In 1989, a small medical device company by the name of Life Call hired Edith Fore, a 74-year-old customer, to star in a commercial promoting its signature product, a medical alert button that seniors could wear around their necks like a charm and press to call for help in an emergency. Fore — or Mrs. Fletcher, as her character was named — demonstrated the device’s utility with a single line — “I’ve fallen and I can’t get up!” — delivered so memorably that its meme-status has survived into the Internet age. (The YouTube clip has close to a million views; there is also a Facebook page, with 4,000-plus “likes.”)
Fore became a minor celebrity, who in her waning years (she died in 1997) had to enlist her daughter to help field media requests. But the device itself — the medical alert button that summoned an emergency response team to Mrs. Fletcher’s house within mere minutes in the commercial — has yet to really catch on, even 25 years after the fact. By recent estimates, only about 5 percent of the 7 million or so older adults who could benefit from a PERS (or personal emergency response system) have actually purchased one, even though they’re relatively inexpensive and quite often reimbursable.
This individual market failure has done nothing to stymie the rise of — or enthusiasm for — gerontechnology. Indeed, we’ve made quantum-order advances since Fore’s day: Life Call’s PERS can now detect your fall and call for help automatically. For about $1,000, plus a monthly fee, the people at GrandCare say they can rig your entire home with sensors that monitor your every move and report the details back to your caregivers in real time. And for $200 and a monthly fee, insoles laced with GPS trackers can be tucked into any shoe and can report the user’s whereabouts to relevant parties (including caregivers and local police).
There are also several types of “smart” pillboxes that remind users to take their medicine, and at least one senior-friendly cell phone that comes with 24/7 access to a nurse-operator. And these are just some of the currently available products; self-driving wheelchairs, companion robots and a whole array of wearable technology (think sensor-laden underwear) are all coming down the pipeline at various speeds, and a growing chorus of enthusiasts say they have the potential to completely redefine the way our society ages.
For all that progress though, experts say that the strange incongruity between what science makes available and what society makes use of — let’s call it the Edith Paradox — persists.
“Despite their availability,” writes Joe Coughlin, founding director of MIT’s AgeLab, “technology has not been widely adopted by older people or their families.” The reasons are easy enough to intuit: Seniors are technology-phobic, or afraid of being stigmatized; they don’t know what products are available or where to find them; or they do know, but the gadgets themselves are too expensive.
What’s not so easy to intuit are solutions to those problems. In fact, in a pipeline chock-full of invention, the most important breakthrough of all might be a better understanding of the social and psychological forces that shape technology adoption: How do seniors themselves think about their own decline? What do they make of the technology that’s being designed to help them? And what will it take for them to adopt the PERS of tomorrow?
There is no shortage of numbers to underscore how pertinent the marriage of aging and technology is to this particular moment: In the U.S. alone, 10,000 baby boomers turn 65 every single day, and that’s not even the fastest-growing portion of the population; the 85-and-older cohort is. Come 2050, there will be a million centenarians; again, that’s in just the U.S. By around the same time, the number of people in India who are older than 60 will outnumber the entire population of the United States. The people who study or work with aging populations are fond of describing this demographic shift as a “silver tsunami.” A giant, irrepressible wave of Edith Fores is heading straight for us, they say, and we had better start preparing now.
“This population is so large that their lifestyles will change our lifestyles,” says Michal Isaacson, an urban geographer at MIT’s AgeLab. “If they drink one extra cup of tea a day, they will change global tea prices.”
Of course, once the tsunami hits, tea will be the least of our concerns. “Right now, the oldest boomers are around 66,” says Charlie Hillman, the founder and CTO of GrandCare. “They’re just getting into their chronic condition years. Wait another decade, when they all start needing hip replacements. It’s going to be ridiculous.” And if that weren’t enough, the number of Alzheimer’s patients is set to quadruple in the next few decades.
“We’ll have police departments that do nothing — all day, every day — but search and rescue,” says Andrew Carle, a professor in the department of senior administration and housing at George Mason University, and a master of sound bites. Carle, a former hospital CEO who founded one of the largest assisted living facilities in the country, now consults on the development of various technologies for aging populations, including the aforementioned GPS insoles. He’s trademarked the term “nana tech” (get it?). Given the dire shortage of caregivers that will be available to tend to this swelling elderly population, he says, technology really is our only hope.
