February 05, 2019| By Jean-Marc Fix, FSA, MAAA, Life/Health Research and Development
Actuary, Stamford
In order to anticipate the future, it
is important to know the past and how we arrived at today. But Yogi Berra would
surely approve when I say that most important of all is to also know the
future. It is true that I, no more than you, can’t precisely predict the
future, but we can learn a great deal through careful observation, as the seeds
of what is to come in 20 to 40 years are likely here today.
Of one thing we can be sure, technology
will have a big impact on our future lives. Let’s look at the impact technology
has now on aging and mortality. We can categorize technology in three
concentric circles:
·
The
biggest outer circle is technology that impacts us all.
·
The
middle circle is technology designed to care for the elderly through access to
quality healthcare and to support both the elderly and their families.
·
The
circle in the center is technology that allows the elderly to maximize their
contributions to society.
We also know that access to care,
access to a social network, aging outside of a health facility environment and
resilience have measurable impact on the elderly’s survival.
So, with this framework in mind, let’s
review recent technological developments - the more obvious being in Health
Information Technology. A study by the New England Healthcare Institute showed
remote patient monitoring reduced hospital readmission for heart failure1
by 60% over traditional care, helping the elderly stay balanced in the
ever-narrowing optimal health zone. This monitoring doesn’t need to be done by
a specialized medical apparatus but could be done by a smart home2
or even by service animals.3 Separately, the potential benefits of
Electronic Health records (EHR) apply to everyone but may play a more
significant role for people with more complicated health histories, like the
elderly. Continuity of follow-up care is a challenge with the elderly, as
treatment from different medical specialists may not always be well
coordinated.
Falls are often the precursor of a
series of unfortunate events for the elderly and are the significant cause of
death in people age 65+.4 Part of the aggravating consequence of a
fall is what is called the “long lay” where the injured party is not found for
hours, or even days. Automatic monitoring by a smart home or a video-monitor
(similar to an alarm or baby monitor), can make this a thing of the past. There
are also tools available for personalized remote monitoring.5
For older patients in need of physical
help to ensure a more nutritious diet, there are several technology-based
solutions, including better-designed appliances and app-based home delivery
services. Along with monitoring, this can delay the start of nursing care and
the mortality burden associated with it, not to mention the psychological
trauma for everyone involved.
There is also room for more
forward-looking technologies – physical enhancements (think exoskeleton),
robots (or should we just call them mobile appliances), and self-driving cars.
We know that losing one’s license is very often the first step toward a nursing
home or an assisted living facility.6 To the extent we can quantify
the impact on delaying entry to a nursing home, we can quantify the mortality
impact. Similarly, we can estimate the impact of reduced falls or reduced motor
vehicle accidents.
There are also considerable obstacles
regarding finances as well as access to healthcare. The traditional benefit
pension plan is on the decline. How will Social Security adapt? The future
elderly, who may have been part of the gig economy and dropped in and out of
traditional employment, will need new tools and new messages that financial
security providers, still need to develop. Unfortunately, in this increasing
technological workplace, a mindset that promotes ageism, instead of assessing
each person on what they can actually do, still exists.
There are also significant unknowns.
The gig economy has the potential to monetize assets that the aging population
may have gathered that are not helping them currently.7 How many
will be able to utilize those opportunities, and what vulnerabilities will that
create, are not yet well understood.
The best technology can only provide
benefits if it is used. Technological adoption decreases with age8
but, in my opinion is very cohort driven. What will be our comfort with technology
when we are 85? I like to believe that it will be significantly greater than
today's 85-year-old. Adoption is also very dependent on perceived value. Most
older people are not interested in technology for technology’s sake but are
quick to adopt it if they can see benefits for themselves. For instance, the
growing use of the internet due to the access it provides to health information
and community through social media networks. Framing technology by
understanding the needs and desires of the elderly will greatly increase
adoption.
Endnotes
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