Old age and new technology -- a combination of words that stimulates the imagination with visions of great promise and potential to improve the quality of life of everyone in advanced age. My MIT AgeLab colleague Luke Yoquinto and I published a somewhat disturbing scenario in Slate about everything that could go wrong in tomorrow's increasingly interconnected smart home -- especially when the single occupant of that home is older, frail and relies on the devices to keep chronic health conditions in check. We argued that a significant number of older adults who might today rely on home-health aides or institutional settings would, within five years, live alone while managing their health and household with such innovations as smart toilets that provide a daily checkup, wearable blood pressure/glucose meters and automated medication and grocery delivery services. We then showed how the interconnected nature of those devices could make older adults vulnerable: When the Internet of Things is only as strong as its weakest link and you're using it to keep chronic health conditions in check, a failure can come from any direction, with catastrophic results.
The vision of the future we put forward is admittedly Jetsons-esque, with smart algorithms taking over the household role of Rosie the Robot: ordering groceries, suggesting meals, and even diagnosing medical conditions. As a result, if the article's comment section is any indication, some readers rejected the premise: There's no way I'm going to be hooked up to all those doodads and devices. It's too weird, and if nothing else, it's too much of an invasion of privacy.
First, I don't think that people realize how appealing it will be for many to hand over privacy to the faceless Internet of Things as opposed to the very tangible human beings involved in nursing homes or home-health care. After all, how many of us own credit cards? Those credit companies have a record of every purchase we make, and yet we gladly sacrifice privacy for the sake of convenience. I think it's safe to say people will line up to forfeit privacy to businesses as opposed to people they know intimately -- especially if those corporations provide useful services.
What's more, we need to recognize that as society gets older in the U.S. and elsewhere, Internet-of-Things solutions for older adults may be more economical than human help -- both for the adults in question and their families, but more importantly, for insurers and government payers such as Medicare. Simply put, if a technology is cheaper than human help and gets the job done, insurers are likely to prioritize it placing it at the top of their preferred reimbursed provider list. At the same time, as changes to Medicare take hold, instituting value-based payments to hospitals and doctors for health results as opposed to the old fee-for-service model, there's going to be a major profit incentive for the healthcare industry to push technological innovations that keep people from, say, returning to the hospital soon after discharge. Moreover, while high-tech is only second to high-quality human touch, the coming shortage of care providers, from nurses to geriatricians, makes technology-enabled care not only affordable, but perhaps the only viable option for many.
The Jetsons-esque future of old age is likely to be cheaper and, for many, preferable to the lower-tech alternative, and therefore a more likely scenario than many assume. As we move closer to such a reality, the key to making sure it's a world worth living in will be not to fight against technology, but rather to work to promote tech development that keeps security in mind and prioritizes the human user (both older adults and medical professionals) over pure thrift. A high-tech old age doesn't have to be dystopian -- but it will require constant vigilance on the part of system developers, researchers, journalists, policymakers and industry to make sure that the creep of technology into old age makes life not just longer and cheaper, but better and with a little dignity too.
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