Exploiting Technology and Collaboration to Enable Quality Aging
Editor’s Note: This article is excerpted from Longevity Rules: How to Age Well Into the Future, a compendium 0f 34 excellent essays where leading longevity experts help policymakers and the public better understand the aging experience. In the essay below, Joseph Coughlin, the Director of MIT AgeLab, explores the role that technology can play in aging well. Copyright 2010, Eskaton.
Aging is not for wimps. While living longer has become remarkably commonplace, living well takes a lot of work. Longevity is creating new and expanded “jobs” for individuals, families, formal caregivers and public agencies. During the past decade many have argued that technology is the answer to aging — without really asking what the question is. This definition of the “aging and technology opportunity” is driven by those who are wildly passionate about invention, but not fluent in the art of innovation — that is, putting ideas to practical use. The questions that should be asked by policymakers, business and the aging community are:
- What are the jobs of aging services that we are trying to achieve?
- How might technology and collaborative partnerships accomplish these tasks or produce superior outcomes?
- Where should policymakers and business direct their limited resources to creatively exploit technology to enable individuals and families to live better — not just longer?
Understanding the Job(s) of Longevity
Real innovations are policies, products and services that respond to the jobs of the consumer or end user. What are the jobs of longevity? They look a lot like what we do in our younger years but become far more critical, diverse, complex, fragile, and as health declines, more out of our personal control.
There is a long list of jobs that support living longer. They begin at the very base of Maslow’s oft-cited “needs” pyramid beginning with safety, security, food and shelter. In the middle there is social engagement, contribution and even play. At the top, where some have the good fortune to be concerned, is meaning and personal legacy. The jobs of longevity require the precision of a tax accountant, the coordination skills of an appointment secretary, and the discipline of a marathon runner.
Consider just a few common and critical examples. Staying in your home can become an extreme sport in old age. A light bulb that you have changed many times before now seems just high enough to make using a ladder a serious hazard. Who does an older adult, or their family, trust to go into the home and do routine maintenance, cleaning and repairs?
Once an occasion to look forward to, dinner is now both exhausting to prepare and lonely to partake in. The basic tasks of shopping, transporting and finally “putting away” the groceries can become barriers to good nutrition, wellbeing and eventually independence.
Transportation works so well for nearly everyone that, like electricity, it is never thought of until it is not available. Driving is overwhelmingly the preferred mode of transportation for most Americans. Yet, over time, an older person may lose their confidence or capacity to drive safely. More than mobility is lost when driving stops — for the more than 70 percent of Americans over age 50 who live in the suburbs or rural areas where transit is scarce — their very connection to life is severed.
Managing health is a job that grows in scope and complexity with age. Managing one disease is difficult, but managing two or three or more is a full-time job. Multiple doctors appointments, maintaining a diet, adhering to 5‑plus medication regimens, managing symptoms, as well as the administration of communications between clinicians and insurers, grows to fill the time and patience available.
An Emerging Care Gap
Older adults are the CEOs of their own longevity. However, as frailty and capacity decline, they often rely on others. Who do we turn to? The state-of-the-art aging “technology” is a spouse, a partner or an oldest adult daughter. She, and it is most often “she,” becomes the coordination and execution point for ensuring that the house is maintained and clean; food is prepared and eaten; trips are planned and driven; and, that health needs and administration are met. According to the Gallup-Healthways Wellbeing Index, nearly one-in-five American families provide 20-plus hours a week of caregiving to support the needs of an older loved one.
Fast forward. This is not your parent’s old age. Boomers are turning 64, one every seven seconds. They had fewer children; are more likely to be divorced; are leading the fastest growing households in America — “households of one”; and, so far, most are aging-in-place in suburbs and rural areas where delivery of services is often problematic. What happens when the caregiver is distant or aging is a “home alone” experience?
Public agencies, such as Area Agencies on Aging, Visiting Nurses, hospitals, faith-based organizations and countless volunteer organizations provide a network of support to meet the most basic of needs. However, they are often overwhelmed and under-resourced. Short on budget, people, logistics and, sometimes, specialized expertise, these organizations vary widely in their capacity to deliver the services demanded by a population of older adults surging both in numbers and expectations.
Investing in Comprehensive, Collaborative and Connected Aging Services
The creative use of information communications technology (or ICT) can greatly improve the access to, and organization of, current aging services. ICT includes web-based applications, social media, mobile communications (e.g., smart phones), and network and cloud computing. These are technologies that efficient consumer-facing organizations invest in to understand, respond and sometimes excite and delight their customer. Applied correctly, ICT can create new partnerships and provide intelligent connectivity between things and people forming a platform of care for older adults.
Businesses should develop and policymakers should invest in the deployment of applications and systems that advance three principles: comprehensive access, collaborative delivery and connected visibility.
