NO MATTER HOW much lifespans are being stretched, the very last chapter is often grim. From the age of 80, in the rich world one person in five will be afflicted with some form of dementia, one in four will suffer from vision loss and four in five will develop hearing problems. Of those who make it to 90, the majority will have at least one health problem that counts as a disability; many will have multiple ones. Unfairly, for poorer and less well-educated people this decline often starts sooner.
In former times, the old used to spend this final, increasingly dependent phase at home, looked after by relatives. Over the past century, as ageing in the rich world became medicalised, care for the elderly was outsourced to retirement or nursing homes (a model that emerging economies such as China are now beginning to copy). But most old people do not want to live in institutions for long periods, and the cost of such care is exorbitant. So the new buzz phrase is “ageing in place”.
That is mostly a good thing, but it does carry risks of its own. An old person’s home may be his castle, but if he suffers from bad balance or tends to leave the cooker on, it can become a death trap. Another risk is that the shift will undo the progress in gender equality made in the past few decades. Having to care for elderly family members is already a prime reason for women to drop out of work. Just as women have tended to leave their jobs to care for new babies in their 30s, a second “hole in the pipeline” is appearing around the age of 50. There is no reason why men could not provide such care, but typically it is women who are doing it—though by the age of 75 men in rich countries become much more likely to do their bit, usually for a spouse.
Technology holds great promise to make life better for the elderly, enabling them to retain their independence and live full lives for longer. Equally important, it can lend a helping hand to those who care for them and provide peace of mind. And it should be good for health and care funders because it helps prevent expensive spells in hospitals and care homes. The difficulty lies in deciding who pays. Much of the technology that can improve the last stage of life already exists, but the uncertainty over funding discourages inventors from pursuing good ideas and venture capitalists from investing in them.
Oddly enough, the greatest potential for improving the lives of the elderly lies in technology built for the young. Two broad developments that seem a perfect fit for the lives of millennials—the smart home and the on-demand economy—might well have an even bigger impact on old people.
At first sight, Dolf Honée’s tidy brownstone looks like any other house in a sleepy residential street in Oostvoorne, a town west of Rotterdam, in the Netherlands. But a set of eight sensors from Sensara, a tech company, have transformed the 87-year-old’s home into a cyber-castle. His children, all in their 50s, keep an eye on when he gets out of bed, goes to the toilet, has a meal or leaves the house, using an app that pings them if anything is wrong. “They’re always watching me,” jokes Mr Honée, but he feels safer, he says “without feeling spied on as with cameras.”
The little things than can cause big trouble
Such a fairly basic version of a smart home can make a big difference to the growing number of older people who live alone and wish to stay where they are. Reinout Engelberts, of Sensara, thinks the main value of such systems is “catching little things before they become big discomforts and big costs for the provider”. Increased toilet visits can flag up a urinary-tract infection; changes in gait can predict an impending fall, the leading cause of death from injury among older adults. By picking up such things early, the algorithms can alert the elderly or their caregivers to the need for simple interventions.
So far most elders experimenting with smart homes or wearables use only basic tools: sensors in their home or a monitor around their wrist. But it does not take much to imagine a home where the occupant’s sleep is monitored via a device in his ear, his fridge suggests what he might eat, based on information from other monitoring devices, and a pill dispenser can give him tailored medication. A smart stove switches itself off if it detects a fire hazard, and smart pipes turn off a tap left running. When the doorbell rings, his smart watch tells him who has arrived. All the while these data are mined for information that might be useful for caregivers.
Most of the technology needed to do all this already exists, at least in prototype form. The hard part is getting providers to pay for it. In the Netherlands five insurers now reimburse users for Sensara’s sensors and the company is in talks with others, including the health ministry. Other insurers are experimenting with reimbursements on wearables. But on the whole providers are still reluctant to pay for a gizmo today that might prevent a hip fracture and hospitalisation tomorrow.
One reason for optimism is that the cost of such consumer products is coming down. Amazon’s Echo, a voice-controlled digital assistant, answers questions, reads the news, can phone relatives and control other smart devices such as lights, thermostats and the television on demand. August’s smart lock keeps track of comings and goings in a home and allows doors to be opened or locked remotely. Such gadgets were conceived with young consumers in mind, but could be even more useful for older people.
In a mock-up of the connected home of the future in Framingham, near Boston, Philips, a health-technology company, displays both its own smart medical devices and the high-street kind. It aims to bring all of them together and crunch the data with its predictive analytics tools. One floor up, in a blast from the past, phones ring in the call centre for Philips Lifeline, an alarm system used by 750,000 elderly Americans that features a pendant with an emergency button. Occasionally a life is saved this way, but many calls are set off accidentally. Such pendants now seem pretty standard stuff, but they did persuade a generation that grew up offline to adopt wearables for the first time. For their children, it should be an easier sell.
“Facebook may have been built for kids who spend all day together in the classroom, but the elderly, who could otherwise become isolated, stand to benefit most,” says Katy Fike, fromAging2.0, an innovation platform. Encouragingly, over a third of Americans over 65 use social media and 64% of those between 50 and 65 do, according to Pew Research. Europeans are a bit behind, but the trends are similar.
Technological elves
The other great opportunity is on-demand services. Cars, grocery deliveries, handymen and concierge doctors at the swipe of a smartphone could all be a boon to older people. Boomers are already familiar with these services, so once they become less mobile they will just use them more. Lyft, a ride-hailing service, is already trying to recruit older customers by offering senior-friendly ways to book without a smartphone. Trials have shown that on-demand ride shares can reduce lateness and no-shows for medical appointments.
On-demand care services could make an even bigger difference. Traditional care companies are inflexible, typically insisting on advance booking in blocks of so many hours. Seth Sternberg, a former Google employee, got so frustrated with this that he launched Honor, a tech-enabled care company through which carers can be booked round the clock, via an app, on a pay-as-you-go basis for whatever time is required. The company has raised $65m in venture capital and operates in 12 American cities. Other entrepreneurs are looking at on-demand nurses and light help in and around the house. Such services would not only make it easier for elderly people to stay in their homes, but also provide work for the younger old looking for gigs. The challenge will be to make the economics stack up.
Demand for this kind of technology will only increase as populations age, but unless funding mechanisms can be found, it will be available only to those who can pay for it outright, thus increasing inequality. In future doctors might prescribe all kinds of preventive technology-based services for older people at risk, just as they prescribe preventive pills today. Government may well have a role in this, but the obvious funders are insurance companies: they, too, have much to gain from prevention.
Encouragingly, in every centre for seniors visited for this report, from New York to Seoul, the most popular classes were in the use of smartphones and tablets, often sponsored by telecoms companies who spotted an opportunity. If insurers and health-care providers do not come up with a funding model, tech and telecoms companies may eat their lunch.
