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.

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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.

–> For more infor­ma­tion on book: click on Longevi­ty Rules: How to Age Well into The Future