Notes from the Aging 2.0 Optimize 2017 Conference

Last week, I attended Aging 2.0’s flagship OPTIMIZE conference. This was my third major Aging 2.0 conference (you can read my comments on the first one here, and the second one here), and it’s neat to see how the aging innovation community has grown and evolved since Aging 2.0 was founded in 2012.

I live-tweeted the conference (that’s part of why I get to go); you can read the Storify collection of my tweets here, or at the bottom of this post.

In this post, I’ll cover a few highlights that I found especially interesting, namely:

• The Aging 2.0 Great Challenges
• Bill Thomas’ keynote
• The “elder workforce” best practice session
• The AI and IOT-enabled engagement and fall prevention session
• The winner of the Aging 2.0 Global Startup Search

The Aging 2.0 Great Challenges

Aging 2.0 announced the launch of a Grand Challenges initiative earlier this year.

The Grand Challenges are:

• Engagement & Purpose
• Financial Wellness
• Mobility & Movement
• Daily Living & Lifestyle
• Caregiving
• Care Coordination
• Brain Health
• End of Life

You can learn more about these grand challenges here.

The topics are “the result of five years of bottom-up and top-down dialogue with stakeholders from across Aging2.0’s interdisciplinary, intergenerational, international community of older adults, senior care providers, thought leaders, and entrepreneurs.”

Although all eight topics are innovation priorities for Aging 2.0, they announced at the conference that in 2018 they will particularly focus on caregiving & brain health.

Challenges such as this are kind of interesting to think about. I think that they are partly a conceptual model to frame the way a community thinks about opportunities/problems, and also partly a marketing approach.

As the saying goes, no model is perfect, some are more useful than others.

This model doesn’t really highlight the need to address housing to foster better aging, which surprised me since “aging in place” and “thriving in community” are important to many. (Note: the original list of challenges, which you can view here, had 12 categories and one was “livable communities.” It also had more categories which seem relevant to enterprise providers of aging and health services, such as “care operations/staffing” and “remote care delivery.”)

There are other categories or issues to consider, which don’t obviously fit into the categories so far. Ageism is one that comes to mind. Another is the need for structural supports and services, as well as policies that support aging adults and also better healthcare for aging adults.

And then being a health provider, I find that the health side of things seems a bit fragmented. There’s brain health & mobility, but not really chronic disease management, or even symptom management (which should start well well before the end of life).

I’m also not a huge fan of “end of life” as a topic, in that I think it generates too much focus on the literal end of life — last days to weeks, hospice, having your code status discussed — and not enough on the last stages of life, such as the years of decline that are common in dementia and in other conditions. (People would rather talk about death than decline.)

Really, you ask people about advance planning and they think they just need to tell their family when/if the plug should be pulled. But there is so much more, and we know this because of course we routinely see patients and families struggling with dilemmas well before someone is on life-support and deathly ill.

Obviously, it’s much easier to critique a model than it is to come up with a comprehensive one that is actually better, and not just focused on different things.

On the whole, I’m glad to see that they will be focusing on brain health (I hope this covers maximizing quality of life for people with dementia and not just Alzheimer’s prevention) and caregiving. I love both those topics, so I look forward to seeing what emerges from this initiative.

Geriatrician Bill Thomas’s Latest Mission: Starving the Dependency Industry

Dr. Bill Thomas is one of the best-known geriatricians in the country; his innovations in improving nursing home care were featured in Atul Gawande’s best-seller, Being Mortal.

I’d heard of Bill Thomas (who hasn’t?) and his website ChangingAging.org, but this was the first time I saw him speak live.

He came bounding out wearing a shirt that says “LOVE.”

Welcome Dr. Bill Thomas to the stage to talk about ageism and how we can #disruptaging #A2OPTIMIZE pic.twitter.com/xRXRHgC3Eh

— Aging2.0 (@Aging20) November 14, 2017

Here’s a summary of the points he made:

• Entrepreneurship and innovation came late to aging, because we are in an ageist society
• The dark heart of ageism is that aging = decline. Hence regular people feel pity for those of us who work in aging. But this is wrong, “we are born to grow.” Aging is the name we give to growth when we are no longer young.
• He started his career asking the wrong question: “how can I make a nursing home better?” He wanted to make them dance. But they’re never going to dance. So he’s now a “nursing home abolitionist.”
• When we think of our jobs in aging as managing decline, this is signaling to older people that they are weak and don’t belong.
• He is now working on independence, as a counter to the dependency industry. “I want to starve the beast!”
• Housing often hinders independence. “Houses kill!” This is because they are often too big, too hard to maintain, and isolated.
• Hence his new project: Minka, which are small customizable affordable dwellings. (For more details on Minka, see here.)
• Dwellings should be “digital natives”
• Aging does lead to diminished reserves. So it’s important to design in ways that help older adults conserve energy.
• When asked “How do you want to age?” he replied: “Together. Aging alone is perilous and difficult.”