Comprehensive Access — You are well and independent, until you are not. Few people plan, let alone can envision, the day they will need support with everyday activities. Consequently, the search for aging services is often after an event, such as a fall, or after a holiday meal when family members “discover” that a parent is not well.
Web-based technologies offer the potential to engage an older adult or caregiver in comprehensively thinking about what is needed now and is likely be needed soon. An automated geriatric care manager that can be consulted when many caregivers research their options — at a lunch break or late in the evening — may provide both the information and the connection to service providers.
Europe is investing in a variety of e‑government initiatives to support aging. These include easy-to-use kiosks in post offices to access pension services as well as mobile phone applications to provide visibility of available transportation options on-demand. The United Kingdom’s National Health Service even sponsors a social media application that collects and shares patient opinions at various facilities (e.g., wait times, parking, medical procedures).
Perhaps most helpful to older adults and caregivers alike is the potential to have one turnkey access point making eldercare simple. Partnerships between retailers and aging services providers may improve user awareness and access.
CVS, Target and others have already invested in retail clinics providing easy and convenient access to medical services. Best Buy is focusing more on health and wellness. Could information communications technology be used to connect aging services with a retail face, simplicity and scale?
Collaborative Delivery — Aging is too big for government or business alone. Collaborative innovation will be required between public agencies and private firms to develop services and then deliver them. Public agencies today, such as the nation’s more than 300 Area Agencies on Aging, have a vast and intimate knowledge of aging. However, their regional fragmentation and varied access to expertise and resources makes service delivery uneven. Private firms have technology and know how to scale service and product delivery, but have little knowledge about aging. Using technology to link public and private providers may produce better, more efficient services and open new markets.
Retailers such as Radio Shack or Walmart are within a few short miles of nearly 90 percent of the American population. Moreover, they have a finely tuned supply chain that makes it possible to source and deliver products efficiently and in real time. How might these supply chain efficiencies in retail be partnered with aging services? For example, could partnerships with food retailers, enabled by Web applications easily accessed by older adults, families or aging services providers, manage both customized nutritional needs and ensure timely, trusted delivery?
Home health services are another opportunity for collaborative innovation between retailers, pharmaceutical companies, Visiting Nurse associations and hospitals. A nascent example of things to come is Walgreens Health Initiatives, from the nation’s largest pharmacy chain. WHI offers pharmacy benefits as well as home health care. These include infusion services, respiratory therapy and home medical equipment. In addition to clinical support, they work directly with insurers to manage coverage and other administrative issues.
Connected Visibility — Information technology’s basic value proposition is connectivity and communication. The jobs of aging and caregiving are often trying to connect and facilitate communication between providers, family members, payers, etc. Common platforms, such as a Web browser on the home computer, may provide a means for older adults to manage the services they are receiving. Banks have already developed relatively user-friendly and secure on-line systems for finance. Could these systems and retail banks provide a management tool for aging services? The same application on a workplace computer or a family caregiver’s mobile phone may provide both efficient administration, as well as stress relief knowing that transportation, health or some other vital service has been delivered to an elderly parent.
Communications between providers is often lacking. For example, at times, the management of one or more chronic diseases can be easy, compared to ensuring that medical specialist “A” has spoken to specialist “B,” “C,” the pharmacist and the patient’s primary care physician. Developing ubiquitous secure online tools that engage the clinicians and the patient or caregiver in collaborative decision making is likely to increase compliance as well as better outcomes.
Targeting Government & Business Investment
The growing demands of an aging population are a call to innovate. Targeted investment in information communications technology, as well as collaborative innovation by both government and business, will address the needs of older adults and their families. Done correctly, services will produce better outcomes and cost efficiencies, and stimulate new markets. Below are some guidelines on how to invest:
- Stimulate collaborative innovation. Invest in technologies and demonstrations that foster public-private partnerships. Partnerships should be based upon improved outcomes, as well as efficiencies and a sustainable economic business model.
- Leverage “big” systems. Wireless providers, cable companies, utilities, financial services and large retailers provide nearly universal access to everyone. They are conduits into the homes and lives of older adults and caregivers. Investing in systems and services that leverage these “infrastructure” companies guarantees access, scalability and superior processes.
- Touch the user not just the provider. Systems that improve the “efficiency” of cost of service delivery alone may eventually benefit the public in the aggregate, but we age one at a time. Investments in systems and services that directly touch older adults are likely to produce better outcomes and are politically and economically sustainable.
- Connect and distribute expertise. Cisco’s telemedicine demonstrations in California and elsewhere are good examples of bringing expertise to the user or patient. Additional investment should be made in using information communications technology to connect providers with each other and with lifelong education on best practices and technology in the full range of aging services (e.g., transportation, home modification, etc.).
—- Joseph F. Coughlin, Ph.D., is the founder and director of the Massachusetts Institute of Technology AgeLab. Based in MIT’s Engineering Systems Division, Coughlin teaches policy and strategic management.
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