The world is aging, largely thanks to improvements in life expectancy for those 60 or older. Societies worldwide have made great strides in lengthening life, but struggle to achieve widespread lifelong health. The diseases of aging take their toll on quality of life for older persons and the friends and family that care for them.
Prevention and early access to care are key to controlling costs associated with the diseases of aging. Both require the active participation of individual health consumers and a shift in mind-set that emphasizes lifelong wellness, not simply freedom from disease. Technological innovation, behavioral economics and increasing health consumerism will each contribute separately to this orientation, enabling people to reach their personal health goals.
Plug in, talk on, get out
Across industries, the empowered consumer is now recognized as a disruptive force. Savvy shoppers in developed markets are ready for on-demand services, transparent pricing and increased convenience, driving changes in how retail, banking and consumer products companies do business. Those same changes are coming to health, albeit more slowly.
As noted in How will we disrupt aging before aging disrupts economic growth? wellness is multidimensional, including physical, social and material components. A recent survey by EY supports this assessment: when asked to define their highest priorities as they age, adults 18 and older list a number of key parameters, demonstrating that physical health is just one aspect of overall wellness.
The second piece of our Engaged Aging series opined that new digital and genetic innovations will one day result in solutions aimed at catching diseases before it manifests. This integration of information and insights will be used to build a prevention mind-set into the way people think about, and engage with, health by deepening our understanding of health risks at a personal level.
While exciting, this ability to intercept disease is still temporally distant. In the more immediate term, there are several ways that existing or near-term technologies can contribute to lifelong, personally optimized health.
Already, medical devices and sensors exist that can monitor health status and gather the data that will fuel pre-disease intervention tomorrow. Such smart devices create positive feedback loops to nudge individuals with the right piece of information, cue or intervention at the exact right moment in time to maintain health.
These technologies serve a range of functions, but many of these devices are designed with active young people in mind, selling the idea that there is an athlete in all of us. Emphasis on optimal performance, on an individual level, is an underutilized approach to wellness in seniors.
Chronic disease management
While consumer-generated data will one day help generate a clearer picture of individualized risk for chronic disease, there are immediate opportunities for technology to improve the lives of those with chronic diseases.
Existing solutions such as electronic health records that provide clinical decision support and remote monitoring are bending the cost curve even as they increase access and high-touch care delivery. Similarly, solutions that improve health literacy provide just-in-time information tailored to the individual’s goals, communication style and the particular situation.
The lack of connection to other people, and to the wider world, has huge effects on health and mortality. Widely recognized as a problem for older adults, many organizations have focused supportive efforts on providing opportunities for greater social engagement even as they deliver other, much-needed services, such as meals or medications.
Telecom and insurance companies could both take a more central role in developing the adoption of new connection-focused technologies and services. Players in both industries have important knowledge about their customers and infrastructure that gives them direct access to the home.
New technologies have to be used in order to be successful. This means they have to have a user-centric design, a low learning requirement, immediately apparent benefits and the flexibility to address a variety of needs. Real scalability will be possible when the following criteria are met:
- Platforms pair these tools with other low-friction devices with low or no learning curve
- Data are collected passively
- Well-designed interfaces enable communication between stakeholders
Indeed, one major step forward would be the ability to integrate many devices into one user experience. Such integration will likely require a platform created in an open source setting.
Opportunities and pitfalls in consumer engagement
In order to accommodate the human variables — the variation in levels of commitment, engagement and incentive to have, use and purchase technology, among others — a number of factors must be taken into account to ensure positive engagement with consumers:
1. Understanding our decisions
While our decisions are rule-based, they aren’t always strictly rational. In behavioral economics, this is described as hyperbolic discounting — in practical terms, that means we are more likely to say ”yes” to the bakery than to the gym, or discount the health gains of smoking cessation if we are a smoker.
We seek to protect ourselves from losses even at the expense of making a gain. As individuals, we also have different tolerances for risk and uncertainty. As any health care provider can tell you, when faced with the same medical decision and facts, people make different choices (including not to decide).
2. Wellness as a trajectory
Health is a lifelong focus on wellness. But a lifetime is too long and wellness is too abstract a goal for us to respond to in a sustained way. To promote healthy behaviors, individuals and their care teams can focus on small behavioral changes that are sustainable. Taken as whole, people are very bad at changing behaviors unless there is a discrete metric or guideline against which to measure.
3. The right incentives
Providing the right guideposts for an individual’s health journey necessitates an understanding of their personal goals and motivation. Seemingly obvious inducements, like financial rewards for weight loss, may not be enough. Indeed, because humans are generally ill-equipped at both planning for the future and maintaining self-control, appropriately designed incentives that weigh current costs more heavily than future gains are critical.
4. (Robot) Chicken Little
The fable of Chicken Little tells the story of a canard-creating cockerel that runs around yelling “the sky is falling,” when it clearly is not. Many of today’s sensors and other health “nudgers” are designed with the long-term outcome in mind, but need to encourage change in the immediate term. The seeming urgency of these alerts, coupled with outcomes too distant to be appreciated, may actually encourage us to ignore them.
As much as sensors are moving to the point where they will be “invisible,” nudges may be most effective when they are just at (or slightly below) the level of our awareness, while still affecting change.