Aging in Place: Why Technology & Gadgets Matter

Can gadgets and tech help us live the way we want to for longer?

Aging in Place — “growing older at home” — is an aspiration of many older adults.

Although exactly what this means depends on details like how one defines “home”; and exactly which phase of “aging” we are discussing. And many argue that “aging in the “right” place” is a better way to think about it.

Regardless of exactly how we define “aging in place”, in my mind there is a compelling argument that the right gadgets and technology can make aging in place more successful and less expensive for some people.

And by “more successful”, I am thinking in particular of higher quality of life, more autonomy, and less “dependence on the kindness of strangers“.

I don’t think this argument gets made much in the media or by the aging services industry, though. So here it is.

Who Should Read This?

This article is for any older adult, or adult child of an aging parent, who is thinking about the whole idea of “Aging in Place”, and the role gadgets and technology might play in figuring out how to grow old in the way one wants.

Table of Contents

• Background & Overview
• What is Aging in Place / Aging at Home?
• Why Gadgets & Tech Matter
• “Use Cases”: Gadgets & Technology for “Aging In Place”
• Planning Ahead
• Costs and Economics
• Join our “Aging in Place Technology Interest Group”  

Background & Overview

In a recent Longevity Explorer discussion about smart home gadgets, many of which were relevant to aging in place, an explorer posed the question:

“Are these gadgets really worth the effort?”

I thought it was a good question. After reflecting a bit, I decided that in my opinion the answer is definitely “Yes. For some people in some situations“. But who are those people and what are those situations?

Thinking about this helped chrystalize my thoughts. Here is the summary.

• Aging in Place is a much more complex concept than usually portrayed and means different things to different people. I think the key elements are maintaining some degree of autonomy as long as possible; living in a place / community you are comfortable with; and in many cases maintaining a sense of purpose, and avoiding feelings of “being a burden”.
• Most people need extra “help” as they grow older, due to various imperfect physical or mental capabilities that typically progress with age.
• “Help” is usually framed in the media and the aging services industry as “hands-on help from humans“. But it does not have to be defined so narrowly, and that is where gadgets and tech come in.
• The intriguing potential of technology and gadgets is that, in some situations, they can restore a level of autonomy (independence) to the older adult — reducing the “dependence on the kindness of strangers”; and / or make “getting help” less expensive than getting an equivalent amount of “help from humans”.
• Discussions of technology and aging often lead to reactions like “humans are better than technology”, or “gadgets are expensive”. While these points are important, we think more nuance is required.

In the rest of this article we elaborate on these themes. Scroll down for more.

Join the discussion: Feel free to add your comments and opinions at the bottom. This article is an opinion, not “proof”. You are welcome to disagree, but please be civil.

Stay in the loop as we explore this topic further:

Join the “Aging in Place Interest Group” (free).

What is Aging in Place?

Aging in Place is typically defined as “growing older at home”.

The common media stereotype is of a frail elderly person growing old in the house in which they have lived for decades, and likely brought up a family.

And, if you accept that stereotypical description, aging in place often requires some “changes” to be practical — many relating to home renovations (ramps, elevators, grab bars etc).

The Longevity Explorer community has had a number of explorations about the whole topic of how and where people want to grow older, and these have revealed a more complex and nuanced situation. Below we unpack some of the issues.

What Does “At Home” Mean?

In our explorations, it was certainly true that many older adults liked the concept of growing older in a “familiar environment”.

While to some that meant “in the exact same building where I have lived for the last xx years”, for many it meant something different.

For many of the participants in our explorations, what they have in mind is less about living in a particular building, and more about things like:

• living in a community where they know people, know the shops, and can keep doing their familiar routines;
• being able to interact with their family and friends.

This suggests a variety of different trajectories that might all count as “aging in place”:

• Traditional: stay in a conventional family home, and retrofit it to make it “age friendly”;
• Downsize in place: Move to a different dwelling (often smaller), that is in the same neighbourhood, but which includes some features that make it “age friendly”;
• Early move: Move early enough in life to create a new life style that feels like home somewhere that will allow aging in place (eg an active aging community of some type).

Balancing “Autonomy” and the “Need for Help”

The more we discussed it, the more we felt successful aging in place is not mainly about the “dwelling unit”.

Instead it is in part about feeling “at home”, as above.

But more importantly, perhaps, it is about the complex interplay between dependency, autonomy, and the “need for help“.

The first thing to acknowledge in thinking about this topic is that most of us, if we live long enough, will need help of various sorts.

