In-Depth: Voice, independence-focused technologies drive aging in place forward

By Dave Muoio
09:02 am

Healthcare is improving with each passing year, allowing more aging patients to enjoy longer and healthier lives. Unlike in years past, though, this population isn’t necessarily limited to years of hospitals and assisted living homes. Driven by a desire for lower costs and increased independence, a broad range of new technologies are aiming to keep aging loved ones healthy in the comfort of their own homes.
“The idea is that you can monitor and manage a chronic disease at home,” Laurie Orlov, principal analyst at Aging In Place Technology Watch, told MobiHealthNews. “All of these efforts to create home-based monitoring of your health are really part of the whole aging in place [concept], which has its offshoots in post-hospitalization, non-readmission, and part of the larger trend of people not moving to assisted living because of cost. They don’t have the wherewithal to do that. They’re deferring that move until they’re mid-80, if ever. So the big trend from a technology standpoint is that more capabilities are going to migrate into the home.”
Whether it’s preventing a return to the hospital after discharge or avoiding a first admission, the promise of these technologies is welcomed by a healthcare industry already stretched thin by the silver tsunami.  
“As we get older we need more from the healthcare system. It’s a universal thing — even those of us who are hyper healthy will wear out over time,” Dr. Joseph Kvedar, vice president of Connected Health, Partners Healthcare, told MobiHealthNews. “We just need more healthcare resources, and as it stands our over-65 demographic is growing much, much faster than our under-five demographic. If all we have to rely upon is human-to-human interaction to do anything we’re going to run out of young people to take care of the old people. It’s not that far in the distance that we’ll start to feel this pressure, so any [technology] that can enable a caregiver or care provider to extend him or herself across a larger population of people is critical.”
While a number of aging in place-focused technologies are already available, more still are being explored. To gauge the aging innovation landscape in 2018, MobiHealthNews spoke with aging tech leaders on the up-and-coming technologies, trends, and challenges facing this field.

Voice technology leads the pack

Across the board, one technology familiar to many consumers was cited as the most exciting opportunity for aging loved ones looking to remain at home.
“Voice-first technology is a really big deal. It is the most significant change, from an ease-of-use standpoint, for older people that has happened in years,” Orlov said.
Physical impairments and disabilities that prevent tapping, pinching, and swiping have long been a barrier between frail seniors and digital technologies, she explained. Similarly, a decade of iteration on touch and swipe-based interfaces have, somewhat deceptively, made these devices more complex.
In contrast, conversational interfaces driven by natural language processing technology are much easier for seniors to understand and navigate, and are accessible to anyone still capable of speech.
“It’s freed up the user interface in such an important way that used to be a drawback,” Kvedar said. “Even with the interface that Apple popularized and Samsung picked up that’s now everywhere on tablets and mobile phones, even with that simple interface some individuals for visual, tactile, or any number of reasons have trouble. So, speaking becomes an almost universal way of interacting with a computer for that demographic.”
Although these interfaces can be applied to several different types of medically-focused offerings, Orlov specifically highlighted their impact within consumer personal assistants such as the Amazon Echo. Here, the flexible tech can reduce the burden of day-to-day living on seniors, allow for easy drop-in voice or video calls to reduce isolation, at the same time that specially-designed Skills can tackle their more focused medical needs — a win-win for seniors and those developing specialized offerings.
“Part of the reason [personal voice assistants are appealing] is they’re designed for all cases and all uses, and then can be customized for some ages and some uses based on software configuration,” Orlov said. “I think that’s an important point in all this. [Avoiding specialty devices], that’s a good thing because making hardware is very costly and not that many companies can pull it off.”  
Andy Miller, SVP of innovation and product development at AARP, said that voice-technologies have become a primary design consideration for his organization’s tech-driven initiatives. Specifically, he described a recent partnership between AARP and Folia Health, a startup that develops mobile caretaker coordination offerings, that is shifting its strategy from apps to voice in an effort to increase engagement and, ideally, collect more useful data.
“We were going to launch [an app-based offering], but then we said ‘Why can’t we make this observational?’ I want to take that to voice,” Miller told MobiHealthNews. “Conversations can be making Mom feel good about interaction, and at the same time you can be extracting little nuggets of information. ‘Hey Mom, how did you sleep last night?’ ‘Hey Mom, what did you have for dinner?’ All these little pieces of information that really matter.”

