Note from the Editors: The following is the fifth in a series of guest articles by experts from across the broadband ecosystem. Eric Dishman, Manager, Proactive Health Research at Intel, has been leading innovative field research and driving collaboration with other stakeholders to focus on information technologies that can help everyday people be more proactive about their health and that of their loved ones.
Eric is the Chair of the Center for Aging Services Technologies, a cross-industry R&D partnership sponsored by the American Association of Homes and Services for the Aging. He was previously at Interval Research. Eric has a Master of Science from Southern Illinois University, and is a Ph.D. candidate at the University of Utah.
Also see the unabridged version of this article including the full text, footnotes and acknowledgements.
Revolutionary Needs for Broadband
“I hate to tell you this, but we really don’t need another technology to help us watch more television. What we really need is something to help us look in on my mother-in-law who lives alone in upstate New York. She has early stage Alzheimer’s, and the closest person who can help her is Tom’s sister who lives five hours away. Surely we’re not the only ones needing help helping our parents!”
In 1999, “Sheila” was part of a digital entertainment study of early broadband adopters done by Intel’s social science team, People and Practices Research. We were using concept prototypes to help the participants imagine future technologies. As we completed showcasing a wireless digital music jukebox, a portable movie player, and a PVR with remote audio chat, Sheila, who had given up her career to care for her ailing mother, held forth. And almost every participant chimed in with their personal health-related story.
In the sleepless nights that followed, I began reviewing my ten years of interviews with more than a thousand American and European households. Stories of health, wellness, and caregiving needs emerged from almost every discussion, even though we had never set out to study such topics. Women, who tend to be the primary caregivers, were the most vocal. They yearned for systems to help with security & health monitoring, maintaining independence, and fostering social & intellectual engagement for their aging parents. They saw a different purpose—and future—for the broadband home.
A Worldwide Caregiving Crisis
Sheila is not the only person who needs help helping her parents. Older people already comprise one fifth of the total population of much of Western Europe and Japan, and many countries will at least double their elderly populations by the middle of the century. Modern technologies have extended human life-spans into the 80s and 90s, and most countries will soon face an enormous and disruptive caregiving crisis.
About 35 million people—one out of every eight—in the United States is over the age of 65 and by 2030 the number will double, to 20% of the U.S. population. The 76 million American “baby boomers” waiting in the retirement wings already face the double challenge of caring for their parents and their own emerging health problems.
Home is Where the Health Is
The worldwide age wave presents technology companies with both huge business challenges and new market opportunities. Companies face decreases in worker productivity and enormous increases in the cost of employee health insurance. The $1.4 trillion annual U.S healthcare budget is likely to skyrocket as the boomers move into retirement. The good news, especially for broadband and home networking companies, is that home care offers the best hope for the healthcare crisis.
The next generation of elders will demand technologies to help keep them fit, functioning, and having fun from wherever they choose to live. At the same time, healthcare payers and providers have no choice but to look for ways to prevent disease, detect illnesses early, drive consumer adherence to care plans and therapies, and support informal caregiving. An always-on, high-speed, safe-and-secure network is a prerequisite for almost any home health intervention/invention.
Proactive Health at Intel
Given the needs of Sheila and the millions like her, Intel Research funded a strategic research program called Proactive Health. Our mission is to catalyze a research ecosystem around information technologies that can help people be more proactive about their health. Our focus is on future elders—that disruptive demography of “baby boomers”—who are dealing particularly with cognitive decline, cancer, and cardiovascular disease. These three conditions account for more than half a trillion dollars of the annual U.S. healthcare budget.
Given the significance of Alzheimer’s, a disease costing U.S. businesses more than $61 billion in 2002, we began our studies by examining cognitive decline. Using methods borrowed from anthropological and other social sciences, we observed and interviewed fifty U.S. households with conditions ranging from “normal” memory decline to extreme cases of advanced Alzheimer’s. We sought to understand what needs, problems, and aspirations our home health inventions should address. Using those findings, we have prototyped numerous “smart home” systems to help address the needs we saw. We are refining these systems for trials in early 2004, moving from the lab back to the lives of real elders with mild cognitive impairment (MCI) and their informal caregivers.
Prototyping a Smarter “Smart Home”
The lives of “Betty” and “Jim,” participants in our field studies, show the need for a home health assistance network that can intelligently adapt to the day-to-day variability of Betty’s decline as well as to Jim’s increasing needs as her primary caregiver. Betty was forced to retire early since, like most with moderate stage dementia, she now forgets how to do everyday tasks, such as getting dressed or making a cup of tea. Jim still works full time but it is all he can do to help her remember to eat, drink, and take her medications. He is quick to point out “that a good day for Betty is when she is able to make tea for herself—this disease has completely changed our priorities.”