This help might be quite minor. For example, you might want someone other than you to climb up the ladder to clean the gutters or change the light bulbs. Or you might want someone to come periodically to update your computer and phone and keep all your gadgets running.

For some, help is major. For example, some people need help dressing or bathing. Or various forms of help due to cognition issues.

There are many in between levels of help. For example help managing finances, help with cooking and cleaning, or help driving.

So, part of aging in place is creating a plan that makes it possible to get the sort of help you need, when you need it.

In discussions around this topic, the Longevity Explorers felt that autonomy was an important aspect of aging in place.

In other words, assuming you need help with task x, who gets to decide when and how that help is delivered?

For example, suppose you decide you want to go to the shop to buy something. Can you initiate that journey and be in control of it? Or do you need to ask permission and wait to go shopping until someone else decides they are willing to take you? Those are two different degrees of autonomy.

Different people seem to care more or less about having autonomy over different specific areas of life. But a common theme in our discussions was that for the majority, they cared rather a lot about autonomy in certain areas. In particular, in the important areas they cared about, people expressed the desire to maintain autonomy as long as possible.

We think that has very important implications for the role of technology and gadgets, because in some cases using a gadget instead of a person returns the control (autonomy) to the older adult, rather than to the “helper”.

Autonomy Example.

Suppose you are not able to easily open jars, due to arthritis. And suppose you use jars regularly in cooking your favorite meals.

Option 1: You have a very friendly home help person who comes by every few days to help cook and clean and generally do things for you around the house. To open a jar, you just put it aside and wait until the home help person comes, and you arrange your weekly cooking plans so that you only use jars on the days the home helper comes.

Option 2: You invest a modest sum in a gadget that makes it possible for you to open your own jars. You are now able to open jars any time you want, and design your cooking and eating plans accordingly.

Which of these alternative scenarios sounds preferable? And which gives you greater autonomy?

Not “Being a Burden”

Another recurring theme that emerged from the Longevity Explorer discussions on how and where to grow older was this.

“I don’t want to be a burden to my children”.

This is a pretty important thing to take into account when thinking about aging in place solutions.

Often, caring for and worrying about aging parents is the role of the adult child (often the so called “alpha daughter”). And a certain amount of such help and support is often happpily given and received.

But perhaps offloading some of that help to gadgets might help relieve the burden on the adult children, and help avoid that “being a burden” feeling on the part of the older adult.  

Why Gadgets & Technology Matter for “Aging At Home”

The argument we are making here is that the right gadgets and technology can make aging in place more successful and less expensive.

And by “more successful”, I am thinking in particular of higher quality of life, more autonomy, and less “dependence on the kindness of strangers”.

There are three aspects to this argument.

• The balance between “help from humans” and “help from gadgets“.
• Specific “Value Propositions” for gadgets.
• The difference between “Aspirational Objects” and those with negative connotations or an aura of stigma.

Humans vs Tech

“Help” is usually framed in the media and the aging services industry as “hands-on help from humans“.

And when “gadgets & technology” are brought into the discussion, people start talking about “replacing humans with machines”, or older adults becoming isolated due to “lack of human contact”. But, while these are real issues, we think they miss the key point. Here is how we see things.

• Some sorts of help definitely need a human, at least at our current stage of technology. For example, if you need help bathing, or eating, or dressing, for now at least, that is likely a task for humans.
• On the other hand, there are a number of tasks and activities that used to need a human but no longer do, or which can be done as well or better or less expensively today by gadgets and technology. We dive into specific examples further down the page.

If you have very significant financial resources, then surrounding yourself with a cadre of well paid, motivated humans with your interests at heart is a great way to get “help”. But many people can’t afford that.

What if you can’t really afford enough high quality, human help to meet all your needs? Do you cut back on hours? On quality? Count on more unpaid help from friends and family?

And, while the idea of getting help from family members and adult children seems very realistic for many, there is always the issue of “not being a burden” — and that means that if there are things gadgets can help you do without “bothering” others, that is likely a good thing.

Back in the day, a small segment of society had servants to relieve them of the burdens of chores like doing the washing and the dishes. That idea has largely been replaced by the idea that a much larger segment of society can use labor saving appliances to relieve themselves from those chores. I think there are some lessons in that analogy for the world of aging services.

Wouldn’t it be good if there emerged a sort of hybrid model, in which gadgets and technology could do some things for you — things that don’t absolutely need compassion and a human touch, for example — and you could focus your $$ on help from humans in areas where only humans can do what you need?

Value Propositions: Gadgets & Technology for Aging in Place

It’s important to be clear that we are not advocating gadgets for the sake of having gadgets.

