Smart Homes for Seniors

So in doing some reading about sensor technology and smart homes I encountered yet again some issues about ethics and technology acceptance both in older adults and in general.

Backing up a second – the future, of course, is already here when it comes to technology. We carry around these things called “smartphones” which contain within them technology that easily eclipses the wildest imaginations of people just a few decades ago (puts Gene Roddenberry’s communicator device thingies to shame). We’re all instantaneously connected to each other now with social media, Twitter, Facebook, etc. Disruptive technologies like AirBNB and Uber are fast-becoming a feature of the landscape.

With all of these technologies we’ve traded a portion of our privacy in exchange for what is in many cases a whopping dose of utility. This is the whole point of so many of these disruptive technologies. Imagine 20 years ago the idea of more or less offering up your apartment for short-term rental to a bunch of strangers using AirBNB, or sharing your personal life via daily updates over social media, or advertising even your garage sale over Craigslist for the world to see?

So in just the last few year alone, privacy has become really a commodity that we’re willing to trade in order to receive concrete benefits in return. (I’ll leave to the side the question of government officials essentially forcibly taking your privacy away via electronic snooping – which I consider a different animal entirely).

This takes us to the question of a potentially very useful technology for a population that, as always, is near and dear to my heart – older adults. The technology in question, broadly speaking, is sensor technology, and typically networked sensor technology (because what good are sensors if you can’t collect and manipulate the data in real-time?). Think positional sensors, such as geotagging, bed alarms, chair alarms. Think movement, such as accelerometers and zone alarms. Think physiological sensor technology, such as heart rate and respiration.

Now think about the real challenge facing us when it comes to the coming” demographic tsunami” that I’ve spoke of repeatedly in past blog posts. What seems to be increasingly clear about this wave of Baby Boomers that are currently beginning to retire and getting old is that they will be faced with a historic deficit of residential care options, particularly long term care, but also assisted living – but on the other hand, may not need these options nearly as much as previous generations due to advances in this particular cohorts ability to maintain their physical condition. This means they’ll be older, physically healthier (and therefore may not need nursing homes), but even if they need them, nursing homes and assisted living facilities will be expensive and harder to find.

This is where technology comes in. Just focusing on sensor technology – lets say my mother (who is getting a bit older) develops dementia. But, she strenuously wishes to stay in her home and remain independent for as long as possible – as do I. So I make some purchases. I outfit her oven, stove, and her faucets with sensors and shutoff systems (e.g., for example, so that if she leaves the stove on and forgets about it, it will shut off automatically – or I can do it remotely myself). I somehow tag mom (with wearable RFID tags, somehow) and set up monitors in various rooms to track her positions and give me real-time updates. I enable a perimeter alarm to let me know when she leaves the home. I give myself remote access to lighting and power within the home. I enable administrator access through my iPad which I carry around with me all the time.

There are a number of products which piece together these functions and can be enabled right now with some minimal know how and configuration, although many of these systems right now are not designed or enabled with older adult care and monitoring purposes in mind. However, there are now technology startups (such as BeClose (www.beclose.com) and Lively (www.mylively.com) which offer products tailored for elder care. Additional useful tasks these integrated, tailored systems can offer is biometrics (e.g., heart rate, respiration, step counting – think FitBit for seniors), which is valuable data that can be fed back to an older adult’s physician. These systems can also offer essentially what amounts to predictive analytic modeling of behavior – e.g., for example after a system observes a senior in their home for a given amount of time, the system can then tell the user where are the most well-traveled areas of the house (and therefore the parts of the house than need the most attention in terms of maintaining safety and livability).

These developments are completely exciting. This means that any number of adults alive today can now realistically expect to be able extend the time they’ll be living independently within their own homes significantly beyond what’s currently the norm. This could spell a reduced need for expensive facility-based care (such as skilled nursing homes or assisted living facilities) and also may provide for reduced costs of facility care as well (the as-yet-unrealized “smart nursing home” of the future).

However, technology positivism should always be tempered with some realism. First of all, there is no one-size-fits-all technology fix for any problem, and that always goes double (and then some) with older adults, who are inherently a far more diverse group than their younger adult or child counterparts – any technology solution to a “problem” of aging or dementia-related issue needs to be carefully tailored and individualized to account for specific functional, cognitive, and sensory changes in older adults.

Also, with monitoring and sensor technology comes ethical issues. How monitoring systems are deployed and used, how consent (always a tricky issue with the cognitively impaired) is navigated, all of these issues come with ethical and moral pitfalls. Moreover, older adults are by their nature more suspicious of monitoring and sensor technology than their younger adult counterparts, although their acceptance of monitoring and sensor technology tends to be tempered by their discomfort with monitoring depending on 1) who is doing the monitoring (e.g., family, physician, government) and 2) the level of invasiveness or ‘granularity’ of the monitoring (e.g. video and audio, audio only, or just positional?). Also, acceptance of monitoring is greater when, for example, an older adult is assured they are not being monitored in the bathroom. Which is tricky – because bathrooms are a frequent, if not predominant location / source of falls and accidents for older adults in the home.

I remain, of course, a gerontechnology booster. If I ever find myself in private practice, I imagine that gerontechnology consulting for in-home caregivers and crafting personalized solutions will be a big part of the work I do – and I’m excited, because the upside potential is clearly huge!

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