A story that I recall reading (or hearing) somewhere ages ago was designed to capture the difference between geriatric medicine and the rest of the medical world, and it goes something like this:
Depending on the procedure, and despite the fact that Medicare has had flat or declining funding formulas for a number of years, we all know that physicians can under Medicare get reimbursed fairly handsomely for conventional medical interventions like general surgery, interventional radiology, et cetera. Specialists like these are not going hungry.
However, geriatric physicians are not whom we look to for invasive, life-saving interventions like what neurosurgeons dispense. Instead, a specialist in Geriatric Medicine (which is a recognized, board-certified medical specialty) will, say, spend 30 minutes in an examination room with an 80 year old, having a discussion about ill-fitting shoes. This is not a sexy discussion to have, and of course is difficult to fit into Medicare billing guidelines for more than a pittance of a payment.
Sometimes significant therapeutic change can happen with better-fitting shoes!
But, that 30-minute discussion about shoes may be what makes a world of difference for that 80 year old in terms of giving them better mobility, less pain, and better safety in their home. It’s incremental, small-scale interventions that can sometimes be what clinches things for this population.
Sexy vs. Incremental Gerontech
So this is what leads me back to my favorite subject. I know that for years, the kinds of discussions I’ve had on my blog and elsewhere about older adults and technology have been somewhat overfocused on ‘sexy’ technology.
My first love – social robotics like Paro, and it’s promise to soothe dementia, cure depression, and even treat dementia in its users. I’ve been enamored with virtual reality (VR), not for it’s purported effectiveness as a tool to treat specific phobias, but instead as a way to give frail, chronically ill older adults the experience of walking again, or visiting faraway lands, as a way to raise their quality of live and treat depression. I’ve preached high-flying approaches to connect long-term care dwelling seniors, and to address fall prevention.
But let’s face it- there’s a couple of things wrong with the idea of hitching our fortunes to the notion there will be some killer technological revolution, some set of “killer apps” that will sweep the country and herald in a new era of technological revolution in older adults.
First, technology adoption and user acceptance is a tricky business, particularly in the case of older adults as end-users. Older adults by definition going to be a generation that’s still to this day somewhat unfamiliar with digital technology (although this familiarity gap is rapidly closing).
Second, there’s an egocentric bias built into technology design that is still a problem – innovative technology is still typically being developed predominantly by twentysomething, upper-middle class Caucasian and Asian males in Silicon Valley – not older adults. As such, it’s difficult (unless designers do a lot of legwork at the outset) for them to make sure their products are designed with older adult endusers in mind. Despite the fact that Facebook is now extremely popular amongst Gen Xers and Baby Boomers (the 40+ crowd), it was initially designed for and by college students and only “seeped into” use later after younger people paved the way and worked out the user experience ‘kinks.’
The Reality (In the Form of some Product Reviews)
Technology *will* be changing the face of aging, but it’s possible change may come gradually. So, as is my habit, here are a few exemplars of “boring” and “incremental” products (much like the 30-minute conversation about shoes I described above – Hat tip to Mark Ray’s excellent article at Nextavenue.org).
Smart refrigerators, anyone?
Samsung Smart Refrigerator
I go to the hardware store with my wife, fairly frequently (she loves home improvement projects). Often when I’m there we pass through the large appliances aisle and (particularly if our kids are with us), we stop at the smart fridges.
Basically these are refrigerators that are tied to the internet. They are typically equipped with a large tablet screen on the outside of the refrigerator, and have cameras and sensors inside that can give real-time information about the contents inside. Of course, you can do fun stuff with the tablet – you can run apps on it and play videos, display a weather feed, etc.
But here’s where it gets really useful. Imagine you have an 80-90+ year old older adult living at home, say, with some impaired mobility and increased fall risk (not at all unusual at that age). Instead of having to go through the trouble of getting up, plodding over to the refrigerator and craning their heads into the refrigerator and digging around to find what they need – they can simply open their app on their phones and look inside? (Note – you can also take a virtual tour of your refrigerators’ contents via the mounted tablet on the outside of these kinds of refrigerators as well).
