As the world’s population gets older, how are we going to manage? Innovative approaches are being developed at the MIT Age Lab
James
Crabtree climbs into the Agnes ageing suit, designed to mimic the
physical restrictions of old age. A plastic inner harness and elastic
bands attached to the feet and hands imitate the movement limitations
created by spinal problems, while foam wrist, knee and neck pads
simulate the symptoms of arthritis. First constructed in 2005 by a team
of MIT researchers with backgrounds in psychology, ergonomics and
exercise physiology, the suit has been used by companies as diverse as
Siemens, Daimler and General Mills. The latter experimented with it to
understand, for instance, the difficulties elderly consumers face when
opening cereal boxes
It
was only after a couple of hours in the suit that it hit me. I was
exhausted. Putting it on hadn’t been that hard, although, standing in a
windowless classroom in Massachusetts Institute of Technology’s
AgeLab,
I did need help from a researcher to hand over the components. First
came the industrial blue overalls. Then the stiff foam knee and elbow
restraints, bulked-up versions of those white tubes you wear to recover
from a sprained ankle or wrist. Then a series of elastic straps and
wires, designed to make it difficult to stretch up, or bend down.
Hard hat with elastic straps to reduce head movement and stretching ability
The
hat looked like nothing special – the generic sort worn on building
sites – until more straps were attached, dragging my head down and
lending a distinctly elderly arch to my back. Then there were the shoes,
softened with special spongy soles that made stepping down stairs
alarming. I began to walk carefully, fearing a fall. Basic tasks became
difficult. Reaching high objects was a struggle, as was a simple chore
such as sweeping the floor. The suit’s goggles turned my vision yellow,
while the double-layered plastic gloves meant the touchscreen on my
phone no longer worked.
Yet
it was the cumulative effect that took its toll. As I was shown round
by Joseph Coughlin, the AgeLab’s amiable 50-year-old founder, I felt
more and more worn out. The researchers call the outfit Agnes, or Age
Gain Now Empathy System, and see it as a carefully designed tool to help
businesses adapt their products for elderly consumers. But, after an
afternoon inside one, I didn’t feel especially empathetic. I felt beat.
I had come to Boston to meet Coughlin on a rainy June morning, to
learn about innovative approaches to the problems of an ageing society,
and, in particular, to discuss how people could avoid moving into
retirement homes in old age. Probably America’s most prominent ageing
expert, Coughlin is a fixture on the conference circuit, and a doyen of
White House advisory committees. His enthusiasm for the subject is
infectious: he seems almost to bounce as he talks, his silver and salmon
bow-tie bobbing up and down. The garment is something of a trademark:
on his office wall, five further examples are mounted and framed in a
glass box, a gift from one of the lab’s many corporate partners.
Joseph Coughlin, founder of MIT’s AgeLab
As
we walk, Coughlin points out other age-related gadgets: a set of
two-way monitors allowing distant children to check in remotely on
elderly parents; a sensor-enabled “smart trash can” to measure how much
food is being eaten; and, most charmingly, a furry white robot seal,
designed to provide stimulation for a dementia sufferer.
Yet Coughlin balks at the idea that technology alone can solve the
many problems thrown up by an ageing population. Instead, he argues that
every social and economic institution – from transport and housing to
education and commerce – must be reinvented, especially if many millions
more are to avoid the indignity and expense of a final trip to a
nursing home. “We need a vision that says ageing is not just about the
frail. Ageing is about all of us, and how we keep people productive for
as long as possible,” Coughlin tells me. “What we’re left with is a
crisis, where we’re using yesterday’s social and policy models to
address today’s new ageing population. It is a fundamental disconnect.”
The disconnect Coughlin describes isn’t difficult to understand. We
are living longer. Much longer. And picking up the tab is going to be
expensive.
