Healthcare and the Elderly are Staying Home

Home is the fastest growing healthcare setting.

-Dereck Aberele, President of Qualcom Inc., 2014

The goals of aging in place and aging in community are to allow older people to stay in their homes and stay connected to their communities for as long as possible. I recently had the pleasure of interviewing providers, like Dr. Allan Teel of Full Circle America, who have created models of excellence for healthcare and monitoring at home and aging in place and community. The work of these organizations inspired me to delve into the global statistics of aging and the health needs of those over sixty years of age. I also looked at the trends toward supporting aging in place and community and healthcare at home.

With the growth of the aging population comes a larger need for care, community inclusion, and connection to local supports and services. Loneliness is known to contribute to the rise of many chronic diseases, including hypertension, stroke, heart disease, and lung disease.[ref]Petitte, T., Mallow, J., Barnes, E., Petrone, A., Barr, T. & Theeke, L. (2015). A systematic review of loneliness and common chronic conditions in adults. Jounal of Open Psychology: 8(Suppl2):113-132.[/ref] Loneliness is also a predictor of dementia,[ref]Harris, P. (2013). Feelings of loneliness and risk for dementia in older adults. Medscape Educational Brief.[/ref][ref]Holwerda, T.J., Deeg, D.J, Beekman, A,T, van Tilburg, T.G., Stek, M.L., Jonker, C. & Schoevers, R. (2012). Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly. Journal of Neurology, Neurosurgery & Psychiatry. dos:10.1136.[/ref] functional decline, and death.[ref]Perissinotto C.M., Stijacic Cenzer, I. & Covinsky, K. (2012).Loneliness in older persons.Archives of International Medicine; 172(14): 1078-1083.[/ref][ref]Holt-Lunstad, Smith, T.B., Baker, M., Harris, T. & Stephenson (2015). Loneliness and social isolation as risk factors for mortality. Perspectives on Psychological Schience. Vol. 10 P227-37.[/ref] Addressing loneliness as prevention is of the utmost importance. Aging in place and community facilitators seek to create connections to prevent loneliness and the outcomes of loneliness.

The increasing needs of the elderly population place a heavy demand on public and private social and healthcare systems. Countries and markets are responding to the demands of the elderly population with innovative models of care, connection, products, and services that provide improved health outcomes at a lower cost and enable older people to remain in their homes for longer. These cost effective models also increase access to care for elderly populations that otherwise could not afford the necessary care and support. Healthcare at home and aging in place and community are examples of such models. These models are supported by a technology market that is responding with an impressive array of innovations for elder care.

The Global Statistics of Aging

In the United States, ten thousand people turn sixty five each day. According to projections from the US Census Bureau, almost twenty one percent of the US population will be sixty five or older by 2050. The global population over sixty is increasing by eight million per year and is projected to increase by twenty four million per year by 2030.[ref][/ref] Global population growth is not evenly distributed. At twenty three percent, Europe has the largest population of those over sixty in the world.[ref]Population aging and sustainable development, (2014). United Nations Department of Economic and Social Affairs. Population division, No. 2014/4[/ref]The United Nations projects that this population will increase to thirty four percent by 2050.[ref]Ibid.[/ref] The projected percentage of those over sixty in 2050 for North America is twenty seven, for Latin America and the Caribbean is twenty five percent, for Asia is twenty four, and for Oceania, is twenty three percent. Between 2014 and 2050, the population of Africa aged sixty and older is expected to double from five to ten percent.[ref]Ibid.[/ref]

The population aged eighty and older is growing the fastest[ref]; Congressional Budget Office, 2013.[/ref] and has the highest incidence of chronic conditions, functional limitations, and cognitive decline. People are living longer, with an average life expectancy of seventy one years.[ref][/ref] In high income countries, that number reaches as much as eighty seventy years.[ref][/ref] The United States and many countries around the world will be facing an exponential upsurge in the need for long term services and supports for their older populations. In the coming years, the elderly will consume an increasingly large portion of overall health spending.

