May/June 2022

Age-Tech Grows Up: A New Era of Smarter Home Care
By Romi Gubes
Today’s Geriatric Medicine
Vol. 15 No. 3 P. 16

Mel Stuart’s 1971 cinematic rendition of Roald Dahl’s Charlie and the Chocolate Factory introduces us to the impoverished, tight-knit Bucket family, living in a dilapidated tiny home. What they lack in material wealth, the Buckets make up for in closeness, with the center of the home housing both sets of Charlie’s grandparents—Grandpa Joe and Grandma Josephine, and Grandpa George and Grandma Georgina. Though bedridden, Grandpa Joe is a source of awe and inspiration, with tales of wonder including that of Willy Wonka’s chocolate factory.

When Charlie, against all odds, finds a golden ticket, Grandpa Joe is the one who accompanies Charlie on his adventure through Willy Wonka’s factory, fraught with peril, excitement, and mystery. Through the twists and turns of the factory, Willy Wonka disqualifies child after child, each in their own way a representation of what Roald Dahl deems wrong with our modern society: indulgence, competitiveness, and obsession with television and technology. Ultimately, it is Charlie—accompanied by Grandpa Joe, in his 90s—who wins Willy Wonka’s heart.

Fact or Fantasy: Romanticized Aging in the West
The story of Charlie and the Chocolate Factory has much to teach us about what we as a society idealize when it comes to the family structure and aging. The accepted narrative is that before the spinning jenny and the first puffs of the steam engine, humans lived in extended family structures, with elders afforded the closest spot to the family hearth. We tend to compare the modern Western experience of aging, where the no longer productive members are warehoused away, with a romanticized version of other cultures where older people are respected and kept at the epicenter of the family. In her 2003 sociological study of aging, “Social Histories of Old Age and Aging,” Pat Thane, PhD, calls this accepted narrative into question, citing sources as old as Shakespeare and even Plato on the destitution and loneliness of old age to prove that the isolation of elders in our society is not a new phenomenon brought on by the advances of modernity.1 While we may be romanticizing the familial structures and aging of yore with idealized families such as the Buckets, it is true that not so long ago it was far more common for aging adults to live with one of their children, providing services and being cared for in return. While other frameworks for aging, such as nursing homes, have been introduced, an overwhelming majority of older adults prefers to remain at home, so the development of home health care and nonmedical home care are crucial. In order for this to be possible in an era when children are not typically providing this service for their aging parents, we must turn to creative solutions to enable older adults to age in place.

The Way Forward
Much has been said about global population aging as a tide that is ready to burst the dams of our social aid structures in developed and developing countries. It is no secret that as the baby boomer generation grays and turns silver, we are going to have a problem. Statistic after statistic points to an impending crisis of social security, pensions, and living arrangements. The post–World War II euphoria that begat the largest generation did not have the same effect on the baby boomers, and they did not have enough children to replace themselves.2 The pace of immigration is not high enough to bolster the numbers, and, paired with rising life expectancy, we now have the largest generation of older adults ever without an effective means or system to care for them.

This article details how the advent of modernity, along with all of its advances, brought about this crisis. However, rather than just being a harbinger of hardships to come, it also points to a way forward. We can continue to romanticize the Buckets, who did not hesitate to spend their last dime keeping their aging parents in the home, but we cannot turn back the wheels of modernity, and we wouldn’t want to—they roll ever onward. While the advances of science and technology have been the catalysts of the current global population aging crisis, these are the very same solutions we will have to consider to find a path forward. Carefully considered technology, developed specifically for older adults, with a human orientation will increasingly be the beacon to which we turn.

How We Got Here
When we lived in agricultural societies, the productive value of activities performed by children was vast in comparison to urban societies that rose out of modernity. Children were valuable in domestic chores and agricultural work and were expected to shoulder the burden of running a household along with their parents and grandparents. As machinery replaced the need for working hands, work in sparsely populated rural areas became scarce, and mass internal migrations toward cities began. Children, who had once been essential partners and of economic necessity, turned into more of a burden than an asset in tight city living. Though many more children survived past infancy, even in the squalor of urban conditions, the number of children per household still saw a significant decline.