He’s an inspiring speaker and brought up many important ideas.

Nonetheless, I found myself a little distressed at the thought of “abolishing” nursing homes. I don’t like them, but some people have a very high level of need (for medical care or supervision). I would love for us to be better at helping people sooner, so that fewer people reach that level or so that it happens later. But we also need the best possible solutions for people who DO need that level of care.

And we need to care about creating solutions for those people, because otherwise we will be marginalizing them and sending out the message that once you are disabled enough, you are less important than the people who can thrive in a small house or otherwise are more independent.

I actually did get to ask Bill Thomas about this, when he was signing books and greeting people after his talk. He basically agreed that we do need the best possible solutions for people with that level of need, but that we also need to do much more to help people before they reach that state, and that’s what he’s working on now.

I did find his comments on ageism spot on, so am glad that he is helping to train a spotlight on this important issue.

Fostering Engagement & Purpose in Aging

“It is not enough for a great nation merely to have added new years to life–our objective must also be to add new life to those years.” — President John F. Kennedy, Special Message to the Congress on the Needs of the Nation’s Senior Citizens, February 21, 1963

A breakout session that I quite liked was titled: “Engagement & Purpose: Elder Workforce Best Practices.” It featured speakers from two organizations, AgeWell Global and Encore.org.

Here’s how AgeWell Global describes itself on its website:

“AgeWell Global is a new model of elder care coordination combining peer-based social engagement and mobile technology to improve health outcomes and drive down medical costs. AgeWell makes older persons part of the solution.”

AgeWell Global’s CEO & Chief Program Officer explained that they have a proprietary 20 question survey, which their community health workers (which they call visiting “AgeWells”) use when seeing a client. They have both a community-based program and a hospital discharge program.

Personally, I love the idea of training older adults to serve as community workers who can visit their peers and bring both a social encounter and perhaps some health monitoring or assistance. This obviously has potential to benefit the older client being visited and also the visiting AgeWell worker, who has important work to do and is learning about health and aging as well.

AgeWell Global won a grant to do a pilot in New York City in 2016, in a naturally occurring retirement community. I haven’t been able to find any reports on how the pilot worked out; hopefully, they’ll be publishing more information on that soon.

Encore.org was represented by Jim Emerman, Executive Vice-President. Whereas the AgeWell Global presentation focused quite a lot on their ability to work with healthcare partners to reduce utilization (which is important, but so business-y and a sad reminder of the pressure do-gooders feel to justify their “value” by healthcare financing metrics), the Encore presentation was more about the many ways that older adults can contribute to society. This I found more inspiring to hear about, in truth.

I hope that over the next several years, we’ll see these effort to engage older adults in various activities really ramp up.

The AI and IoT-enabled engagement and fall prevention session

Speaking of engaging older adults, the session on artificial intelligence (AI) and the Internet of Things (IoT) was much more interesting than I had expected it to be.

It featured really three case studies, each of which involved different people and used different technology.

Aging and Alexa

The case study that I found by far the most interesting was a pilot in which a group of Carlsbad By the Sea CCRC residents (I believe they were all in the independent living section) learned to use Alexa, Amazon’s voice-activated assistant. This project was encouraged by the Center for Innovation and Wellbeing of Front Porch.

John Sanders, a resident of Carlsbad by the Sea, explained the experience that he and some of his fellow residents had, learning to use Alexa. I was struck by a number of things:

• We should be hearing from more older adults at these types of conferences! I wish more companies or organizations would bring some of their older users to speak. There is nothing quite like hearing from a real person who has used a product or service.
• The residents had a group about Alexa, in which they could exchange ideas and help each other learn. This is a great idea when it comes to technology for older adults, as it creates a social learning environment.
• Some residents who live alone reported that they liked having Alexa to talk to.
• Some residents expressed interest in Alexa addressing “safety” issues, such as lighting the way to the bathroom at night.

To learn more about how this community of older adults is learning to use Alexa, this article includes a first-person account plus links to a YouTube video: Greetings from the Alexa Club!

I would also recommend this MIT Technology Review article, for more on this pilot: The Octogenarians Who Love Amazon’s Alexa.

Elli-Q, a social robot designed for aging adults

The next presentation was for Elli-Q, an “active aging companion” being developed by Intuition Robotics. To see videos demonstrating Elli-Q, see here: https://www.intuitionrobotics.com/elliq/

If I understand right, what makes a robot a “social robot” is that they are designed to interact with people and try to observe and respond to social cues.

What was interesting to me, in this session, was the explanation of how artificial intelligence can enable these robots to learn from the way they interact with a particular person. Dor Skuler, the CEO of Intuition Robotics, explained that Elli-Q can be proactive in suggesting activities that an older person might enjoy (or need to do, like take medications), and that the robot can learn which conversational style seems to be the best fit for an older person.

