Tracking the Health of the Silver Economy: The Human Considerations of Healthcare Tech for the Elderly

When the Apple Watch Series 4 was launched in September you could almost hear the global healthtech industry take a deep inward breath. The giant has put a stake in the ground showing its commitment to healthcare wearable technology, and the rest of us had better rise to the challenge. Wearable healthcare tech going mainstream matters … especially if you’re over 70.

The Apple watch has been a younger person’s product but it’s now the first ever mainstream wearable to be FDA-cleared (US Food and Drug Administration) and a move into something more responsible.

The new smartwatch FDA-cleared features include an electro-cardiogram feature (ECG) allowing users to obtain a 30 second reading which passes data to your Health app on the iPhone, and an alert system if your heart rate goes too low or high. Neither are intended to be used by people under 22 years old. It also features a fall detection set up automatically for over-65s. These direct-to-consumer firsts will inevitably shake up the healthcare wearables and IoT developments of the last decade. But how will people, particularly the elderly, actually feel about it and what will it take for them to use it?

The Senior market has also been described as the Silver Economy. In business terminology that translates to ‘all products and services that are expected to improve disability-free life expectancy or to help dependent elderly people and their caregivers on a day-to-day basis’. Doesn’t sound like much to look forward to. But this group is changing and Apple know it.

The silver economy has embraced the philosophy of the Quantified Self, perhaps more so than other generations. They have more time on their hands to interpret data and at their stage in life tracking day-to-day fitness can be an all-consuming pastime. The health data possibilities are limitless – in Japan they’ve even invented a toilet that doubles up as a doctor by analysing your urine flow.

Like most other adults, the over 70s have dabbled in wearables, buying into the convenience of Fitbits, other similar alternatives and even smartwatches to monitor their steps, nutrition, weight and sleep quality to prolong good health. They want to retain their independence for as long as possible but there inevitably comes a time when they are more vulnerable, possibly more infirm and have more serious health issues. This is the crossover point where wearables and IoT can come into play on a more profound level.

The elderly are also growing in numbers. Between 2015 and 2030 the number of people in the world aged 60 years or over is projected to grow by 56% and to have doubled its size by 2050, reaching nearly 2.1 billion. We are living longer and healthier, and ageing is now everyone’s business.

The relatively fledgling wearable market has looked at solutions where peace of mind is considered for both the elderly, their carers and relatives, and their GPs.

The elderly have been wearing lanyards with panic buttons for the past 20 years but the industry is now seeing more sophisticated wearables like the Reemo Health Smartwatch with live concierge help, Omron’s blood pressure monitor ‘watch’, and Buddi’s wristband (that looks a bit like a Fitbit) with alert buttons and a sensor that works with smartphones so a message is automatically sent to your connections if it detects you have fallen. Feebris’ platform analyses data from healthcare wearables to understand health problems in the elderly.

Along similar lines, Canary Care have created a home monitoring and elderly alert system for independent living in the UK and TruSense have developed smarthome technology for seniors in the US. Mysphera and its Activage project in Spain backed by the European Commission – an IoT movement monitoring system to track movements of the elderly in their homes (tracked by relatives as well as by a central location) with a vision of enhancing the empowerment of ageing people and increasing their independence by keeping them in their homes as long as possible.

A raft of direct medical tech products has also emerged including the AdhereTech smart wireless pill bottles that send real-time data and issue automatic alerts if medication doses are missed, the everyday Withings wireless blood pressure monitor and the AliveCor KardiaBand heart-monitoring watch accessory. Then there’s the recently launched Nightwatch smart arm bracelet epilepsy device, and BodyGuardian – a heart remote monitoring system in a wireless positional patch which tracks ECG and average heart rate for arrhythmias including Atrial Fibrillation. The patient’s data is automatically detected and wirelessly delivered to a monitoring centre.

The market has remained niche but Apple is poised to take these types of technologies mainstream and in doing so more desirable and simpler to use. The world’s first trillion-dollar-valued company’s commitment to healthcare tech is good news for the elderly and their pursuit of independence and avoidance of assisted living. (Think how the iPad was produced with a young demographic in mind but was a runaway success with the elderly who had never owned PCs and loved having a simple, hassle-free operating system.)

One wonders where Apple will go next and what the implications will be for the incumbents in this field – either support from new ecosystems developed by the tech giants, or being put out of business altogether. In Healthkit, ResearchKit and CareKit, Apple is already striving to provide a safe healthcare platform around which an ecosystem can be created: https://developer.apple.com/healthkit/.

All of this sounds like progress is on the immediate horizon but the human considerations of healthcare tech for the elderly should be emphasised. For the elderly themselves factors like convenience, independence, discretion, mental health, not feeling stigmatised, not being change averse (and the converse) are deal breakers for adoption.

But most importantly 44% of elderly people are living with a disability (https://www.dlf.org.uk/content/key-facts). There are profound implications on the design of technology for this user group not to mention the aforementioned practical and ethical barriers for consumer wearables that hope to address their clinical needs. For example can a patient with dementia rely upon a wristband or watch that they may not remember to put on? There are real dangers of consumer wearables being confused as products for the infirm elderly with acute clinical needs.

Not to mention the other issues of charging wearables and other hardware, affordability, proximity of carers, false alarms, misinterpreting data, the responsibility of interpreting data and regulatory considerations. While smarthome technology may give peace of mind to the elderly and their carers, keeping them in their homes for longer and easing financial pressure on the state, what will the safety repercussions be? And can privacy be respected if we’re tracking every aspect of their lives from nutrition to medication, temperature to room and home device usage, leisure time and sleep time?

Also worth mentioning is security. Apple sells itself on the guarantee of data privacy as a closed platform but as quantified fitness transitions to medical grade quantified health, breaches and hacks like those through home IoT devices over the past few years would be disastrous.

Reassuringly, there are growing numbers of elderly enjoying relatively good health, and for whom staying healthy is increasingly important. And it is this part of the market that Apple have their sights set on. Even here however, lie dangers – should you rely on your Apple Watch to give you an early warning of an irregular heart rhythm as a substitute for a regular health checkup with your doctor? Of course not, but we don’t know yet whether devices such as the Apple Watch will provide a false sense of security that ultimately encourages more risky behaviour.

The fact that Apple have publicly embraced the healthcare arena will mean others follow them, including the silver economy. They will undoubtedly embrace the move of healthcare wearables and IoT into the mainstream to support their independence but the difficult questions around human considerations, disability, privacy and personal data are yet to be answered.

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