To be sure, inventions that can prevent falls, or delay the age at which an elderly person requires assisted living, or reduce the number of caregiver hours required to tend to the basic needs of those in their 70s or 80s, have at least the potential to improve quality of life for seniors and their loved ones and to minimize the health care costs that the silver tsunami is expected to bring with it. But for any of those aims to be realized, inventors will have to design their products in a way that appeals to their target audience. To do that, they’ll need to imagine what 80, 90 and even 100 actually feels like.
The front room of MIT’s AgeLab is warm and flooded with natural light. Hilde Waerstad, a physical therapist who works there, is giving me a crash course on the psychology of getting old, and she’s drawn a timeline with green flower icons on a wall made of white dry-erase board. “For anyone younger than 60,” she says, pointing to the middle image of a flower not yet wilted, “there is a tendency to think of aging as something that will happen in the distant future, or better yet, will happen to some other person. We actually say things like ‘I’m never getting old’ — and only half in jest.”
In truth, of course, aging is an unavoidable biological reality, and one that hits far sooner than most people realize. If you are reading this and you’re older than 40, your vision is already going, your skin is losing its elasticity and sheen, and bit-by-bit, your bones are thinning out. If they haven’t already, your digestive track and the rest of your viscera will soon follow suit, as will your hearing and memory.
“Our first response to these changes is usually denial,” Waerstad says. That is, we try frantically to stop the clock, or we pretend that it isn’t winding down in the first place. By the time we reach our 70s, though, our priorities have shifted. “People aren’t as afraid of — well, death isn’t the main issue at that stage,” she says, clearing her throat. “It’s the impairment. Nobody wants to feel like a burden.”
As Waerstad talks, technician Arielle Burstein is strapping me into the lab’s age simulator, AGNES (for Age Gain Now Empathy Suit). I’ve donned a pair of oversized coveralls and Burstein has strapped a harness around my waist. She’s stretching and hooking a series of pulleys around the harness in a configuration that is supposed to mimic spinal compression. Next, she’ll add gloves, goggles, earplugs, boots and a helmet to the get-up. I am 36, but when Burnstein is done, I will have the vision, hearing and physical mobility of an 80-year-old.
Then we’ll go for a walk.
In recent years, AGNES has become a bit of a celebrity; she’s made an appearance at TED talks, done spots on NPR and "The Dr. Oz Show," and appeared in innumerable news articles around the world, usually about the planet’s growing elderly population. But her original purpose was to help product designers better appreciate the challenges of growing old. “The people who design geriatric technology are generally much younger than the people we’re hoping will use it,” says Waerstad. “They have no understanding of what it feels like to be in that state of decline because they haven’t experienced it for themselves yet.” The goal of spending an hour or so as AGNES is to change that.
As we make our way down to the street, I am stooped over at about a 45-degree angle; I can barely see, hear or turn my head. Just standing up straight is tiring, and I quickly find that I need to lean on things as I walk, mainly on Waerstad and Burstein, but also on whatever railings I can find. The plan is to walk to the Kendall Square T stop, go down into the subway station and buy a metro card. It’s the kind of trip I make multiple times a week, in both Boston and New York, without a second thought.
Out on the street, the two women get to chatting; I wish they would speak louder, or at least stand on the side of my good ear (I’ve lost an earplug, so I’m only half deaf now). I also wish they would stay where I can see them. They’re both farther to my sides than I can turn my head at the moment, and I’m feeling a little unsure of my own two feet.
After what feels like an hour, but was probably only about 20 minutes (which is still four times longer than it would take me as my 36-year-old self), we approach the crosswalk in front of the station. We make it only to the traffic island halfway across before the signal stops us, which is fine by me, as I need a moment to rest. The whole of Cambridge seems to be moving on fast forward, with clusters of college students whizzing by me on both sides. I want to shake my fist, yell at them to slow down. I’m feeling feisty though, and defiant. I imagine myself braving harsh terrain, on a grand quest. To buy a metro card.
But knowing that I’ll be this way only for a short while makes it easy to be cavalier. So I conduct a silent interview with myself: What would it be like if this were really you? Would you feel comfortable taking a stranger’s arm? How self-conscious would you be about your hearing? Your slowness? Would you still feel feisty then?
