White House/VA Conference
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"Today, we have 600 million people who are over the age of 60 in the world—35 million in the United States, 90 million in India, 140 million in China." — Eric Dishman, PhD |
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Thank you. It's an honor to be here on behalf of both Intel and the Center for Aging Services Technologies, or "CAST" as we call it. I particularly want to thank Dr. Marburger´s office. He and his staff have been very helpful with our launch of CAST, a new organization to help accelerate the commercialization of aging-in-place technologies. My topic today is about using everyday technologies for inventing independence, for giving seniors and their families more choice about where they prefer to age in place, whether at home or across the continuum of care. I am going to focus decidedly on aging here today, with an argument that if we look at aging and what´s coming demographically, and if we design with the aging challenge in mind, we´re going to end up developing home and personal healthcare systems that are good for all disabilities and all citizens. |
 Eric Dishman, PhD, received three Bachelor of Art degrees from the University of North Carolina at Chapel Hill in Speech Communication, English (with Honors), and Drama. He went on to earn a Master of Science in Speech Communication from Southern Illinois University, and is a PhD candidate in Communication from the University of Utah. Dishman joined Intel in 1999 as a senior social scientist with the People and Practices Research group in Oregon. He is currently the director of Intel’s Proactive Health Lab and National Chair of the Center for Aging Services Technologies (CAST). Before joining Intel and CAST, Dishman was one of the founding members of the social science research team at Paul Allen’s lab, Interval Research. |
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I´m going to wear several hats today. The first is as a family caregiver. When I was a teenager, my grandmother was in the full throes of Alzheimer´s, and I can tell you that not having the time to get your driver´s license at the age of 16 because of the impact that Alzheimer´s has on you and your family leaves quite an impression. For 20 years now I´ve been wondering what could be done to help people with Alzheimer´s and what could have assisted the four or five of us who were trying to care for my grandmother. My second hat is as a social scientist who has worked in technology companies for the past 16 years. My very first job out of grad school was for Paul Allen, the cofounder of Microsoft, developing technologies to help build better nursing homes. We led an anthropological study of a nursing home to try to understand the needs of seniors. After we had built all these wearable heart monitors and wireless safety sensors—and that was kind of hard to do back in 1992—we realized we had asked the wrong question. Not "How do we make better nursing homes?" but "How do we move technology into the homes of people so that they can live wherever they choose?" That´s a theme I'm going to carry through today as I show you some prototypes from my lab of technologies we´re using to help people with Alzheimer´s to maintain their independence. This theme has carried over to my current work at Intel in our Proactive Health Lab, where we´re trying to figure out what technologies can help today´s and tomorrow´s seniors to live better with, or even to prevent, cardiovascular disease, cancer, and cognitive decline. Many people ask, why Intel? We´re not a healthcare company in any way. But we see home healthcare as an important market and ecosystem that Intel´s chip technologies—in your PCs, PDAs, and cell phones—will increasingly be used for, especially with the aging. My third hat, as Chair of CAST, is as an evangelist and advocate for aging–in–place and home health-friendly policies. Back in 2002 at Intel, when we´d just started my lab, we instantly received an avalanche of press and attention about the prototypes we were building for Alzheimer´s households. Then I started getting calls from engineers and scientists from big companies like IBM and GE and Honeywell and small research labs, many of the research labs Steve Tingus (director, National Institute on Disability and Rehabilitation Research, Department of Education) and his organization fund, asking, "How did you get Intel to focus on aging? How do we get some of these great technologies that are sitting in our labs out into the hands of seniors and their families?" Over the last 18 months, what started out as an informal conversation housed at the American Association of Homes and Services for the Aging (AAHSA), has now turned into CAST, a 300 organization-strong advocacy force to try to accelerate R&D to help people age in place. Our debut event last March—thanks to Senator Larry Craig (R-Idaho) and his staff on the Senate Subcommittee on Aging—brought together some of the leading universities and companies working on aging-in-place and assistive technologies. This was followed by Senate testimony and a major presentation to the National Governors Association. The exciting news is, momentum for aging-in-place technologies is growing. Three hundred