Combine this feature with the increasingly-common availability of online grocery ordering and delivery, and you have something that could be powerfully useful for older adults looking to “age in place” in their homes. But again – nothing earth-shatteringly revolutionary here. Just a refrigerator that has been outfitted with some additional cameras and sensors, and networked to the internet.
The biggest downside to these so-called smart refrigerators is cost – these are usually the most expensive refrigerators in a typical hardware store lineup.
Samsung Induction Cooktop
I’m not necessarily pushing Samsung products (no conflict of interest here to declare!) but they offer another great example of a simple idea that really can translate into great utility for an older adult who is living at home.
Induction cooktops are basically a system of using electromagnetic charges to heat specially-designed cookware, but that leave the stoves themselves cool to the touch. For older adults in the home the utility is obvious here – if they forget to turn off the stove, there’s limited risk posed after the meal is done. There’s also some additional benefits – induction ranges are around 60% more energy efficient than gas stoves, and they have obvious safety benefits for households with children in the home as well.
Again, similar downsides to smart refrigerators – induction cookware (and the stovetops themselves) are expensive compared to their traditional counterparts. But given the safety aspects, they may be worth the cost!
Again, it doesn’t require complex artificial intelligence algorithms or computer technology to innovate on a simple idea and make it (in some cases) light years better. In a separate article I wrote for Psychologists in Long Term Care a few months ago, I reviewed a couple of aging-related startups. The first was Authored.
This is a company that’s leading the charge to make “adaptive apparel” fashionable and mainstream, as opposed to relegated to a niche market marketed in occupational therapy circles and via long-term-care industry catalogs. “Adaptive clothing,” as a quick reminder, refers to clothing that has been engineered to improve usability for people with functional and/or cognitive issues. For example – older adults with arthritis may have a great deal of difficulty with traditional buttons, but would benefit greatly from using snaps or Velcro. Older adults with dementia who may become agitated when a shirt is pulled over their heads, or may become combative when it’s buttoned from the front, may benefit from a shirt that opens from the back.
For Authored, though, it’s than just adding snaps, buttonhooks, and Velcro to clothes and calling it a day – Authored has taken pains to re-engineer adaptive clothing from the ground up. From their website: “We have reduced or eliminated irritating seams, used premium and durable fabrics and positioned closures to reduce discomfort while improving accessibility.” They’ve also made sure that their clothes look fashionable, and not ‘fuddy duddy.’
I *like* focusing on what Authored has done because they’re as much about innovation in usability as they are in terms of innovation in aesthetics and style – and I feel like the media attention Authored has gotten thus far (e.g., they’ve been featured on the BBC as well as last year’s Aging 2.0 conference in SF) has probably helped to make companies like Tommy Hilfiger, Target, and Zappos begin innovating their own lines of “adaptive clothing.”
Much like what Authored has done for adaptive clothing, Eatwell has been doing the same for adaptive flatware and dinnerware:
And again – these kind of adaptations can be critical for older adults who have arthritis, or cognitive impairment that may be affecting their perceptual abilities or otherwise. Adaptive tableware has been something utilized by Occupational Therapy for a very long time – and when employed properly, it’s an intervention that can, in the main, extend the amount of time an older adult or person with disabilities can eat independently.
What makes Eatwell’s products different than their competitors is again, they reengineered adaptive tableware from the ground up, utilizing evidence-based research down to the correct color contrasts to employ in their tableware in order to maximize meal percentages eaten by their test subjects. Much like adaptive clothing, adaptive tableware will be a growing sector of the retail market in coming years – it will soon be a much more mainstream product!
Moral of the Story
So sure, artificial intelligence, machine learning, wearables, mobile apps, etc., etc. – these will all have a place in the gerontechnology landscape as the population ages. But we need to keep an eye out for the “incrememntal tech” that will change the world and make the greying of the population a little easier as we progress into the brave new world that’s out there!