We want to focus on gadgets and technology that accomplish specific things of value to the older adults and caregivers that use them.

Here are the specific “value propositions” we look for. When we find a new gadget, the question we ask is:

“does it help accomplish one or other (ideally several) of the value propositions below?”

• Gadgets & Tech should be able to do certain things in ways that mean the older adult is back in charge of their own destiny.
• Compared to getting “no help”, gadgets and tech should be able to improve quality of life.
• Compared to getting “help from humans with everything”, gadgets and tech should be able to reduce costs.
• For the caregiver, gadgets & tech should be able to enable them to provide better care with less stress and perhaps in less time.

And, in terms of economics, this is often an important consideration:

In specific situations (use cases), judicious use of gadgets and technology may be able to postpone the time at which you either need more “professional help” than before, or need to “move” to a setting where you can get more professional help, such as an assisted living facility.

These value propositions are all extremely task dependent, and as mentioned above, we see the ideal situation as a balance between “in person help” for some things, and “gadgets that help” for others.

Below are specific areas / “use cases” where we think gadgets and tech can make a big impact on aging in place.

Aspirational vs Stigma

An emerging trend we have written about elsewhere is the convergence of consumer electronics (eg Apple Watch) and “Agetech”.

The idea is that increasingly one can get features in regular consumer electronics that happen to be especially useful for older adults (fall detection and alerts in an Apple Watch are an obvious example).

The reason this is important is that a trendy piece of consumer electronics is an aspirational object, whereas conventional agetech products have usually been seen as “beige and boring” — and are seen by some as being stigmatizing.

If you have a choice between a trendy consumer gadget that helps you age in place better, or a “service” that is clearly branded as being for “frail old people”, which seems more desirable?

Want more in-depth research on Aging in Place Gadgets & Technology:

Join the “Aging in Place Interest Group” (free).  

“Use Cases”: Aging In Place Technology & Gadgets

Here are some more specific examples of areas where Tech-enhanced Life and the Longevity Explorers are finding gadgets and technology can play an important role in making Aging at Home / Aging in Place more successful.

Everyday Objects

While often not counted as “tech”, our Longevity Explorers have made it clear that some of the most useful gadgets for enabling extended autonomy at home are things like jar openers, the right sort of toenail clippers, and other gadgets we think of as “everyday objects”.

It makes sense if you think about it. After all, these are objects that help with “everyday activities”.

The activities are often relatively minor on the scale of things, but done fairly frequently. So, not being able to do them can have a significant impact on everyday life.

If you want to dig deeper, you can see more at this Topic Hub:

• Topic Hub: Everyday Objects that Improve Life.

Medication Management

Medication management is a poster child for the potential value of technology in aging in place.

This article is not the place to address all the subtleties of technology to help medication management. But here are the key points.

• Imperfect medication adherence among older adults, together with “suboptimal medication prescription lists”, are widely acknowledged “issues” that can have major health consequences.
• Among those consequences, the need for better medication management is on the short list of “top reasons” why a person gets moved into Institutional Care (1).
• There are now available a broad spectrum of medication management “tools and technologies”, ranging from simple reminders to complex automatic pill dispensing robots.

By matching the right technology to a specific life situation, we think there is potential for a number of improved outcomes — for both the older adult and for their family and or caregivers.

If you want to dig deeper, you can see more at this Topic Hub:

• Topic Hub: Medication Management Guide: Tools & Strategies.

Communicating (Telephone / Video Calls etc). Avoiding Social Isolation.

If there has been any positive aspect of COVID, it is that it has forced people to focus on ways to communicate better virtually. And, in particular, it has caused people to think about the plight of those older adults who are isolated and unable to easily use modern communication tools.

During 2020 we did a lot of work in which we explored different technologies for virtual interaction, and tools that made it possible to have virtual interactions like video calls, even when the older adult was not already skilled with specific technologies.

The techniques for virtual interaction are especially relevant to aging in place, since social isolation is one of the big challenges of successful aging in place, and reduced mobility or cognition can make social interaction by traditional methods challenging.

If you want to dig deeper, you can see more at this Topic Hub:

• Topic Hubs: Social Isolation & Loneliness

Transportation & Mobility at Home

The emergence of ride sharing apps like Uber and Lyft have transformed the landscape for “getting from point A to point B” for those capable of using the tools.

And a layer of “interface tools” have emerged to help the less tech-savvy too. For example, various services act as intermediaries to take a phone call and schedule a ride-sharing ride for you.

Of course, COVID, and vigorous “resistance” to ride sharing platforms by various factions, potentially jeopardizes these new capabilities (time will tell).