companies, long-term care providers, and university labs joining forces in 18 months shows a real "there" there. Now we need to move this ball forward with a true nationwide effort to prepare for the age wave. Thus, my presence here with you today. I´d like to turn for a moment to the logic and motives behind Intel´s research and our support of CAST. Realizing full well that even a company our size cannot promote this kind of paradigm shift alone, Intel´s goal is to catalyze an ecosystem of evidence-based technology research around home health and wellness solutions. We don´t want to just throw these home health systems out there and hope that they work. Unfortunately, the commercial market is more forgiving than the scientific community, so we may end up with a lot of technologies out there that haven´t been proven and don´t work. That would be a critical mistake. We want to show outcomes. We want to show that these technologies are feasible and efficacious, that they save money and can lead to a better quality of life. Our own focus is decidedly on the consumer, the home, and the person in their everyday life, not on the clinical and IT enterprise. Our research is much more about "daughters" than "doctors," although getting the two to work together in harmony is the only real solution to our age wave crisis. The current U.S. healthcare system, already pushing the economic limits at $1.6 trillion annually, is not prepared to deal with what I call a disruptive demography. This worldwide age wave is coming soon to a reality near you. Today, we have 600 million people who are over the age of 60 in the world—35 million in the United States, 90 million in India, and 140 million in China, where the one-child policy is wreaking havoc because there are not enough caregivers to help take care of their aging population. We´re not alone in this in the United States when we talk about baby boomers. It´s a worldwide phenomenon, even though they don't use that term across the oceans. We are all going to witness a disability epidemic that comes strictly from aging. In 2050, many countries in the world will have 25 to 30 percent of its population over the age of 60, including the U.S., with household disability becoming an everyday experience for most citizens. This is an important Department of Commerce issue. American-based companies are woefully behind in the development of assistive and everyday technologies for home healthcare and aging-in-place. The aging population is already larger in some parts of the world. Western Europe and Japan´s over-60 populations are already at 20 to 25 percent, while the rest of the world averages between nine and 19 percent. Also, the liability climate has been greatly reduced in Western Europe and Japan, so that they don't have to fear, as many of the American-based companies do, investing in technology R&D in the aging arena. Many foreign countries also have a wireless build-out to the home—thus, a national, government-subsidized commitment to give every citizen broadband access, not driven by getting your Hollywood movies to your set-top box, but being driven by the practical economic realities that these governments are going to have to deliver new healthcare services and technologies to the home. We need to move the locus of innovation, IT, and healthcare technology from the mainframe to the home—from mainframe healthcare to personal healthcare. Just think about the mainframe personal computer decades ago, and now we all have personal computing on our desktop or even in our pocket or purse. Well, that´s what we have today for healthcare, a mainframe system that is far away from our everyday experience except when we get sick. Today we have to make a pilgrimage to the hospital or to the doctor to use enormous, expensive machines. We need to put personal technologies into the hands of seniors themselves, making them more proactive on a daily basis about their health and wellness before they ever have a problem. We need to give technologies to the boomers who are going to be doing all that caregiving. Fifty-four million adults are caregivers today. Over the next decade, one in two adults in the United States workforce will be caring for an aging parent. Caregiving is going to be our next full-time jobs. We've got to leverage this family and friend workforce because we´re not going to have enough professional caregivers. Even if we increase the output of nursing programs and physician programs by a factor of 10, we would not have enough formal staff to take care of this age wave that´s coming. We need to address the issue of telemedicine. How do we connect this data back to the healthcare mainframe and invent new paradigms of remote care, without having to force those with disabilities to travel? David Brailer (Coordinator, National Health Information Technology Project) made a subtle point earlier that I think is very important: The electronic health records we´re putting in place—and I´m thrilled that the government is standing up to push standards and to help make this happen—are a 21st century pipeline that´s only going to be effective if we develop 21st century healthcare. If we somehow managed 100 percent adoption of electronic health records and wrung all of the efficiencies out of them that are possible, most