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In order to anticipate the future, it is important to know the past and how we arrived at today. But Yogi Berra would surely approve when I say that most important of all is to also know the future. It is true that I, no more than you, can’t precisely predict the future, but we can learn a great deal through careful observation, as the seeds of what is to come in 20 to 40 years are likely here today.
Of one thing we can be sure, technology will have a big impact on our future lives. Let’s look at the impact technology has now on aging and mortality. We can categorize technology in three concentric circles:
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We also know that access to care, access to a social network, aging outside of a health facility environment and resilience have measurable impact on the elderly’s survival.
So, with this framework in mind, let’s review recent technological developments - the more obvious being in Health Information Technology. A study by the New England Healthcare Institute showed remote patient monitoring reduced hospital readmission for heart failure1 by 60% over traditional care, helping the elderly stay balanced in the ever-narrowing optimal health zone. This monitoring doesn’t need to be done by a specialized medical apparatus but could be done by a smart home2 or even by service animals.3 Separately, the potential benefits of Electronic Health records (EHR) apply to everyone but may play a more significant role for people with more complicated health histories, like the elderly. Continuity of follow-up care is a challenge with the elderly, as treatment from different medical specialists may not always be well coordinated.
Falls are often the precursor of a series of unfortunate events for the elderly and are the significant cause of death in people age 65+.4 Part of the aggravating consequence of a fall is what is called the “long lay” where the injured party is not found for hours, or even days. Automatic monitoring by a smart home or a video-monitor (similar to an alarm or baby monitor), can make this a thing of the past. There are also tools available for personalized remote monitoring.5
For older patients in need of physical help to ensure a more nutritious diet, there are several technology-based solutions, including better-designed appliances and app-based home delivery services. Along with monitoring, this can delay the start of nursing care and the mortality burden associated with it, not to mention the psychological trauma for everyone involved.
There is also room for more forward-looking technologies – physical enhancements (think exoskeleton), robots (or should we just call them mobile appliances), and self-driving cars. We know that losing one’s license is very often the first step toward a nursing home or an assisted living facility.6 To the extent we can quantify the impact on delaying entry to a nursing home, we can quantify the mortality impact. Similarly, we can estimate the impact of reduced falls or reduced motor vehicle accidents.
There are also considerable obstacles regarding finances as well as access to healthcare. The traditional benefit pension plan is on the decline. How will Social Security adapt? The future elderly, who may have been part of the gig economy and dropped in and out of traditional employment, will need new tools and new messages that financial security providers, still need to develop. Unfortunately, in this increasing technological workplace, a mindset that promotes ageism, instead of assessing each person on what they can actually do, still exists.
There are also significant unknowns. The gig economy has the potential to monetize assets that the aging population may have gathered that are not helping them currently.7 How many will be able to utilize those opportunities, and what vulnerabilities will that create, are not yet well understood.
The best technology can only provide benefits if it is used. Technological adoption decreases with age8 but, in my opinion is very cohort driven. What will be our comfort with technology when we are 85? I like to believe that it will be significantly greater than today's 85-year-old. Adoption is also very dependent on perceived value. Most older people are not interested in technology for technology’s sake but are quick to adopt it if they can see benefits for themselves. For instance, the growing use of the internet due to the access it provides to health information and community through social media networks. Framing technology by understanding the needs and desires of the elderly will greatly increase adoption.