VR, robotics still in the running

Voice may be drumming up the most excitement, but other novel technologies are still looking to earn their place in the home.
“Whether it’s an actual, true movement forward or we’re just hearing more about it, virtual reality … has become a bit of a hot topic,” Kvedar said. “Programs for older folks in cognitive decline to bring them back to their youth — those seem to be quite well received.”
A number of vendors such as Rendevor or One Caring Team create specialized VR experiences to transport seniors with limited mobility to settings from their past, or new locations they never had a chance to visit during their youth.
These companies and other VR advocates argue that the experience can offer a measurable benefit to seniors. For Orlov, however, the benefits of implementing VR over other sources of entertainment aren’t yet clear.
“VR can be a wonderful experience for an older adult who gets to put on a set of glasses and experience a place that they are not,” she said. “That could be a wonderful thing, but I would say that’s more in the category of entertaining than actually useful. I know people are talking about it as having useful potential, but I’m not seeing it yet … at least for this population.”
Miller, on the other hand, was more optimistic about the technology’s potential. Along with these virtual experiences, he also described a VR implementation by another AARP-partnered startup, VRHealth, that allows seniors to receive therapist-guided physical therapy without needing to leave their home.
“Imagine if you could put a VR headset on, and for knee replacement, you put a couple straps above and below your knee so it can know range of motion, and you’re in a virtual world with your physical therapist,” Miller said. “All that data is going back to the therapist’s office and it’s auto-correcting — you’re doing it improperly, bending it the wrong way, and it’ll give you feedback. Not to mention because it’s immersive, you can gamify the entire thing. That’s really intriguing.”
Another futuristic approach to aging care often in the same conversation as VR is home robotics. These offerings can take a number of different forms: tabletop conversation devices such as PilloElliQ, and Jibo (notably hit with layoffs earlier this month);  smaller animal-like comfort companions from Paro and Hasbro; or much larger robots intended to replace the tasks of human caretakers.
The first two categories were generally lauded by Kvedar and Miller, both of whom noted the technologies’ focus on reducing senior isolation and ensuring medication adherence.
“In particular with Pillo, it’s interesting because it has a cylinder, a cartridge that holds medication that can come prepacked from a pharmacy or loaded manually,” Miller, whose organization is partnered with Pillo, said. “But if you think about this, medication adherence and compliance issues [are] such a big concern for us, if we can create a better mechanism to ensure there is not human error in the taking of medications through the use of robotics and voice, that’s a big one.”
Similar to her thoughts on VR, Orlov was hesitant about the value brought by these various companion robots — especially when considering their high cost and the availability of cheaper, more flexible consumer offerings.
“Nobody has come up with a really good way that a robot that moves, as opposed to a tabletop, can really be helpful yet in replacing the task work being done by people, which is the dream,” she said. “Tabletop robots: ElliQ, Jibo, [Pillo], they’re all interesting and they may have some utility, but their constraints outweigh their utility. They don’t do much. You can have just as social an experience with Echo Show and Skype, [or] you could have a social experience with someone else at a lower cost. This idea is that it will be able to sense your emotions and somehow learn enough about your personality to mitigate social isolation in some way, but I think with the price point that they’re at? Not yet.”

