31 August 2014
This article first appeared on Forbes.
In the past year my wife and I have moved my father from Missouri to Colorado, acted as amateur health assistants and social workers, found him the resources he needed to live as safely and independently as possible, all while both of us were in the middle of balancing work and graduate studies. It has not been stress-free, for any three of us.
I have noticed from talking to friends and seeing their posts on Facebook, we’re not alone. Generation X is entering that phase when the parents who cared for us need the favor partially returned. The process likely looks similar to what Baby Boomers have experienced, but how will it be for millennials? By the time their parents become seniors, will technology have radically changed the way both parent and child face the questions of health and independence?
Yes, say Nilesh Chandra and Chris Steel, Healthcare IT Experts from PA Consulting Group. Don’t expect wearables, smart materials and robots to solve all problems, but a tech boom in affordable and life-altering health and lifestyle technologies is coming.
“We see tremendous opportunity for very significant developments, not only in the wellness space where there is so much hype at the moment,” Steel says, “but more fundamentally in technologies for keeping people at home longer and also the care of chronic conditions longer term.”
From the most positive perspective, Chandra and Steel told me in a phone interview, technology will use the smart functionality of devices and materials as well as massive data sets emerging from ever-increasing numbers of wearables to help older adults live better lives longer. The image is of devices (everything from wrist bands to your clothes and even embeds) far surpassing the wellness and health-tracking they do now. They envision tech that can take all of your vital signs, know your nutritional habits, know exactly where you are and how you are moving, note your weight, blood sugar, etc. and deliver them to caretakers. They also see smart injectors that could someday assist older adults in medicine delivery and textiles that assist with mobility (imagine suits that strengthen your body for walking or internal GPS systems that keep you from spaces with high-risk for falling).
This is not a new vision by any means. Ten years ago, researchers from Austria and Switzerland, after studying the possibility for wearable technology, concluded that wearables will particularly “prove useful in improving the quality and reducing the cost of caring for the aging population.”
Relatively speaking, says Chandra, we’re just moments away now.
“One of the broader things we’re seeing is the movement toward platforms,” says Chandra (Apple HealthKit and Samsung Healthcare). “The potential with platform is that you finally get to the place where all of this technology and all these different applications can talk to one another and exchange data with one another.”
On the other hand, the negative perspective immediately conjures worries about security and privacy and, perhaps, new forms of discrimination based on medical data. The concerns are nothing new either. In 2006, for instance, researchers at the 28th Annual IEEE conference were asking questions equally vexing today: “The physician needs to know who the patient is and may need to do some mining on the data over time, but does the insurance provider? What level of knowledge do different providers get? What level of data mining capabilities should different providers be allowed? Ethical practices are not well defined for the vast array of disclosures to secondary users, such as managed care evaluators and insurance companies.”
Answers to these questions are still being developed, Steel says.
“It’s a massive issue for the market and one that people are absolutely focused on being addressed,” he says.
One thing we know for sure: It’s going to be big business. Chandra and Steel estimate health wearables will be a $5 billion business by 2018, a number that sounds conservative. In this case, however, much of consumer cost will shrink, the consultants say.
So where will the child fit in all this? It turns out, the role is critical and nearly as old as human beings themselves. If the parent wants, their children will be able to know how they are faring, what they need and t0 be able to advocate for their health and independence in ways never imagined before. But that information comes with responsibilities.
“It’s very clear that just having a piece of technology is not the answer,” Steel says. “It needs to be provided as part of the properly thought-through care package for the individual. The individual might be fortunate to have strong family support or they might not, in which case support from a visiting nurse organization and a care management plan that’s put in place from a primary care physician is incredibly important. With accountable care, patient-centered solutions are going to become the norm, because the money is going to flow that way. Which always helps.”
And do parents want this? While my dad lived with us for six months, we addressed the issue of spiking blood sugar, at the behest of his doctor. A Type II diabetic, he has all the same struggles with savory and sweet temptations that most of us have. For him, and millions of others, those temptations are a serious peril to his overall health.
Okay, “we addressed” is a falsely bland way of saying I preached, spied, confiscated and limited my way to keeping my dad away from foods dangerous for diabetics. To say he hated it is pretty strong, but still may be understating the fact. He knew what I was trying to do was help, but being told you can’t eat things you’ve eaten your whole life, and crave regularly, was awful.
Wouldn’t it be even worse, I asked him recently, to have a machine spy on everything you ever do?
“No,” he said after considering it, “if it knew how to make me healthy, I would probably like it.”
“But if I frustrated you with my preaching, wouldn’t it be even worse from machines that see everything?”
Apparently not. The objectivity of the technical device, combined with the knowledge human beings who care were watching, might be exactly the combination that largely keeps my dad away from those kinds of snacks. Millennials, then, might have a tool that truly make this hard process easier.
The critical issue is the message for the patient, Chandra says.
“Patient adoption works really well if the choice given to them is framed within the context of their health,” he says. “That works rather than, ‘I want to monitor your blood sugar and diet.’”
“I know I need it,” he concludes. And I know exactly what he means. In fact, I could use that exact same kind of monitoring. Four years ago, I lost 80 pounds primarily motivated by watching what Type II Diabetes was doing to both my mom and dad. So far, I have kept most of the weight off and recently tested with no signs of pre-diabetes, which is all good news. But when you are obese for 90% of your life, the war to keep off the pounds is sometimes epic. One of the key ways tech could help the next generation of seniors (and, therefore, their children) is helping to prevent the problems my dad has.
“An personal health wellness application, even a menu that tells you calorie information,” Chandra says, “is actually a great public good, because it is educating people who in the past didn’t know. It’s partly a question of awareness. And where we can help raise awareness of conditions, of the implications of lifestyle choices, that’s obviously positive.”
A whole other set of questions arise, of course. At the center is: What does healthy actually mean? Earlier this month, Google announced its Baseline program which, as the Wall Street Journal described it, “will collect anonymous genetic and molecular information from 175 people—and later thousands more—to create what the company hopes will be the fullest picture of what a healthy human being should be.”
The concerns about such an approach were voiced immediately. One of the most compelling came from Dr. Kedar Mate, vice president of Institute for Healthcare Improvement, who told NBC: “Genes are about 15 to 40 percent, behavioral patterns 30 to 40, socioeconomic factors 20 to 30, etc. So even a wonderful genetic model is not a total picture of health.”
And perhaps genetic information will be protected, but what about those behavioral and socioeconomic factors? They too will be tracked and it could be millennials will face a new kind of discrimination that many will accept as valid.
“That’s not something I’m aware of as a concern right now,” Steel says. “I’m sure it’s something will become more of an industry issue to get to the bottom of and probably will result in more regulation.”
It’s something I think about from a number of perspectives as the child of two parents whose genetic determinants and lifestyle choices have lead to health problems. All I can do right now is watch myself carefully. I, like my dad, would take the technological assistance, but not without concern.
But for now, different concerns mount. A few months ago, it became clear to me that my mom is having similar problems to my dad (they’re divorced). I can honestly say that the time-consuming, perplexing and emotional nature of this newfound responsibility can be overwhelming. It is comforting to think about how technology could make it easier. In some ways, I think it will. But that human side of watching your parents age is another matter. Technology is light years away from solving that.