The stairs leading down into the station are especially forbidding; I take them a half-step at a time, clinging to the railing as I go. The metro card dispenser is tough to read (why don’t they have more light around those things?) and even more difficult to operate (the buttons are too small!) — but I manage. Waerstad and Burstein debate whether or not I can handle the train itself; I want to insist that I can, but my back hurts and I’m tired, and the platform looks crowded.
“I think I get the gist,” I say. We turn back to the lab.
Brian Reimer is the AgeLab’s leading car researcher, and right now he’s trying to understand the nature of trust as it pertains to automated technology in passenger vehicles. Car research looms large in the AgeLab, namely because the cessation of driving due to age (fatal crashes increase by age, starting at about 70) comes at a great cost to both seniors and caregivers.
While self-driving cars, as we tend to think of them (capable of navigating the roads while the operator takes a nap), are still a long way off, a whole menu of partially automated features is already being made available in newer cars: Collision avoidance alerts the driver with a beep or light to obstacles in front of the car and, in some cases, slows down automatically. Smart headlights adjust the range and intensity of light to improve night vision, and lane departure systems warn the driver when the vehicle slides out of its lane without signaling. If they live up to their promise, features like these will make driving safer and easier for everyone, and will extend senior independence by an appreciable margin.
But as far as Reimer is concerned, that’s still a big if. “These systems are appearing in cars, and we have no understanding of what the frequency of use is,” he says. “For certain things, like lane departure warning, some of the data shows no benefit, or shows a negative effect in some cases.” The problem, he says, is a lack of training. So far, car companies have not done nearly as good a job teaching people when and how to use these automated features as they have done promoting them.
And the way Reimer sees it, training is a make-or-break issue. If we don’t help people get used to the new technology now — teach them the advantages, drawbacks and appropriate use of each new feature — we risk losing them forever when glitches emerge or when an operator error leads to calamity. “Something as simple as adaptive cruise control accelerating at the wrong moment can terrify a person into never trusting automation again,” he says. “It’s far easier to lose trust than it is to gain it, and that’s particularly true for older adults.”
In one test of the impact that training might have on the perception and use of semiautomated technology, Reimer and his team looked at Ford’s Park Assist — a semiautomated parallel parking system that detects which parking spaces the car will fit into, and then steers the car into the spot while the driver controls the throttle and brakes.
Prior to receiving any information about the system, participants said it would not reduce their stress while parking. But Reimer and his colleagues compared subjects’ behavior and physiology while parking with and without the system after they were trained to use it. When drivers approached a parallel parking situation, their stress levels — as measured through heart rate and body temperature — were lower when the automation was available to help them. The lesson, Reimer says, is that training makes a difference.
It’s a lesson that extends beyond automotive technology: For any item that makes it to market, someone will have to teach seniors (and the rest of us) how best to use it. The uncertainty over who, exactly, might fill that role is such that in a nationwide survey conducted by the AgeLab in 2005, potential investors ranked it as the single biggest factor holding up progress. Yes, they said, there is a glut of age-related technologies stuck in laboratories around the country. And yes, the potential market for those items is huge. But there is no framework, no set of people responsible for integrating that technology into geriatric care. The same survey found that even at universities with programs in both aging technology and medicine, the two have yet to be formally linked.
With academics and large companies mostly on the sidelines, small startups have been left to muddle through on their own. “We feel a lot of times like we’re the first cellphone company in town,” says Charlie Hillman, founder and CEO of GrandCare, the company that can wire your home with sensors. “But somebody’s got to be the first to jump. We can’t get the technology out of the lab until there’s a market for it, and there can’t be a market until there are people willing to take a shot. Look at the early Internet companies. They were all financial disasters. But without that little bit of faith in the beginning, where would we be today?”
Hillman is not worried about persuading seniors and their loved ones of his sensors’ many benefits. In GrandCare’s experience, introducing products ahead of time — i.e., before a family member becomes significantly impaired — can go a long way toward alleviating the sense of stigma and apprehension. “We take a Trojan horse approach,” he says. “I want seniors to get used to using that touchscreen well before it comes to ‘You’ve got to take your pills,’ or ‘What are you eating?’”
The key to that, he says, is to keep the interfaces simple and to integrate health and safety features with ones that facilitate connectivity. “We put a lot of stuff into Facebook feeds and Skype,” he says. “And the tablet era has really helped a lot because seniors love tablets: big, bright, backlit screen; no keyboard; no buttons.” In fact, tablets have become so popular among seniors that Hillman credits the devices with transforming the way they view sensor technology. “It took a while for them to get over the Big Brother aspect,” he says. “But now it’s, ‘Well, I don’t want to move to assisted living, and I don’t want somebody I don’t know coming into my home every day to deliver care.’ So this becomes a best option.”