This sounds very useful, it would be a big step up from the currently available apps and other services, which are relatively “one size fits all.”

Now would an older person enjoy interacting with Elli-Q? Having just found out that many older adults are enjoying Alexa, I can now imagine some cognitively intact adults enjoying Elli-Q as well, especially since Elli-Q is more expressive and seems to have more capabilities than Alexa.

But I think we’ll run into two issues: cost, and cognitive impairment. Cost matters because I can’t imagine a robot being cheap. People might enjoy a robot, but will they pay for it, when something like Alexa is way cheaper?

And cognitive impairment matters, because where I can see people considering spending money is for the support of someone with dementia. People are especially eager for solutions that can help people with dementia when they are home alone, or solutions that can otherwise relieve some of the care burden for family caregivers.

But how will people with memory problems respond to a social robot? Unless it’s in the context of a group in memory care — where there would be real people to help as needed — I worry that it’s likely to be confusing to them, but who knows? There are some companies trying to develop Alexa as a tool for people with memory problems; I’m still waiting to see real world results on that front. Perhaps we will eventually see some real world results regarding social robots and dementia, as well.

By the way, in a different session, Alan Go of Kaiser Permanente remarked that they have not found mobile apps very successful, to get high-risk individuals to better manage their health, so they are looking into social robots as well (they are piloting one from Catalia Health, called Mabu).

AI for fall prevention in memory care

The last case study of AI involved a newer company called SafelyYou. Basically, they have developed a method of using artificial intelligence to monitor video and spot the moment when a resident in memory care falls. Many of these falls are not observed. By providing video of how the fall happened, facility personnel are better able to make changes to reduce the risk of future falls.

In a small pilot study, the authors reported an 80% reduction in falls. (Doesn’t look like they attempted any statistics.)

There are extensive details on how the technology was set up and the results in this recently published JMIR article:

Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study

This was another example at Aging 2.0 of a productive partnership with a residential facility. I suspect such partnerships will be crucial to the development of most successful innovations for aging adults.

Now, how can this technology be applied to help people with dementia who are not in residential memory care, and can it help with more than falls? That was unclear to me, honestly this seems like a very niche product for now, but that’s not necessarily a bad thing. (Another Aging 2.0 attendee noted that this type of technology could perhaps be used to detect elder abuse, but I am guessing you would have to train the artificial intelligence to recognize elder abuse, and that might be harder than teaching it to recognize falls on video.)

What is most important is to help people with an important problem that needs better solutions. Falls in residential facilities are a pretty considerable problem. I look forward to seeing how effective this innovation is when it’s used and tested at a larger scale.

The Winner of the Aging 2.0 Global Startup Search

The conference ended with a session presenting the finalists of the Aging 2.0 Global Startup Search. (Descriptions below are from the Aging 2.0 website.) They were:

• OnGuardian: “OnGuardian empowers family caregivers by streamlining support, collaboration and access to information while providing care recipients with an easy to use voice interface, powered by Amazon Echo and Alexa.”
• Silver Bills: “Using technology, we receive, scrutinize and ensure that our clients’ bills are paid accurately and on-time. Our clients no longer need to write checks or remember due dates.”
• Steadiwear: “Steadiwear has developed a battery-free & lightweight glove that responsively stabilizes the wrist joint in Essential tremor & Parkinson’s Disease.”
• Unforgettable: “A next generation social retailer providing life-changing dementia products to improve the lives of all those affected by dementia worldwide.”
• Uniper Care: “Artificial Intelligence aging-in-place platform helping older adults “thrive” at home in an independent, connected, fun way. Making active aging a reality by using accessible technology.”

Each company had a few minutes to present to a panel of judges, during which time they explained the need for their product/service, the size of the market, why they were a good solution, why they were likely to be viable as a business, and so forth. They also had to answer questions from the judges.

The winner was Unforgettable.org, a UK-based website and online store providing products for people with dementia. Here’s how they describe themselves on their site:

“Welcome to the world’s best marketplace of products and services for dementia and memory loss. We are making it easier for carers to discover products that really help and for product and service providers to reach carers at home.”

Apparently, they are doing quite well in the UK, and are hoping to expand to the US next year. They are also a B-corporation in the UK, which means they have an explicit focus on a social mission.

I found this company interesting for several reasons. First and foremost, dementia and dementia caregiving is a particular interest of mine. I agree that helpful products and services can make a big difference, but I’m often not sure where to find them. So I’m interested in a site that can help on that front.

I have come across sites specializing in selling dementia products in the US, but none of them have blown me away.

Among other things, I think a good site for this purpose should have plenty of real user reviews and a generous return policy.

I haven’t yet had a chance to explore what Unforgettable has to offer, but hope to do so soon.

Meanwhile, if you know of a good site in the US that makes it easy to find and obtain helpful products related to dementia, let me know what it is!

For More on the Summit