estimates say that we would get about an 8 to 10 percent cost savings. That´s not going to take care of the doubling of the most expensive population to care for in the world. So, the electronic health record is a crucial piece of infrastructure to build, but it is not enough to stop there. We have to think about how technologies—many of them in our homes, in our cars, even on our body—are going to enable earlier detection of problems and diseases before they become expensive and emotionally draining on people. We need to figure out how to promote healthy, daily, preventive behaviors. We´ve known for decades that smoking cessation, a bit of exercise, and eating better are going to save potentially hundreds of billions of dollars. The hard problem is: How do we change peoples´ behaviors? That´s a huge challenge—the kind of going-to-the-moon challenge in which our nation must engage. How do we support both family and friend caregivers? That´s going to be the only way of getting out of this demographic mess. Telemedicine is a great starting place. However, most telemedicine that´s being designed today keeps the doctor and the nurse in the loop on every single encounter. Again, this doesn't solve the scaling problem with the age wave that´s coming through. We´ve got to leverage the technologies that are already appearing into peoples´ everyday lives, the HDTVs, the DVD players, the cameras, the cell phones, the PDAs. Those technologies form the infrastructure by which we need to do next generation healthcare. We don´t have to build this whole home health infrastructure from scratch. We need to put new capabilities into these devices that many people are already carrying around with them—and will be increasingly buying and using. That is going to help change the game in healthcare—being able to rely on everyday consumer electronics to help with safety monitoring, disease detection, medication reminding, and wellness coaching. A recent vision video we put together at Intel details how technologies that are in people´s everyday lives can lead to freedom and independence for seniors and people of all ages with disabilities. All of the pieces in the video are actually things we are researching in our lab today. In fact, we just finished a small study of the devices seen in the vision video. The sensors in the cane ended up being hugely beneficial, because a lot of the people that we´re studying with cognitive decline forget to pick up their cane or use their walker when they get out of bed. They wake up thinking they´re still 40 years old and forget they even need a cane. We can do some fairly elegant, simple things technologically that just say, "Hey, don´t forget to use your cane" and try to prevent falls before they ever happen. A lot of this is low-hanging fruit. Much of this technology has been around for 15 or 20 years. My industry and the consumer electronics industry don´t pay attention to this, for whatever reasons. Part of what we have to do is educate researchers about existing opportunities to move products into the aging arena. We have to show that there is more to life than the youth market and digital entertainment. I want to just close by giving you a quick overview of some of the evidence-based technology research we´re doing on cognitive decline. We spent a year studying 100 households in four states across the U.S. with a wide range of cognitive decline, from full-blown Alzheimer's to vascular-based dementias, Lewy body dementia, and stroke recovery, so that our engineers who are, by and large, not yet facing disabilities in their life, can realize there´s a lot of people out there that need help getting dressed by themselves. Many people out there can´t remember the meds that they need to take, or even how to go about making a cup of coffee. I´m going to just give you one extended example from our study. Barbara is 59. She is diagnosed with unspecified dementia. We´ll come back to that because the differentiation of dementias and different kinds of cognitive decline is enormously difficult today. I was thrilled, by the way, to hear that Steven Tingus had funded some of the work on cognitive technologies at U.C. Boulder. I think that´s going to be an important step to help differentiate some of these forms of cognitive decline that plagues millions of U.S. families. Barbara was diagnosed after years of "weirdness," as her family put it, which was similar with my grandmother. We used to say about my own grandmother´s "confusion" that her blood pressure medication was just acting up. But it was probably ten years—way too late—before we ever sort of admitted to ourselves or noticed that she was having signs of dementia. Barbara´s husband, Jim, had to retire early from engineering to be a full-time caregiver. This upper middle-class family is quickly facing poverty because of the disease. Jim and Barbara are "spending down" their life savings frighteningly fast. The family is trying to keep her at home, but the daily challenges are stacking up. Jim is so afraid of Barbara falling that he doesn´t even let her go out and walk, which means now she´s not getting enough exercise, which in itself is complicating for the disease. Intel is putting wireless sensors into the ends of canes to try to figure out not only whether