Inspired by the story of Betty and Jim, we built a prototype system in our lab to prompt and assist someone to fix a cup of tea and to monitor her or his progress of that activity over time. Using “mote” technology—-a small plug-and-play processor and wireless transmitter from our Intel Research Berkeley lab—-we have plugged in five kinds of sensors: 1) motion sensors for activity detection; 2) pressure sensors in chairs to know whether someone is sitting; 3) switches to know when drawers, cabinets, or objects in the kitchen have been moved; 4) RFID antennas situated between the family room and the kitchen to identify small tags placed in peoples’ shoes; and 5) an IR-tracking camera that detects whether a badge-wearing “patient” has fallen. All the real-time data travels through the motes’ wireless network back into a host PC for processing, prioritization, and communication.
To help address the problem of dehydration—at this stage of the illness people often forget to drink enough—our system infers that no one has been in the kitchen or opened the cabinets where the mugs are kept. If it reaches a certain threshold of concern, the assistant software locates and prompts her first with a commercial for tea and then with an explicit textual prompt on a nearby television. Patients may get distracted as they move towards the kitchen, so we use classic “smart home” technologies like X-10 control of the lights and other sound sources such as the stereo to try to keep them on task and offer instructions via nearby TVs or other consumer devices.
Our current prototype is primitive in its inference and assistance abilities. Nonetheless, our ultimate goals for the system are not only to successfully help people like Betty with kitchen activities, but also to longitudinally track how much help was needed, how often, and which steps were most difficult for the user so that we might detect further cognitive decline.
Unfortunately, Betty’s condition is likely to worsen to the point that she may need full-time caregiving from Jim. The home health network then needs to assist Jim in this task. We observed many advanced Alzheimer’s patients sitting most of their daylight hours in the same chair, but the caregivers’ fears of their loved one falling demanded constant vigil and co-presence. Systems such as the chair sensor and fall detector help caregivers monitor the safety of their loved one, thus freeing them to work or rest in other parts of the house. Our current prototype system alerts Jim that “Betty has gotten up” on whatever home device is closest to him, followed by a more urgent alert of “Betty may have fallen” if the system senses from the infrared cameras that she is at floor level.
These prototypes are very preliminary, and the systems engineering challenges to make these technologies work for real elders are enormous. Nonetheless, as digital convergence and the wireless revolution continue to make new home functionalities possible, these systems become much more plausible. As we aim for real home trials, the key technical capabilities we are working towards include:
Conclusion: Evidenced-Based Collaborative Research
Just as pharmaceutical companies develop new drug therapies using an “evidenced-based” approach, home health and wellness technologies must prove their worth in cost savings, disease reduction, or improved quality of care through carefully designed technology trials. We cannot achieve these goals on a large enough scale or quickly enough to meet the needs of the worldwide age wave without the cooperation and collaboration from many sectors. We need large-scale “collaboratories” to:
Over the past year, Intel has worked with the American Association of Homes and Services for the Aging to launch one such initiative called “Center for Aging Services Technology” or CAST. It is a volunteer-driven collaboration amongst people in technology companies, university labs, government agencies, and elder care providers across the United States to spark more research and development of technologies that will support the health and wellness needs of the imminent age wave.
Technology companies need to understand that there is much more to life than “efficiency” and “entertainment,” which monopolizes most of our industry’s imagination and investment dollars today. In a recent interview in Fortune, Andy Grove warned: “We’re going to have a schism. Keep in mind, revolutions have been waged over taxation and over dividing the economic pie. But this is life and death—some people will get access to this ‘health-care mainframe,’ and everybody else dies”.
The caregiving crisis presents us with both enormous opportunities and obstacles as our planet ages. If companies as well as people are to remain healthy in the midst of these demographic disruptions, then we would all do well to have the healthcare epiphany, to answer Sheila’s call for “help helping our aging parents,” and to notice the caregiving needs that are inexorably and inevitably becoming part of our own everyday lives.
[Eric Dishman: Many of the concepts in this essay come from work done with my Intel colleagues Jay Lundell, Margaret Morris, and Brad Needham. Also, much thanks goes to Ashley Armstrong for her excellent editorial input.]
For the full text, more pictures, footnotes and acknowledgements, see the unabridged version of this article.