But in the meantime, think about this example.

An elderly frail individual lives alone in a suburban house far from easy public transport, and anyway she has difficulty walking more than a short distance. She no longer drives and wants to get to an appointment (social event, groceries, personal care etc).

• Scenario A: She asks a friend for a favor, or she books a timeslot with the friendly paratransit service run by a local non-profit or government service. They take her, but likely at a time of their convenience, and perhaps only to a place on a specific route.
• Scenario B: She books a ride sharing ride, it comes when she wants, and goes exactly where she needs, and can pick her up after if she wishes.

Which gives a greater sense of autonomy?

We are also starting to see some promising solutions emerge to the challenges of short distance mobility. Things like going for a walk, or being able to go “off road”, for example.

To dig deeper, see this Topic Hub:

• Topic Hub: Transportation & Mobility Tech

Shopping for Groceries and Personal Items

Another silver lining of COVID is that many older adults have become comfortable with shopping online for all sorts of things.

This is a skill that will continue to be useful once COVID is long gone, especially as a person moves into a phase where driving is a challenge, and mobility is limited.

“But what about a person who can’t master online grocery orders” you say?

Here is an interesting anecdote that illustrates what is possible, from one of our explorers.

Says Explorer G:

“My 89-yr-old mother lives a thousand miles away. My sister lives a two hour drive from her. So neither of us can “just pop in”.

During COVID, we realized we needed to help her with grocery orders, because even though she she has a computer, and iPhone, she is not really comfortable with buying things online and was not keen to try and learn.

So, here is the system we came up with.

Once a week, my sister and mother would talk by phone. My mother would share a list of grocery items she wanted. My sister would order them from the supermarket in my mother’s neighbourhood, using the online shopping website. They would be delivered to my mother’s door a few hours later.

My sister would pay for the groceries online, then add the amount she spent to a simple online spreadsheet that we all could see. 

My mother is not keen on using online banking, but I can access her account. So once a week I spent 5 minutes checking the spreadsheet and then triggering a payment from my mother to my sister for the “grocery amount”.

Of course, prior to doing any of this we discussed it with my mother to be sure she thought it all a good idea and was comfortable with the details.

Bottom line: it was easy, took very little time, and could be a model for a long term solution if need be.”

Other Key Areas We Are Exploring

There are quite a few other areas where technology and gadgets should be able to help make aging in place more successful, and we plan to explore them in depth in the future.

Here are some of the areas on our exploration list.

• Meals
• Money Management
• Household Chores
• Personal Care (bathing, getting in and out of bed, using the toilet, walking, eating)
• Incontinence
• Health Care
• Cognition Impairment
• Caregiver augmentation & stress reduction

Learn when we publish new research

Join the “Aging in Place Interest Group” (free).  

Planning Ahead for Aging in Place

Any article about Aging in Place stresses the idea that it is a good idea to “plan ahead”.

The reasons are pretty obvious. It’s hard to take steps to renovate your house, or move to a better spot, when you are in the midst of some sort of health crisis.

When “Convenience” Turns into “Enablement”

Planning ahead is important for gadgets and technology too, and here is a key point.

When you “can” do everything yourself, gadgets and tech offer “convenience”, and you may or may not consider that worth the effort.

When you “cannot” do everything for yourself, then “gadgets” turn from “offering convenience” to “restoring your ability to do things”.

That’s often worth quite a lot of effort.

An important take-away for me is that you probably need to figure out how to incorporate the appropriate gadgets and tech into your life “before” you really need them, rather than “after”. That way, when you “need” them, you are ready.  

Costs and Economics of Aging at Home

Whenever we discuss this sort of thing, someone is sure to ask:

What about the costs?

And when we give some of the examples above, like the ridesharing example, someone says “But paratransit is free and Uber costs money”.

We acknowledge those points. But we think the following points are also important.

• Some people think autonomy is worth paying for.
• Having humans come by and “help” usually costs quite a lot.
• If gadgets can help you stay “at home” for longer, then you save the costs of assisted living, or an alternate institutional living situation.
• “Free” help from family members is not “free”. There is a cost in stress and time and “burden” for the family members. They may be very willing to do it. But it’s not “free”.
• “Paratransit” and other services provided by the government and philanthropy are also not “free”. They are paid for by taxes or donations. Those same taxes or donations could also be used to subsidize gadgets. From a societal point of view, the right question is “which services and gadgets should society subsidize?”  

Learn More

Join the “Aging in Place Interest Group” (free).

References

(1) NIA / NIH Aging in Place page

(2) Dr. M. Renfro talk on medication and dementia, ASA 2016.