What Hillman does worry about, though, is health insurance and reimbursement. “The health care environment is not generally favorable to innovation right now,” he says. “Just one example: Doctors don’t get reimbursed for Skype consultations, even though it’s better for the oldest patients because nobody has to drive, and cheaper for society.” At the moment, GrandCare does significantly more business in Australia, Canada, England and New Zealand, where Hillman says the system of costs and incentives is better aligned than it is in the U.S.
Entrepreneurs aren’t the only ones wringing their hands over the cost barrier: Researchers have found that — for some technology, at least — income level is a stronger predictor of adoption than age. In one survey of adults aged 65 and older, 43 percent of households with incomes greater than $75,000 had smartphones, compared with just 8 percent of those with incomes less than $30,000.
If we aren’t careful, then, the coming gerontechnology may do more to reinforce social isolation among older adults than to eliminate it. “It’s more than just an equality issue, here,” says Lisa D’Ambrosio, a social scientist with the AgeLab. “In many cases, the people who could most benefit from technology are the same ones that can least afford it. So that gets into ‘What’s the value of any of this if we can’t get it to the people that need it?’”
Joe Coughlin, the AgeLab’s founding director, likes to say that there are two ways to use technology: exploitatively, to fill an existing need; and creatively, in service of a higher ideal. To illustrate the difference, he compares the cathedral builders of 12th-century Europe to the gerontechnologists of today. The cathedral builders, he says, “went well beyond the practical requirements to build the structure or guarantee its strength and permanence.” They designed flying buttresses and vaults, yes. But they also innovated; they built things bigger and more beautiful than they technically needed to be, and in the process, they elevated the human spirit and inspired future architects to a grander, more ambitious vision of what their profession could achieve — for ages to come.
So far, he says, gerontechnologists have been exploitative. We treat old age as a problem of health and safety, while ignoring the importance that seniors themselves place on things like staying connected to loved ones, contributing to society and even solidifying their legacies. We innovate one device at a time. We build cottages when we could be designing cathedrals.
Of course, to design anything so grand as a cathedral, one must begin with the proper vision. By every indication, the seniors of tomorrow (that’s me!) will be far less tech-averse than the seniors of yesterday, or even today. But they still won’t want to feel old or useless, or like a mere sack of health problems to be managed. What they will want is technology that helps them preserve independence and maintain connections to family and to the wider world; the most useful items, then, will find a way to satisfy multiple needs at once. How about a medication minder that doubles as a videophone? AgeLab researchers developed exactly that — they call it eHome — but industry has yet to pick the item up and run it to market.
Which brings us to the next step: A cathedral requires not only vision, but a sturdy foundation and a whole team of builders working in concert toward the same end. In this particular case, that means financial incentives, public-private partnerships and people who are trained and ready to shepherd technology not only from the lab to the marketplace, but also from the marketplace to people’s homes.
A few days after my trip to the AgeLab, I visited my parents in New Jersey. My father is 73 with chronic-obstructive-pulmonary disease (COPD) and a bad case of sleep apnea. My mother has just turned 70 and walks with a cane, thanks to two bad knees. They’re both stubborn. He refuses to wear his breathing mask at night, even though the doctor says it could literally save his life; she insists on doing all the housework and laundry herself, even though it's clear she has trouble staying on her feet for too long. She also still drives.
As we move through the day together — an appointment with the lung specialist, a trip to the grocery store and lunch at home — I try to imagine what their lives will be like a decade from now. I tell my mom about this story, about some of the technology that’s being developed. I ask her what she thinks — wouldn’t it be great to have a companion robot that could help her around the house? Or a self-driving car that could chauffer her to doctors’ appointments? “That’s what I have kids for,” she says, laughing. OK then, how about a T-shirt that could monitor Dad’s heart, even administer CPR if it came down to it? She gives me a sideways, what-planet-are-you-on glance.
“I’ll believe it when I see it,” is all she says.
Correction: An earlier version of this article mistakenly identified Charles Hillman as the CEO of GrandCare; Hillman is the company's chief technical officer (CTO).