Modernity and mechanization had a clear effect on the size of households, yet this in itself would not be a strong enough catalyst to push us toward a demographic crisis. The end of World War II brought along something unexpected. In his article “Warehousing the Elderly” in Challenge: The Magazine of Economic Affairs, Charles Stewart, Jr., PhD, wrote, “The combination of high birth rates in the period directly following World War II and the low rates thereafter, along with increased longevity will result in a huge increase in the elderly share of the population. Between 1960 and the present, the population age 65 and over has increased from 7.5% … it is projected to rise slightly over 20% by 2040. It is the oldest of the old whose share of the population will be increasing most.”3 Lower overall birth rates, along with increased longevity and the spike in population post World War II, created a pressure cooker of the global population aging crisis.

A Solution — ‘Warehousing’ the Elderly
With the breakdown of the classic model of aging within the family structure, a new solution for the third stage of life was introduced: nursing homes and assisted living facilities. These facilities often incorporate many of the services necessary for older adults. From companionship and intellectual stimulation to practical needs such as pharmaceutical services, gyms, and transportation to places of interest, assisted living facilities and group homes are often seen as the natural and best solution to provide for the needs of our aging population. However, these solutions are costly; many older adults cannot afford them. Even those who can overcome this economic barrier prefer to age at home. Ninety percent of older adults prefer to age in place, maintaining their dignity and independence and continuing to be surrounded by the community they have always been a part of. The systems we have set up for the aging population, which typically remove older adults from their homes and communities, are expensive and don’t always address their emotional needs.

A thoughtful short documentary from The Economist titled The World Ahead: The True Costs of Ageing ruminates on the inefficiency of the “warehousing” model and asks how societies can provide high-quality, affordable care and calls for a fundamental shift in how we think about different life stages.4 Soaring health care costs and concerns about public and private pension programs and retirement funds are also a source of concern. When these programs were established, they depended on a growing younger population fueling the economy and covering the costs of older generations. This burden increasingly will be placed on fewer shoulders and cannot be allowed to reach a breaking point.

Can Technology Solve Human Problems?
Technology has pervaded almost every area of our lives, including transportation, entertainment, education, hybrid work models, and even dating. Compared with other industries, technology was late to affect the older adult care sector. Though sorely needing technology, this sector has continued to be reticent about integrating it more thoroughly. Part of this is due to the general suspicion that older adults have toward technology, genuine concerns about privacy, and the inhuman and cold nature of using technology to care for humans. These challenges need to be the bulwarks when developing any technology for older adults—fiercely guarding privacy and not replacing human touch and connection with impersonal tools, but rather enabling those caring for older adults to extend and perfect their services through technological tools.

Despite this, the use of technology for older adults and those who care for them has been on the rise. Home care agencies have begun to integrate simple management software to help run their back end, train their staff, and manage certifications. Companies have begun developing phones and tablets adapted to the needs and abilities of older adults, and panic buttons or wearables for fall detection have circled the market for a while. However, perhaps the true watershed moment that announced with a boom and a bang that there is no way forward in this conundrum without technology was the COVID-19 pandemic.

As shelter in place ordinances commenced, older adults found themselves isolated and marginalized more than ever before. The COVID-19 pandemic meant loneliness and social isolation for older adults, an increased lack of access to resources, as well as additional limitations on in-person care and familial care. As the world switched to virtual platforms, older adults were left behind.

A Roadmap Forward
Today’s age-tech industry presents diverse, innovative solutions that enable older adults to confidently age in place and enjoy the comfort and independence that comes with precise and timely support. Entering the third stage of life no longer has to mean choosing between safety and independence.