Paro
the seal. Paro is an animatronic ‘therapeutic’ robot baby seal,
designed to comfort elderly patients suffering from dementia. Paro
responds to touch and sound, waking up and getting sleepy depending on
the frequency with which a user interacts with him. Although born in a
lab, Paro is now commercially available, with many thousands of units
sold in Japan since it was first put on the market in 2003
The
first American baby boomer reached retirement this year. For the next
19 years roughly 10,000 more will retire daily, doubling the population
over 65m to 72m, or one in five Americans, by 2030. The same is
happening in Britain, where the elderly population has now outgrown the
young. And it is the very oldest demographic that is growing most
rapidly: the
Office for National Statistics
says the number of over-85s will more than double by 2035, to 3.6m. But
that’s nothing: by then there will have been a seven-fold increase in
centenarians too.
This so-called “silver tsunami” stems from a seemingly unstoppable
increase in longevity, driven in part by improvements in medical
technology. American demographer James Vaupel has shown that human life
expectancy in most advanced nations has increased in a linear pattern,
rising by about three months a year for the past 170 years. Some experts
think this trend will flatten out, but as yet it shows no signs of
doing so. A 2010 study in
The Lancet predicted that, assuming it keeps going, half of the babies born since 2000 will live to see their 100th birthday.
As a result, pension systems designed for a decade-and-a-half of
retirement now face being stretched over three decades instead. Social
care systems are also in crisis, as the scandal over
Britain’s bankrupt private care home provider Southern Cross all
too readily demonstrated. And the problem is going to get worse: one in
10 of those in their late sixties requires some form of daily personal
help, but the number rises to around half of those over 85.
Spongy-soled shoes affect mobility and balance
Yet
nursing homes are expensive, with annual costs in the US ranging from
$78,000 for the average nursing home to $194,000 for full-time
home-based care – a bill only a tiny fraction of Americans can hope to
afford. The British government’s recent
Dilnot review
of social care proposed a £35,000 cap on the fees that any individual,
or their family, would have to pay. Yet this still leaves a funding gap –
likely to grow to around £6bn a year by 2026. And all of this at a time
when government budgets across the western world are being cut.
The debate about how to fund long-term care hides another issue. No
matter how wisely the current system is reformed, this remains a system
no one actually wants to use. Indeed, as a 2005 study from the
American Association of Retired Persons
(AARP) points out, around nine in 10 of those shortly to retire express
a strong preference to stay in their existing homes during their
retirement.
Back in his office, Coughlin is clear that current care models no
longer work. “The senior living industry, from independent living on a
campus to nursing homes, at the very best is under question, if not
under siege,” he says. “Retirement in the future is not going to be
about moving to the beach or to the golf course, even if you can afford
it. Ageing well is about living in an environment that has the intensity
and the density of activities that keep you engaged and healthy.”
A harness sits around the waist and legs
In part to help realise this vision, Coughlin persuaded
MIT
to allow him to set up his lab back in 1999. He was frustrated by
traditional academic approaches, which treated ageing largely as a
medical problem. There were experiments to coax mice or worms into
living longer, and money to help cure diseases. But the result was what
he calls the longevity paradox: “We spend billions of dollars trying to
live longer, but no one puts any thought or any investment into how to
live longer, better.”
Tools like Agnes proved especially useful in exploring one sector
that Coughlin sees as critical to the future: transport. Here, as in
other areas, technology is part of the answer – cars augmented with
clever information systems can make drivers more aware of hazards and
obstacles, and so on. MIT’s AgeLab even includes a driving simulator
housed in a full-size cherry-red Volkswagen Beetle, with sensors to
monitor driver eye movements and pulse rates.
Yet the wider issue of driving is one technology can’t solve. Seven
in 10 Americans live in rural or suburban locations. For many, public
transport isn’t an option. Most will eventually get too old to drive.
Coughlin puts it like this: “Even if I keep you healthy and bring meals
to your house, if you don’t have transportation you have the same
accommodation as a prison.” Without new ways to travel, the options many
elderly people face are grim. But that isn’t the only problem.
