By Dr. Joseph Coughlin at MIT (Copyright 2010)
Editor’s Note: This is an excerpt of an excerpt, based on an original essay by Joseph Coughlin, Director of MIT AgeLab. Coughlin’s essay was part of Longevity Rules: How to Age Well Into the Future, a collection of 34 essays by leading longevity experts that help policymakers and the public better understand the aging experience.
Aging is not for wimps. Living well takes lots of work, even if living longer is now common. Longevity creates new tasks or “jobs” for individuals, families, professional caregivers and public agencies. Technology can help, but it’s just part of the answer. It’s too often driven by those who are passionate about invention but lack 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 tasks & jobs that get more difficult as we age?
- How technology and collaborative partnerships can help us accomplish these tasks?
- Where should society direct limited resources to exploit technology and enable individuals and families to live better, not just longer?
What are the jobs of longevity?
They look much like they did in our younger years but are now more diverse, complex, critical, fragile, and out of our personal control, as health declines. The long list of jobs begins at the very base of Maslow’s “hierarchy of needs” beginning with safety, security, food and shelter. Higher up in the pyramid are social engagement, contribution and play. At the top is meaning and personal legacy.
Staying in our homes can become an extreme sport in old age. Consider the simple task of changing a light bulb once using a ladder becomes a serious hazard. So who can we trust to go into the home and do routine maintenance, cleaning and repairs?
Meals become both exhausting to prepare and lonely to eat. The basic tasks of shopping, transporting and “putting away” groceries can become barriers to independence, good nutrition, and eventually well-being.
Transportation is taken for granted when we can drive, but it becomes a problem when it’s not available. Especially for those in the suburbs or in rural areas where public transportation is scarce, the loss of mobility can mean the very connection seniors have to live is severed.
Managing health becomes more difficult and complex with age. One disease is tough enough, but managing two or more becomes a full-time job, with multiple doctors’ appointments, maintaining diets, adhering to complex medication regimens, tracking symptoms and trends, and communicating with clinicians and insurers.
An Emerging Care Gap
We are all responsible for own longevity, but as frailty and capacity decline, we often must rely on others. Who do we turn to? Often it’s a spouse, a partner or an oldest adult daughter who becomes the coordination point to ensure that the house is clean and maintained; food is prepared and eaten; trips are planned and driven; and health needs and administration are met. Studies show that nearly one-in-five American families provide over 20 hours a week of care giving to support older loved ones.
The need for elder care is increasing rapidly. Another Baby Boomer turns 64 every seven seconds, but who’s to care for them? Boomers had fewer children; are more likely to be divorced; are most live in suburbs and rural areas where delivering services is more difficult.
Public agencies and countless volunteer organizations may not be able to meet the most basic of needs since they are often overwhelmed and under-resourced, short on budget, people, logistics and specialized expertise.
Investing in Comprehensive, Collaborative and Connected Aging Services
The creative use of information and communications technology (or ICT) – including web-based applications, social media, mobile communications (e.g., smart phones), and network and cloud computing – can greatly improve care for older adults. Businesses should develop and policymakers encourage the deployment of applications and systems that advance three principles: 1. comprehensive access, 2. collaborative delivery and 3. connected visibility.
1. 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, accident or holiday meal when family members “discover” that a parent is not well.
Partnerships between retailers and healthcare providers are helping to improve user awareness and access. CVS, Target and others have already invested in retail clinics that provide easy and convenient access to medical services. And Web-based technologies and online discussion sites (including our site, mHealthTalk.com) are connecting older adults and caregivers to information sources and online discussions. These resources are part of the solution since they prompt critical thinking about today’s needs and tomorrow’s and facilitates information sharing.
2. Collaborative Delivery — Aging is too big for government or business alone. Public agencies have a vast and intimate knowledge of aging but lack the technical expertise to provide solutions. Private firms have the technology and know how to scale service and product delivery, but they have little knowledge about aging. Collaboration between public agencies and private firms is required.
Retailers like Walmart have finely tuned supply chains that make it possible to source and deliver products efficiently and in real time to stores within a few short miles of nearly 90 percent of the American population. How might these supply chain efficiencies be partnered with aging services? Could food retailers, for example, be enabled by Web applications for older adults, families or aging services providers, and thus manage both customized nutritional needs and ensure timely, trusted delivery?
3. Connected Visibility — Information technology’s basic value proposition is connectivity and communication. The jobs of aging and caregiving include the need to communicate between providers, family members, payers, etc. Common platforms are needed, such as online apps that help older adults manage the services they are receiving.
Communications between providers is often lacking. Medical specialist “A” is not always in sync with specialist “B,” “C,” the pharmacist and the patient’s primary care physician. Ubiquitous and secure online tools are needed to engage clinicians, patients and caregivers in collaborative decision making for better outcomes.
Targeting Government & Business Investment
The growing demands of an aging population are a call to innovate. Targeted investment in ICT, 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, electric utilities, banks and large retailers provide nearly universal access to everyone. They are conduits into the homes and lives of older adults and caregivers. So, 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” and 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. The use of video conferencing can bring expertise to the user or patient. Additional investment should be made in using ICT 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 information on the book that contains the full version of his essay, click on Longevity Rules: How to Age Well into The Future
For more info on the MIT AgeLab and their AGNES suit, see this New York Times article.