Lowering the Curve: Health Tech and the Elderly

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The topic of healthcare and the elderly keeps coming up at the Jumpstart Holdings water cooler. (No, it’s not metaphorical, we do actually have a water cooler. We stand near it, not around it, but still.) Conversations have revolved around ways to improve healthcare delivery, make technology accessible, support independent living for cheaper, longer among the elderly, and a few other ideas. After dancing around this issue for a while at the office, I sat down with JSF CEO Vic Gatto to hash it out a little more specifically.

It’s an interesting and important topic because the simple fact is that healthcare innovation tends to rely pretty heavily on technology. And while technology tends to be geared towards younger populations, older populations are the heaviest users of healthcare services and spend about three times more per person per year than working-age adults (as of 2012). So we end up with a problem that can be roughly summarized as innovation vs accessibility. The elderly are far less comfortable than younger generations with consumer technology, but consumer technology plays a huge role in modern healthcare.

There are of course (many) companies working in the elder care space, and using technology to do it. However, on further examination many of these are actually targeting the Baby Boomers providing/managing care for their parents.

So that brings up another important point: demographics. Instead of the “elderly,” we really have two groups of people when thinking about tech adoption. The first are people over 75 (maybe 80, these are rough delineations) who are generally not interested in learning new technology. The second are the Boomers, 55–70ish who will and do use technology, and learn new tech, but for whom stabbing at a screen and pinch-and-zoom isn’t native.

It’s not a matter of ability, but of learning curve. For any given piece of technology, we have a more or less fixed amount of effort that goes into learning it. Learning curves are additive over time. For a millennial, it’s been spread out across pretty much their entire life. They learn and evolve with the technology. For example, icons and interfaces are familiar across platforms (such as the three stacked horizontal lines that denote a menu on a mobile webpage) and so they become part of our routine. When a new app arrives, the learning curve is shallower because we already have a feel for the basic interface. For a 75 year old retiree without that context, though, getting up to speed takes the same cumulative effort but they’re starting from scratch.

People need to learn in a process driven way to get through this. Vic used the example of Pokemon. The developers don’t tell you you’re going to have to walk forever to be successful. Instead, capturing your first Pokemon is almost effortless but gets harder (with more walking) as you move on. The designers built a game that boils the frog, teaching skills slowly. Microsoft did something similar, teaching people to use a mouse on games in Windows and then using the same types of actions (right vs left click) in productivity software.

So what about healthcare? Unfortunately, the industry hasn’t historically been as good at this progressive learning thing as, say Microsoft or game companies. Patient/consumer-facing apps are making a lot of progress. Health tech in general though has been more focused on following regulations and hitting meaningful use milestones than on making things accessible for non-tech savvy patients. We’re not worried about how it feels so much as whether it gets us to reimbursement.

In thinking about solutions, we talked about a framework espoused by Chris Dancy, “the most connected human on earth.” Simply put, technology should be kind. It should serve the user (novel concept, eh?). Practically, there are three components to kind tech. It should be:

  • Intuitive — The elderly (and, really, all of us) need to be able to use something with minimal onboarding.
  • Passive — Health tech should be observing, not be in our faces yelling all the time. It gets too easy to tune out an alarm that never turns off.
  • Proactive — When a problem comes up, it needs to let us know so we can intervene.

So we need tech that is positioned as a gentle friend, not a nagging relative. It seems likely that this will be especially true in the elderly who already have things set up pretty much how they like them. Combine a steep learning curve with an annoying output and it’s going to be hard to drive adoption.

The other part of this discussion around health tech and the elderly is social/cultural. Healthcare is intertwined with social and behavioral challenges. We have more health issues as we age, and we tend to be less busy. When we’re young and healthy, we’re probably not very eager to go get a checkup. “I’m busy and I’m not sick.” Retirees, on the other hand, may be more interested in heading in to see their doctor. It gets them out of the house. It’s an activity. The convenience of saving time isn’t as big of a deal, perhaps. The waiting room becomes an experience. Put another way, people may not enjoy going to the doctor, but they enjoy going to the doctor.

Therefore, the question becomes: how do we combine the human aspect of healthcare — the personal interaction and engagement — with the need to build tools that will help prevent problems from occurring and make treating them more efficient and financially sustainable? How do we do this in the segment of our population that is both the heaviest consumer of healthcare resources and in general the least-likely to take advantage of more efficient, cost-saving technology?

There is no way to succeed without adding technology, of course. We have too many people aging in this country to scale medical care without it. But it has to incorporate the human element and the personal touches. Someone in the office set it up as “hacking human culture.” In other words, presenting technology so that people are excited to adopt it because it fits with how we are already wired to behave, regardless of our age.

For what it’s worth, this tech gap could easily continue ad infinitum. I’m in my 30s. Facebook arrived on the scene as I was finishing college. I got my first email address (@juno.com, thank you very much) somewhere around age 10. I feel pretty tech savvy. And yet, I recently saw a toddler in the airport handling an iPhone like it was an extension of his body. In a few years those kids will be looking at me, shaking their heads as they say, for the fifteenth time, “look, it’s simple. You just scan your retina to identify yourself and then hold the tricorder over the site where the pain is localized.”

With that in mind, maybe it’s about the philosophy we put behind the technology rather than the actual implementation. I think that’s what Chris Dancy is getting at, and Vic when he talks about health technology that serves us and fits in with human nature rather than nags us. What this looks like in practice is up to other people, but it’s a fascinating topic that we keep coming back to. Consider this an invitation to join us at the (now metaphorical) water cooler and give us your take.