The time is ripe for revolutionizing care and improving the quality of life of older adults. This change will occur within the framework of aging at home enabled by quality in-home health care and nonmedical care. Companies are continuing to push the boundaries of what is possible to achieve in senior care. From early detection medical and clinical artificial intelligence–based software, fall detection systems that are working toward removing the necessity of wearable life-saving devices, robots that help with companionship and medication reminders, and even virtual reality glasses that allow families to understand the experience of Alzheimer’s and Parkinson’s disease, it seems as if the sky is no longer the limit.

Older adults are also being recognized as an important marketing sector for technology. By 2030, the consumer class is expected to increase from 3.9 billion to 5.6 billion, with nearly similar contributions from each age group. Older adults, however, will be the only group of this class whose contribution will increase significantly faster from 459 million to 760 million, reflecting a 66% increase. Companies are waking up to this reality and beginning to design their products with older adults in mind, at times even including them in the process of research and development.

The next generation of age-tech will not be focused solely on addressing narrow problems as they come up (eg, emergency buttons) but will rather be holistic solutions that are geared toward improving quality of life and longevity, as well as extending older adults’ ability to remain independent longer in the comfort of their own homes.5

Today, we are using artificial intelligence to create a layer of virtual care at home using algorithms to analyze audio data that are sensitive enough to detect a urinary tract infection, determine when falls are most likely, or inform protective measures at the onset of dementia. Technology is the vital partner to home care agencies grappling with staffing shortages, providing a window into the home environment during and after care hours, predicting factors in rehospitalizations and injuries so that adequate steps may be taken well in advance. Human caregivers will not be replaced by technology, but rather supported and enhanced by sophisticated, real-time data and technological tools that will make home care agencies smarter, more proactive, and better able to navigate risk while optimizing the aging in place experience.6

Conclusion
Revolutionary changes in the way we live always leave collateral damage, and the advent of modernity no doubt brought about a rise in the social isolation of older adults and the increasing inability of our society to sustain them. However, just as technology may have gotten us to where we are today, it is ultimately the solution that will find a path forward and will even improve quality of life for older adults and fundamentally change what it means to enter the third stage of life.

While it is easy to see the aging of the global population as an insurmountable challenge, this is also an opportunity for visionaries and entrepreneurs to change the world. This trend can be harnessed to create revolutionary technologies that will not only make bearing the brunt of the aging population feasible, but will actually lead to economic growth and flourishing and to help people age better and lead longer, happier lives. While we may not go back to housing our Grandpas Joe and George and Grandmas Josephina and Georgina in a bed in the middle of a cramped dilapidated house, perhaps technology will prove that this idealized past pales in comparison to our future.

— Romi Gubes is the cofounder and CEO of Sensi.Ai, the first artificial intelligence–based virtual caregiver. As a senior enterprise software engineer, Gubes brings more than a decade of managerial, product, and research and development (R&D) experience from various fortune 500 companies. Prior to founding Sensi, Gubes was senior developer at Vonage’s R&D innovation center. Driven by her passion to truly impact the world for the better, Gubes has been harnessing her wide tech background to develop revolutionizing solutions in the elderly care realm.

References
1. Thane P. Social histories of old age and aging. J Soc Hist. 2003;37(1):93-111.

2. First-ever census bureau report highlights growing childless older adult population. United States Census Bureau website. https://www.census.gov/newsroom/press-releases/2021/childless-older-adult-population.html. Updated October 8, 2021.

3. Stewart C Jr. Warehousing the elderly. Challenge. 2006;49(4):73-85.

4. The true costs of ageing. The Economist. December 21, 2021. https://www.economist.com/films/2021/12/21/the-true-costs-of-ageing. Accessed March 3, 2022.

5. All that glitters is not silver. In: Domínguez-Rué E, Nierling L, eds. Ageing and Technology: Perspectives From the Social Sciences. Bielefeld, Germany: Transcript Verlag; 2016.

6. Mac Manus S. How can technology help us meet the needs of our ageing society? British Council website. https://www.britishcouncil.org/anyone-anywhere/explore/communities-connections/technology-ageing-society