The rising rate of obesity in the elderly population promises to compound the sharp growth rate of chronic illnesses and disability. Today, about 380 million people worldwide have diabetes.[ref]Deloitte Center for Health Solutions, (2014). Healthcare and life sciences predictions 2010. A bold future? p. 2.[/ref] Those with obesity,[ref]Chuang, Y.F., An, Y., Bilgel, M. Wong, D.F., Troncoso, J.C., O’Brien, R.J., Breitner, J.C., Ferruci, L., Resnick, S.M., & Thanbisetty, M. (2015). Midlife adiposity predicts earlier onset of Alzheimer’s dementia, neuropathology and presymptomatic cerebral amyloid accumulation. Molecular Psychiatry. Doi: 10.1038/p. 129.[/ref] diabetes,[ref]Gordon, S. (2015). Type 1 diabetes linked to higher risk of dementia. U.S. News and World Report Health.[/ref][ref]Anderlson, P. (2015). Type 2 diabetes linked to Tau tangles in brain. Medscape Medical News/Neurology.[/ref] and cardiovascular disease have higher rates of dementia.[ref]Justin, B.N., Turek, M. & Hakim, A.M. (2013). Heard disease as a risk factor for dementia. Clinical Epidemiology, 5: 135-145.[/ref] As of 2010, as many as three out of four people age sixty five and older in the United States were living with multiple chronic conditions.[ref]Anderson, G. (2010). Chronic care: making the case for ongoing care. Princeton, NJ: Robert Wood Johnson Foundation.[/ref]

Most of the world is already experiencing a substantial shortage of skilled caregivers. As the elderly population increases and birth rates decrease, the need for caregivers will far exceed the capacity of family members and friends. These facts tell us that the burden of elder care is growing rapidly.

Health systems around the world are unprepared to address the needs of the growing senior population. Restructuring of care delivery systems and policy changes are needed to find alternative methods to deliver person centered care to the elderly. The public and private sectors must work together to find a lower cost solution to deliver a higher quality of care.

Healthcare at Home and Aging in Place and Community

Health systems are seeking to deliver health access, equity, and quality at a lower cost. The most widely accepted way to accomplish that goal is to deliver long term care, chronic care, and aging services in the home. Nearly ninety percent of Americans over age sixty five want to stay in their homes for as long as possible. Eighty percent believe that they will live in their current home until they pass away.[ref]AARP[/ref] A new model of care is needed, one that includes independence, choice, and connectivity to community.[ref]Boyle, G. (2004). Facilitating choice and control for older people in long term care. Health and Social Care Community, 12(3):212-20.[/ref]

An estimated two thirds of American seniors rely on social security as their primary support.[ref]AARP[/ref] The average annual social security payment is fourteen thousand dollars. The average cost of a skilled nursing facility is eighty one thousand dollars per year.[ref]Poo, A.J. (2015). The age of dignity. Preparing for the elder boom in a changing America. The New Press, New York and London, p. 154.[/ref]

In the 2006 reauthorization of the Older Americans Act, Congress authorized the Community Innovations for Aging in Place Initiative. The mission of the initiative was to create communities that support the ability of older adults to remain in their communities and in their homes for as long as possible.

In May 2008, the United States Administration on Aging reiterated its support for the development of age friendly cities and supportive communities that enable seniors to age in place and community for as long as possible. The administration stressed the importance of collaboration from multiple sectors to achieve this goal. A central focus of the United Nations Convention on the Rights of Persons with Disabilities was the right of functionally limited individuals to be included in their communities.[ref]Active ageing: a policy framework, (2002), Geneva: World Health Organization; (, accessed Oct. 10 2015).[/ref]