Independence in and out of the home

Connected home sensors and other continuous monitors remain a regular topic of conversation at health and tech conventions.
On the one hand, improved reimbursement is leading more providers to prescribe remote care technologies to their patients, especially in rural areas, Orlov noted. On the other, many older patients remain uncomfortable with the idea of constantly being monitored, Kvedar said, or of their children being informed of their more embarrassing health failures.
“What hasn’t gained much traction and has some issues to work out are the ‘monitoring everywhere you go in the home’ set of technologies,” he said. “It’s because, I think, it’s an engineering breakthrough. People get interested in that, and it is kind of magical, but the flip side is finding the right utility. The reason the whole set of technologies is having challenges, to me, is that people that are older and in their home don’t want to be watched by [their] children. There’s this dynamic where the older adult child is thrilled to have this monitoring tool, but mom or dad a few states away don’t want to be monitored at all.”
Even when these technologies are implemented, he continued, their potential benefits often aren’t being realized.
“The use of those data streams in mainstream clinical care is almost non-existent, and I know that for me to say that probably is shocking to hear,” Kvedar said. “The adoption of remote monitoring in healthcare delivery is about six or seven percent, and most of that is weight scales, blood pressure cuffs. We have such a long way to go before this sea of data coming from the home is of use for healthcare delivery. A little bit shorter, if we can get it right, is making that data useful to the patient or the caregiver.”
Data-collection devices may be hit or miss, but others more focused on safety and communication continue to play an important role, Orlov said. Wearables focused on fall safety, hearing, injury or episode detection, emergency services alerts, and communication are all improving, and each can help liberate the homebound senior from their usual surroundings.  
“I think we have to understand that it’s great to talk about voice-first stuff and things monitoring in the home, but people want to go out and about; older people want to walk the dog, and they want to walk in climates that may not be really attractive at not, or in cold weather [or] rain,” she said. “The question is what do they have on their body. Maybe they have a smartphone, maybe they can grab it when they’re on the ground, they can pick it up and call somebody. Or, they can have a wearable that has fall detection capability in it, or they can have a wearable that they can speak to, or they can have a wearable that has some health tracking capability in it that’s important to that person’s chronic condition.”
For many aging seniors, the desire to leave the house will inevitably lead to conversations with loved ones on whether or not they are capable of sitting behind the wheel. For families, these discussions can be heartbreaking at best and deadly at worst, Miller explained, but may someday be avoided if ongoing research into autonomous vehicles pans out.
“I think autonomous vehicles are going to change the way that older folks live because one of the biggest challenges, both as an adult child and a parent, is having to say ‘Mom, Dad, you can’t drive anymore,’ because historically that meant isolation. I can’t do what I used to do, my life sucks, it’s over,” Miller said. “Well, with autonomous vehicles, it’s probably not.”
Whether or not these technologies pan out, Kvedar noted that the rise of ridesharing services has already opened a door for older individuals that should be explored further.
“Yes, autonomous vehicles have an enormous application … but in the meantime we certainly can do more with services like Uber and Lyft,” he said. “If we can get more and more folks [who] are at that point of their life where driving starts to be dangerous to adopt something like that, I think it’s a good bridge to the autonomous vehicle, which is still a few years away.”
Several companies have already jumped on the opportunity to leverage ridesharing networks, whether it be non-emergency medical transport coordinators like Circulation or senior-specific, phone line-based service GoGoGrandparent. Connecting aged individuals with these kinds of services and other technologies that enable social interactions is extremely important, Kvedar stressed, as isolation and depression are and will continue to be a substantial risk as connected homes become more capable of addressing seniors’ day-to-day needs.
“All of the new delivery service options you can get on everything, and I know a number of companies that are doing Uber-style house calls and [others] that are delivering medication. Those kinds of things may have a role to play in keeping people comfortable,” he said. “But we mustn’t forget isolation. You might be surrounded by everything you need without going out of the house, we know that if you don’t have connection with other human beings, that’s a detriment to your health. Some research suggests that isolation has the same health effects as smoking 15 cigarettes a day, so … if they’re not connected to other people that’s probably not a good design strategy.”

New advances on the rise, but familiar tech issues remain

Much like the issue of tech-driven isolation, other issues plaguing the tech industry at large also pose unique threats to an older population. One of these is hardware manufacturers’ expectation that consumers will have no trouble purchasing and transitioning to the latest release of a hardware offering.
“Device obsolescence is a big issue in all tech markets. What looks like a good device in 2017 or 2018 looks like a hockey puck you want to put in your closest a few years later,” Orlov said. “I’m hopeful that Amazon is not going to, for example, get bored with the cylinder that sits on a counter and say it’s not supported. They could easily do that, but hopefully they won’t.”
In the case of Amazon’s voice platform, Orlov said she was encouraged by the platform’s approach to cloud-based software updates, which are generally handled with little input from the user and do not require new purchases. Harder to solve are older users’ concerns about in-home privacy and whether their information is at risk.
“This is an early market and subject to change over time, and one of the changes, certainly, is a lot of concerns over privacy. Every single blooper or anything that happens with technology gets extremely well publicized … [and] older people are actually a little bit afraid of always-listening devices,” she said. “Those I’ve spoken to when I’ve given speeches have expressed some concerns that someone is always listening to them, and making them not listen to them involves touching the device, tabbing it off. We don’t, generally, have the ability to yell a command ‘Okay everyone, stop listening now.’ That’s a barrier — the fear of lost privacy, the fear of misuse of information, the fear of accidentally buying something.”
Orlov said that seniors’ fears of data hackers generally have merit, but noted that the always-listening devices most often cited by seniors do not appear to be any more of a target than other technologies. Miller, however, expressed a greater level of concern and said that without further protections he also wouldn’t be fully comfortable installing many devices.
“I buy [connected homes] as a value proposition. The problem with that is the minute I hack in and get access to your network, your doorbell, or your sensors, they’re all going toward one network and I have access. Now you’re talking about video? I don’t know if I feel comfortable buying for my mom a system that has video access if someone hacks into that.” he said. “There’s all these different entry points into these in-home networks. That’s what scares me.”
Further compounding the issue for Miller is seniors’ general susceptibility to bad actors, whether it be phishing emails, automated phone calls seeking money, or any other number of tech-enabled scams they might not be equipped to handle. Fortunately, he said, we may already have a glimpse at the types of technologies that could someday protect seniors from these kinds of threats.  
“I do think AI, blockchain have a role here … but that’s going to happen all on the backend, it’s not going to be consumers leveraging the AI,” Miller said. “It’s early days, but you’re going to see more and more AI and blockchain implementations on the B2B side that will create tremendous impact for the consumer, even though they have no idea what the technologies really are."

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