Elastic straps to reduce mobility
The
tragic consequences of a generation of elderly drivers unwilling or
unable to give up their car keys were brought home to Katherine Freund
more than 20 years ago. Her three-year-old son Ryan was knocked down by a
car driven by an 84-year-old man, in front of their suburban home in
Maine. The driver suffered from dementia. Ryan ultimately recovered, but
at the time he suffered severe injuries and fell into a coma. “My
little boy was run over by an apparently nice old man, who thought he
had hit a dog,” Freund tells me. “So I began to think about how in the
world that happened, and how I [could] make sure that it never happens
again to another little boy, and another nice old man.”
Having heard about her two-decade-long campaign, I drove up from
Boston to visit Freund’s office, housed in a converted mill a few miles
outside Portland. The city is the largest in Maine, which also happens
to be America’s most aged state – making it a test-bed for ageing and
innovation. Freund is small, carefully dressed, and has a quiet, intense
voice. As we talk, sitting around her boardroom table, she pulls out a
chunky ball of blue wool and begins to knit.
For a number of years after her son’s accident, she tells me, she
turned the problem over in her head. Most elderly people have no
alternative to cars. Public transport is limited. Taxis are expensive,
or unsuitable. There are few rules to stop you driving. Faced with a
choice between giving up either their cars or their freedom, most
elderly people drive for longer than they should. And, as a consequence,
older drivers have the highest accident rates of any group apart from
teenagers.
A folded Agnes ageing suit
Freund’s solution was
ITNAmerica,
an innovative not-for-profit organisation that brings together
volunteers, vehicles and clever computer software to provide around
50,000 subsidised car rides a year to elderly people across the US. The
organisation is, in effect, a cheap, community-run taxi service staffed
by a mix of paid and volunteer drivers. Launched in Portland in 1995, it
charges an annual $40 individual membership fee and an average of $9 a
trip, much less than a regular taxi. Partially supported by charitable
grants, the service has now expanded to more than 20 cities across
America.
The organisation’s HQ seems low-tech, right down to the room for a
taxi-style dispatcher. But behind the operation lies a clever software
package that the organisation had to build from scratch, using complex
algorithms to match riders and volunteers. ITN’s other bit of ingenuity
comes from its use of credits. Volunteer drivers build them up – most
are over 60 themselves – and can then cash them in when they choose to
stop driving. A volunteer in Los Angeles, meanwhile, could build up
credits to donate to an elderly parent on the other side of the country.
Freund has also struck deals with local supermarkets, so both ITN and
its users get rewarded if they take a trip to the shops.
At ITN’s headquarters I meet Sandra [not her real name], a regular
user in her late eighties. She has neat white hair and is dressed in a
green cagoule. Speaking clearly but slowly, she tells me she suffers
from a degenerative joint disease, which made it difficult to turn her
head while driving. She had all but given up on her car, relying on ITN
instead. Recently, she sold her car to the organisation, too, earning
extra ride credits in return: “My insurance was due in April, my
automobile registration in June, and a new driver’s licence in August. I
thought: this is ridiculous!”
Miss
Daisy. Housed in a cherry-red Volkswagen Beetle, Miss Daisy is a
driving simulator designed to test the effects of cognitive distraction
and medication use on older drivers. The car now sits permanently within
the AgeLab, having been winched into the building via a modified
elevator shaft
Sandra’s decision to sell is just one more small victory for Freund.
Attitudes are also changing, she says. When she first suggested unsafe
elderly drivers ought to be banned she received hate mail, mostly from
elderly drivers themselves. Now she thinks more people recognise the
problem. ITN still has to find a way to be self-funding, but, having
added an affiliate in a new city roughly every year since she began, her
ambitions have grown: “We aim to do for transport for older people what
Ebay did for flea markets,” she tells me.
It is a tall order. ITN will have to grow well beyond its current
50,000 annual rides to meet the demand from the roughly 14m Americans
Freund says will need alternative means of transportation by 2030.
Still, back at MIT, Joe Coughlin is optimistic: “ITN is easily the most
innovative transport project I have seen in 20 years. I think that
Katherine is on a footing to do for alternative transportation for the
elderly what Ralph Nader did for auto-safety.”
