Aging, Technology, and a Much-Needed Change in Thinking

“We all want to live a long and healthy life…”

This was my opening statement at an event we co-hosted last month. We did so in collaboration with our friends at the d.health Summit, after learning that they were bringing their yearly thought-provoking gathering on all things aging to Boston. When Ray Dorsey first brought me into the fold as a member of their advisory board, he said to me, “The ‘D’ is for disrupt, not digital,” which, in my opinion, best describes why this is a must-attend conference for anyone in or interested in the field.

It’s an event we hope comes back to Boston. And so, to show our support for Ray, Anna Stevenson and company, we collaborated with them as well as the Personal Connected Health Alliance (PCHAlliance), to host a two-hour preconference event on June 5, the eve of the Summit. We called it Aging and Technology: An Intimate Discussion with Thought Leaders. Included in the mix, besides yours truly, were friends Bruce Leff from Johns Hopkins, Charlotte Yeh from AARP, award-winning journalist Laura Landro and Ray himself. Three of us gave brief talks, followed by a panel discussion that was moderated by Ray.

I enjoyed the event and gained many insights, so much so that I thought memorializing it in a post would enable others to learn too.

My talk covered themes from my book — The New Mobile Age: How Technology will Extend the Healthspan and Optimize the Lifespan — as well as some insights I’ve gained since it was published about six months ago. I debuted my new stage buddy, the robotic cat (one of the Joy For All Companion Pets from Hasbro), which my daughters named Checkers.

The gist of my discussion was this:

• We all want to live a long healthy life: ‘long’ as in longevity, and we’ve done well there, adding 25 years to the lifespan in the past century; ‘healthy’ is where we have uneven results. That is the healthspan.
• From a societal perspective, we need to better engage older individuals, providing them with opportunities to maintain a sense of purpose, social connections, and increased physical activity. Technology can help with all of these.
• For individuals, the decisions we make that lead to a shortened healthspan are a combination of data and emotions. Technology can help us with the data part of the equation.
• Caregiving is in need of an overhaul, going from our current one-to-one model to a one-to-many model. Technology (robotics, artificial intelligence and other digital and emerging technologies) is critical. I brought Checkers onstage to point out that, if we use technologies such as companion pets wisely, we can begin to attack this challenge.

Bruce Leff, a geriatrician and Director of the Center for Transformative Geriatric Research at Johns Hopkins, is a pioneer in bringing the hospital into the home. He talked about his experience going on house calls as a medical student, where he noticed how the relationship changes when a provider visits a patient in their home. You are a guest and behave differently and deliver more personalized care.

Bruce further asserted that the future of hospitals is specialized, acute care. (I agree, but we keep on building buildings. When will the tide turn?) He suggested that a supply chain for services in the home needs to be developed, as home-based care will become part of the US healthcare system within the next 25 years, and hospitals will eventually turn into large ICUs.

Charlotte Yeh, Chief Medical Officer for AARP Services, is always inspiring. Her message is that we must rethink what getting old really means. People over 50 are happier, better at problem solving, pattern recognition, and empathy, and have twice the success rate in entrepreneurship. Wisdom is a real thing. And if that wasn’t enough, she pointed out that the 50-plus community contributes more than $7.6 trillion dollars to the economy. Charlotte built a compelling case as to why we should stop thinking about older adults as a burden, and instead see them as an asset.

She also emphasized the importance of a sense of purpose, positive attitude, and connectedness, and provided some meaningful statistics:

• Older individuals with a sense of purpose have 40 percent lower health care costs
• Older adults who feel isolated cost Medicare $6.7 million additional dollars
• And, a positive view of aging helps you live 7.5 years longer

She concluded with her rallying cry: Instead of aging in place, we should be thriving in motion!

We also had a terrific panel discussion, where Ray asked penetrating questions. To kick off the conversation, Laura Landro, who had just published a piece in The Wall Street Journal, talked about trends in care delivery, noting that the hospital as we know it is becoming a thing of the past. Things like micro hospitals and ambulatory surgery are where it’s at today.

Charlotte added that there needs to be a shift from the medical model of care to a personal model of care — in healthcare, health is the ultimate outcome. For the consumer, living well is the ultimate outcome, but our current provider structure has failed to acknowledge the shift.

Ray asked the group to address those factors standing in the way of greater adoption of connected health technology. I offered that we haven’t done our best at thinking about what the individual wants and needs, or how to design technologies to appeal to the patient. For example, products to help the ‘sandwich generation’ — designed for adult children of aging parents — can be a turnoff for the parent or feel intrusive. Charlotte rightly pointed out that we also need to understand what a technology is solving. For example, feelings of isolation are very different then feelings of loneliness, and are solved via very different tools.

Responding to the question about how to close the intergenerational gap, Charlotte suggested we start in the workplace by hiring older adults, which has been shown to improve productivity. I noted there is also a digital divide, which creates design challenges. For example, people with two or more chronic conditions tend to use less technology, yet they could potentially benefit the most.

Ray posed a final question: If you could make one change to help aging Americans, what would you do?

Bruce suggested that we liberate payment from the doctor visit, which could go a long way to opening up new opportunities.

Charlotte said we need to change how we measure success. Rather than looking at data on mortality, morbidity, and hospital readmissions, we should measure life satisfaction, she noted.

If I had to identify one change to help aging Americans, it would be to accelerate value-based payments. In this way, we change what we measure and change what we pay.

And, finally, Laura urged us to work on patient engagement, and on finding ways to figure out those who are in most need and then pay for services that will help them take better care of themselves.

We’re looking forward to continuing the discussion — Partners Connected Health, PCHAlliance and the d.health Summit — as part of the 2018 Connected Health Conference taking place in October.

The importance of this topic can’t be overstated. As we enter the era where our over-65 population outstrips our youth in numbers, we need to completely rethink the older demographic and how we can leverage this amazing asset as a society.

[This piece was originally published on The cHealth Blog by Joseph Kvedar, MD, VP of Connected Health at Partners HealthCare. Follow him on Twitter at @jkvedar.]