book Don't Give Up on Me! and launched an organization, Circle of Life Partners, to provide the bridge you so describe. For what it's worth, I wasn't a typical caregiver as I'm an alum of the business school at Harvard, a former pharmaceutical executive, and a scientist who can hold her own with harried physicians who overtreat or overprescribe...none of which prepared me for the decade of care through my parents' last years. It was frustration that drove me to find a solution for the tens of millions who are in the sandwich. Medicare reimbursement for home care is only a piece of the solution. Employee assistance programs that provide geriatric care management is another. Changing our Councils on Aging into Councils on Wellness is a third. I could name a dozen more solutions that don't cost much but would save millions and improve the lives of our older loved ones.

Thanks for writing and speaking about aging. I've been told that we should meet - I'm one of your biggest fans!

Few people seem to understand that once dementia begins, it is very difficult for people to learn new gadgets and apps, or even to adjust to new routines and objects in the environment. Because short-term memory is the gateway to learning, it takes a lot of repetitions for Grandpa to move from "What's that thing?" to "Oh, that's my new remote." Learning a new app on a new smartphone is out of the question for many in the current population of seniors.

Another problem we're seeing in the adoption of technology is the reluctance of geriatrics professionals to spend time learning about new devices. That's understandable: they're already inundated with pharma reps and overscheduled with patients, and learning new technology requires an investment of time. The problem may be compounded by the fact that so many new products are entirely inappropriate for their patients, poorly developed, or rather obviously aimed at garnering profits rather than improving lives. If some gero pros have developed a built-in bias against tech gadgets, I can't blame them.

It is up to us to build something that actually solves problems in the first place, and then to break through that resistance and demonstrate the product's worth. But there's so much noise in the market you can't just scream over it. AIP Technology Watch may help with that!

Merilee Griffin

Laurie, you are correct about older patients having less smart phones than younger ones. The mHealth solutions that will succeed are those tied to caregivers as well. There are many clinically oriented people in the arena thinking along these lines. Not chicken/egg issue at all.

Your point about seniors having low adoption rates of new technologies is well accepted, but many barriers to adoption will soon to be broken, making seniors a new opportunity for the right products.

Apple iPhone & iPad are known for extreme ease of use and accessibility features that make them usable by 2-yearolds, 82-yearolds, and people with blindness or other disabilities. But there's been one big problem for seniors - they required a PC and home network to receive content and apply maintenance. That changes with iOS5 and iCloud as I describe in http://www.mhealthtalk.com/2011/06/ipad-for-all-ages/.

I'm also expecting new conversational speech capabilities in iPhone5 that could attract even more seniors. While I do agree that many (most?) seniors are tech phobic and unlikely to seek out new technologies, their adult children could lead them to it.

I agree with a few of your visitors.

The target for many of the business/ideas/start-ups shouldn't necessarily be the aging adult but rather the adult children caring for their aging parents.

The app that lets you monitor your loved one without feeling like your prying into their lives... have they taken their medications, are they out of bed or have they fallen? Peace of mind is very valuable to many people caring for aging loved ones.

Many seniors will not purchase high tech devices even though they may benefit from them... but their children will buy them if it saves them time, money and gives them peace of mind.

Thanks for sharing Laurie!



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