. . .
Just getting around, however, isn’t enough to ensure a contented old
age. In Boston I meet another woman who began to worry about the wider
difficulties around a decade ago. Susan McWhinney-Morse had lived in
downtown Boston’s elegant Beacon Hill neighbourhood since the mid-1960s.
She had counted Senators John Kerry and Ted Kennedy as neighbours, and
raised four children. But as retirement loomed, she, along with a group
of about a dozen local friends, began to fret about their options.
Residents of Beacon Hill Village
Lively though it was, Beacon Hill was not especially well designed
for the elderly. Help from the government was limited to the poor or
disabled. Visits to nearby assisted-living facilities and nursing homes
convinced her such places were dull, isolating and expensive. “This was a
group who weren’t going to go out to the ‘burbs, to a warehouse, to be
warehoused for the rest of their lives. No way,” she tells me. “I
thought, this is where I come from ... I’m simply not going to go.”
Two years later, in February 2002, she launched
Beacon Hill Village,
a charity designed to support the elderly population in the area. Like
ITNAmerica, help with transport was a big part of the plan. But the
group added discounts at local stores and medical facilities, and a
programme of social activities, ranging from political discussion groups
to trips out of town. A range of volunteers and paid professionals were
available too, to help with everything from odd jobs to more formal
care services.
More unusually, the organisation provided a concierge-style phone
line, which members could call for advice on pretty much anything they
wanted, whether it was a medical issue or finding a local handyman. Some
used the service for more unusual purposes: one inherited an antique
lamp shade and rang up asking how to get it repaired; another wanted a
trip to a local horse race track to pick up her winnings.
Smart
trash can. Part of the AgeLab’s 'E-Home project' to redesign living
arrangements for older people, the smart trash can uses radio frequency
identification (RFID) antennas to tag objects in a kitchen. This allows
the bin to sense when items have been used or thrown out – letting
distant family members or caregivers look out for unusual eating
behaviours
The idea caught on: around 400 local residents
have now signed up, each paying $640 for individual annual membership.
The concept attracted wider attention too, especially after an article
about the organisation appeared in a magazine sent out to 30 million
members of the AARP. A range of imitators began to spring up, and now
similar villages exist in 64 communities across the US.
Sitting around a table at the organisation’s Beacon Hill office,
McWhinney-Morse explains her vision for this “village movement” in
grand, historical terms. “We were the generation that, after the second
world war, got into our cars and drove to college and never came back,”
she says. “I can remember going to a department store with my
grandmother, and before we got back home the goods were delivered. That
world died with the war. And what that world did was help to support
older people in their own homes.” It is these networks of support that
must now be rebuilt.
Implicit in the movement is a further rejection of the idea of moving
away from home to retire. McWhinney-Morse mentions Del Webb, the
American developer who built Sun City, the famous retirement community
in Arizona. “His model was: come to retire, come to Arizona, come play
golf. But don’t die here, because we have no facilities.” However, she
also admits to doubts about how replicable the Beacon Hill model can
become. It was never designed, she tells me, entirely to replace a
nursing home or long-term professional care.
But back up in Maine, I met one couple who claim to have found just
that answer – a new, inexpensive means of caring for elderly people who
otherwise would need to go into a home.
. . .
Jim Maxmin and Shoshana Zuboff make unlikely saviours for the social
care industry. An American, Maxmin spent much of his life as a
businessman in Britain. He became chief executive of Volvo UK at the age
of 34, and went on to lead both Thorn Home Electronics and later Laura
Ashley – often shuttling back and forth across the Atlantic on weekends.
Zuboff, a noted thinker on the impact of new technologies in the
workplace, was one of the first women to join the faculty at Harvard
Business School and was awarded tenure and an endowed Chair at an early
age.
