The title of this post might seem odd for someone that will spend the next several years building tech for seniors at a Chicago-based primary care practice. However, to paraphrase Bill Clinton, “it depends on what your meaning of ‘for’ is.” I believe that independently putting technology in the hands of seniors will not meaningfully improve their care experience or their health. Instead, we need to build tech that compliments the human-driven experience rather than replaces it. Here’s why.
“Elderly” is Not a Market Segment
In the US, there are 60M people (15% of the population) that receive health insurance through Medicare. These individuals constitute $703B in healthcare spending each year, with people 85+ costing nearly 2x those in the 65-84 range, per capita. Per my post on Medicare spending (Medicare Isn’t Free), 25% of these 60M people make up 83% of the spending. Given the multitude of health issues faced by these individuals, there is a ton of opportunity to improve how they receive care.
However, it is wrong to treat everyone in this age range identically. In fact, they are even more diverse than the general population. Particularly on the dimensions of education and income status, the elderly population varies significantly.
The solutions driving better care for a high school dropout below the poverty limit should be completely different from those supporting college educated individuals with large retirement savings. Communication, technology access, and care preferences all differ between these segments.
Seniors Have Different Preferences and Goals
When building technology to support this demographic, it is also important that we consider differences in their care preferences from the younger population. Although 88% of seniors have a primary care physician, the majority of their costs (33%) come from utilization of high cost hospital services. Additionally, these individuals demonstrate a high loyalty to their physicians, a low willingness to travel, prefer weekends for appointments, and are typically skeptical of technology. Keeping patients out of the hospital while also considering their preferences should be a primary goal.
Secondly, better senior health cannot be measured by the same metrics we use for other individuals. Their objectives are less concrete, but just as important. Being able to see well enough to read a book or stand long enough walk down the aisle at their daughter’s graduation are not easily quantifiable metrics, but they are how physicians should think about the care they provide. As such, technology needs to be deployed in accordance with these goals rather than proliferated to solve every single health issue faced by this population.
Health Problems Coupled with Low Tech Access
92% (!!) of seniors have at least 1 chronic condition, with 77% having at least two. Moreover, cognitive decline, mental health issues, physical injury, malnutrition, audio/visual impairment, incontinence, and STDs (yes, this is true) all disproportionately impact the elderly. Think about all of the targeted technology applications that exist in the market today. Do you really think giving an individual access to 10 different health apps to manage their varied conditions will be successful?
Even if seniors were confident using technology (though only 26% say they are), the access gap in this segment is worse than the Medicaid population. Only 42% own a smartphone (17% over age 80), and only 67% say they go online (44% over age 80). When they do own this technology, the majority still need guidance performing even the most intuitive of tasks, let alone troubleshooting issues when they arise. This is not a knock on the elderly, it is merely a result of the era in which they were introduced to tech. It is important to note that these statistics are rapidly improving, but tech alone will not solve the challenges faced by those in this segment today.
The Right Technology Is Out There
There is no doubt that tech can play a major role in supporting the senior population. It can help them stay at home longer, maintain their independence, stay in touch with their providers, and provide families with peace of mind. For product managers and engineers, we need to do better at building the right tools for this population. This means ease of use, n=1 customization, simple instructions, and training support are a must - along with decreasing the stigma around using assistive devices.
Ultimately, I believe it comes down to building technology that engages seniors while also adequately supporting their care teams in the delivery of treatment. As such, the following use cases should be in focus:
Population Health: Pop health tools can provide caregivers with the right information to engage seniors prior to exacerbations. Putting this information in the hands of elderly patients is not as effective as delivering it to trained professionals at the right time. While this is likely true of other populations, it becomes more important when your patients suffer the health challenges prevalent in the elderly.
Home-Based Care: Fall detection sensors, telemedicine (with - you know - a phone), and messaging applications can help seniors maintain their independence for longer. Spending time in the hospital is risky for anyone, but especially the immuno-compromised. These solutions will also reduce the amount of arduous travel needed for patients to see their doctors. Unfortunately, reimbursement methodologies have not quite caught up with this concept and physicians have not been adequately compensated to incentivize its use. With the continued growth of managed care programs (i.e.., Medicare Advantage), I expect this market to continue to grow rapidly.
Self-Driven Care: Okay, I know I said that putting tech in the hands of seniors isn’t the solution. However, there are a few very specific use cases where these can be helpful. Namely, visual / hearing impaired support and medication management. Given the number of seniors impacted by these challenges, we should focus senior tech on solving these problems adequately.
Community Support: Loneliness and depression are massive challenges in this population. Computers are exceptionally good at keeping us in the loop with our deep networks of friends. While this has become a bit of an epidemic for younger individuals, seniors can benefit from connecting with their communities via technology. However, we also need to provide in-person community centers that facilitate face to face interaction in order to combat the access issues mentioned previously
Ultimately, behavior modification is so much harder in the elderly population. There are way too many behaviors that physicians would like to change, and we could not possibly deploy the personalized tech needed to address all of them. Instead, by providing care teams with the data and tools to better engage the unwell while also deploying a few targeted solutions directly to seniors, I believe we can meaningfully impact both the health and the treatment costs of our elderly. They are the reason we are all standing here today, and we need to design better solutions so they can live meaningful, fulfilling lives far into the future.