An Opportunity for Technology

In the 2015 report Opportunity knocks. Designing Solutions for an Aging Society,[ref]Sinclair, D. & Creighton, H. (2015). Opportunity Knocks. Designing solutions for an ageing society. International Longevity Center-UK, Engineering and Designing Center at Cambridge University & the Institute of Engineering and Technology.[/ref] Cambridge researchers asserted that technological innovation is vital to meet the needs of an aging population. The researchers predicted that widespread technologies will give the aging population a better quality of independent living and longer life expectancies. The authors also suggested that such innovations could boost the economy of the UK because the market for elder specific goods and services is growing as that population grows. “This report highlights that there is a huge commercial opportunity for companies to design inclusively, driving increased customer satisfaction and boosting their market share by delivering more competitive products and services,” explained Professor John Clarkson, director of the Engineering Design Centre at Cambridge.[ref]University of Cambridge Research News(2015). Health costs of ageing will shoot up without technological innovation.[/ref]

The World Health Organization defines telemedicine as the use of information and communications technologies to improve patient outcomes by increasing access to care and medical information.[ref]WHO (2009). Telemedicine. Opportunities and developments in member states. Report on the second global survey on eHealth. Global Observatory for eHealth series, V.2, p. 8.[/ref] Based on analysis by the global company HIS, the global telehealth market will increase tenfold from 2013 to 2018. Within those years, the global revenue for devices and services will increase from about 440 million to 4.5 billion US dollars. The use of telehealth devices and services is expected to grow from 250,000 in 2013 to seven million in 2018.[ref]Roashan, R. (2014). A dedicated study on telehealth that provides detailed analysis of the world market. Telehealth report—2014, IHS.[/ref]

In some instances, technology is used to modernize existing models, like time banking. The Sutter Health linkAge time banking program does just that. Time banking is a framework for people to exchange skills or teaching. When a member gives assistance, they get a credit. They can use the credit to choose from the variety of offers posted on the linkAges website. One member may exchange yard work for photography lessons. Time banks create intergenerational community connections. Younger members often offer rides in exchange for babysitting. There are time banks around the world. Stay tuned for my forthcoming interview with Dr. Paul Tang about the linkAges program, which will be published later this winter. Another innovative use of existing technology is the array of location devices for people with dementia.

Dr. Allan Teel, with Full Circle America, has been using technology to conduct remote monitoring of his clients for thirty years, with the goal of allowing the client to remain in her home for as long as possible. He creates individualized customizable person centered smart homes. Smart homes are homes that collect information remotely and relay that information to a support team. Smart homes are becoming more and more common in the US and globally. Dr. Teel uses passive devices such as webcams, motion sensors, and door sensors to monitor the patterns and movement of his clients. He also uses active remote monitoring devices, such as blood pressure cuffs, pulse oximeters, peak flow meters, pedometers, glucometers, and a scales. These devices can either be manual, which is cheaper, or Bluetooth enabled, which sends information directly to him. Dr. Teel also uses telemedicine and video consultations to connect to his clients. Please see my interview with Dr. Teel, as well as a series of interviews and case studies by my colleague Sofia Widén for more information about these kinds of devices and how they are used to improve care in the home.

Newer developments in remote monitoring and home based care have been made possible by sophisticated software platforms that coordinate all of the patient’s information, including remote monitoring, across the patient’s entire care continuum. BlissCONNECT is one such platform. American Well is another.

In published predictions about healthcare delivery systems of 2020, Deloitte partner Sara Siegel stressed the importance of aligning human interaction with digital health to create patient centered care that balances care delivered by  human caregivers with care delivered through technology.[ref]Deloitte Center for Health Solutions, (2014). Healthcare and life sciences predictions 2010. A bold future? p. 10.[/ref] The PricewaterhouseCoopers Health Research Institute estimates that technology that facilitates aging in place will earn sixty four billion dollars of traditional provider revenue in the United States over the next twenty years.[ref]Gumpert, K. (2015). U.S. startups aim to help seniors ‘age in place.’ Reuters.[/ref]

The Future is Promising

Research indicates that we are on a path toward increased healthcare at home and aging in place and community. The market is responding to the demand with innovative care designs and technologies. Public and private healthcare providers are designing creative methods to connect the older population with their communities, to facilitate aging in place, and to deliver healthcare at home. The next few decades promise to see this evolution on a global scale. I am thrilled to have a front row seat to witness improvements in elder care delivery, access, affordability, and health outcomes.