Jim Maxmin and Shoshana Zuboff are the founders of Elder Power
Maxmin and Zubboff’s genuinely is a marriage of ideas, given they are best known for co-authoring
The Support Economy
, a popular management book published in 2004. In it they argue that
the frustrations consumers feel, especially when they are put on hold
on the telephone, or otherwise badly treated, can only be overcome
through an entirely new model of “distributed capitalism” with new
systems of “deep support” for customers at its heart.
These ideas provide the background for the duo’s thinking on ageing,
but the spark came from unusual coincidences beginning with their
decision to move to the country. Keen to raise a family, they bought a
disused dairy farm in the picturesque seaside town of Damariscotta,
about three hours’ drive north of Boston in rural Maine. Their first son
was born, and they began to get involved in the local community, giving
presentations about their work.
They also met a local doctor, Alan Teel, who had started a business
using webcams to monitor elderly patients who wanted to remain in their
homes. After years of struggle he was unable to cover his costs. Around
the same time a budget crisis saw the state of Maine cut the support it
provided to Damariscotta’s private residential care home, threatening it
with bankruptcy.
Both got Maxmin thinking. His experience at Thorn Home Electronics,
which included Radio Rentals, taught him that if you can accelerate the
depreciation of a piece of technology, such as a webcam, you can then
give it away to a person who would otherwise not be able to afford it.
Overheads could be lowered further if local people could be persuaded to
volunteer as receptionists or bookkeepers, or simply to check in on
elderly people at home. The care home’s building could also be an asset:
its rooms could host other medical services, while its kitchen could be
used to cook food for non-residents.
Maxmin spent long evenings poring over spreadsheets, puzzling over
how to make the numbers add up. Eventually he hit upon a combination
that seemed to work, and
Elder Power,
as the new organisation came to be called, was launched in 2008. It
offers different packages of care, ranging from $100 to $600 a month,
for which customers receive a mixture of visits and daily phone calls,
along with cameras and motion sensors to monitor their wellbeing. More
personal support – including transportation, help with meals and bathing
– is provided too, although some of it costs extra.
Publicity came gradually, first by word of mouth then through
presentations at local churches and community groups. A handful of
elderly people joined, then a few dozen more, with the group eventually
growing to more than 100. Much like Beacon Hill Village, the project
aimed to use local facilities. But unlike Beacon Hill, Maxmin and
Zuboff’s business takes all comers, often providing intensive support to
those with severe conditions, including Alzheimer’s.
The
prototype AwareCar, a souped-up dark red Lincoln MKS, uses on-board
eye-tracking cameras to measure the effects of fatigue and distraction
on driving ability, while sensors measure heart and breathing rates. The
car has helped researchers understand what type of information helps to
focus, or distract, elderly drivers on the road
More importantly, Maxmin says, his model worked, providing almost all
of the services associated with a nursing home, at a tiny fraction of
the cost. Zuboff wrote up the experience as a case study in a recent
issue of the management journal McKinsey Quarterly. Her figures showed
that while the average monthly cost for nursing-home care in Maine
remains at around $7,000 – rising to $24,000 for 24-hour home care –
Elder Power allowed its members to stay in their homes for an average
cost of $702 a month.
Maxmin admits there are no miraculous solutions to the problems of a
fast-ageing society. We will all have to work longer, save more and pay
more in tax to cover the costs of a world with a greyer population. Even
so, he thinks models like Elder Power can have a much wider
application. Perhaps moments like the collapse of Southern Cross, he
tells me, could (in the right hands) become moments of opportunity. More
generally, models like Beacon Hill Village, ITNAmerica and Elder Power
show glimpses of a future in which more elderly people can stay in their
homes for longer. All three use innovative technology, make use of
assets in their local community and bring together the resources of
local businesses, volunteers and the state to solve problems none could
have solved individually, at reasonable cost.
Back at MIT, Joe Coughlin also refuses to be downbeat. “I would argue
that longevity is probably the greatest achievement of human kind that
has gone ignored. If you talked to anyone and said, ‘congratulations,
you’re going live 30 to 40 years longer than your grandparents did in
the 1900s’, that would be seen as a bonus prize.” With a bit of
ingenuity, it’s a prize worth taking.