the person is about to fall, but whether there are patterns in the changes of motion that you can collect. Can wireless sensors, over time, help us detect when this person is moving into a time period where they´re more likely to fall? Can we intercede, in the case of someone like Barbara, so that she is still free to take neighborhood walks? I should point out that these systems need to deliver just the right amount of assistance. Everyone that we studied was highly variable in their cognitive decline. On Tuesday, for example, one female participant was so far gone she didn´t know me from her husband. One Wednesday, she seemed totally fine, but by Thursday, she was having trouble dressing herself. The fact that we´re sending people once every 12 months for doctor visits that last only 15 minutes—15 minutes to diagnose the progress of their disease!—is pretty scary when you realize just how variable the health of these seniors can be. Intel is funding research at the Oregon Health & Science University to analyze the keystrokes of folks with cognitive decline who are still using a PC to see if we can look at changes in how they´re interacting with their PC keyboard on an everyday, natural basis as a potential indicator of the onset or the continuation of the disease. Similar studies are being conducted with remote controls and even video games. A lot of the seniors in our studies actually do use a PC and they play Freecell or Solitaire. We're actually looking at how they play the video game and the number of lost moves over time to see if that´s a better cognitive test than a once-a-year, 15-minute encounter at the doctor´s office. Another thing we´re doing is really trying to figure out is how to remind people like Barbara how to do ordinary tasks. We didn't know Barbara had any problems at all until she went to make coffee for us. An hour and a half later, she had not come out of the kitchen and was still standing there transfixed because she couldn´t determine the steps and sequences to making coffee. We´re using simple sensors, cheap Radio Frequency Identification Device (RFID) tags that are on the shelves at Wal-Mart and elsewhere, to try to develop a system that can say, "First of all, you´re becoming dehydrated. It´s 3:00 in the afternoon and you haven´t had anything to drink." With many of the patients that we studied, their physicians thought that their Alzheimer´s was progressing, but it was often dehydration causing their memory loss. Longer term, can technology help us intervene at the point at which someone is having trouble with an everyday task? In the case of someone like Barbara, it´s a TV system that says, "I think you're having trouble making coffee. Would you like some help?" And it tries to guide the person through that task step by step. Assistive technologies like these require much hard computer science and artificial intelligence (AI) research. Why haven´t those AI researchers being funded by the National Science Foundation (NSF) applied their intelligence to a domain like this? Their discoveries may lead to better science for their own field, and may lead to real products that could help all of us. For Barbara and so many of the people with early stage cognitive decline, name recognition was the first thing to go. They were terrified to answer the front door or the phone, not because they can´t function any longer, but because it´s embarrassing not to know who is on the other end. At my lab at Intel, we´re collecting sensor data about how much time they´re spending with other people and how much time they´re using the phone. We´ve developed basically a "caller ID on steroids´ system that shows on the screen who is calling, as well as a social network map of other people they know in common, because a lot of times they still don´t remember the name or face when they see a photo. Most importantly, the system prompts them to let them know the last time that they spoke to these people and what topic they talked about. Some of our study participants would call their adult child at work 8:00, 9:00, 10:00, 11:00, 12:00, 1:00, not remembering they´d already called. This system, when you dial out, says, "do you realize you´ve called your adult child at work today five times? Here´s what you talked about." By the same token, many of the families that we observed each thought the other brothers and sisters were calling in to check on Mom, when actually the phone hadn´t rung in a week. In this case, we´re just using simple technologies to say to boomers, "Here´s a way to visualize your Mom´s social network. You can see who´s been interacting with Mom and Dad. You can know whether or not the phone´s been off the hook." The goal is to increase the social health between the households. These ideas—the early research prototypes I´ve shown you today—may not be the right answers to our age wave crisis or for Alzheimer´s. They are simply possibilities. Intel´s goal with CAST is to assert that even if we don´t have the right answers here, at least we should be asking the right questions and exploring possibilities. We should be asking "How can we promote freedom and improve the quality of life for seniors and their caregivers while somehow reducing healthcare costs? How can home health and aging-in-place technologies deliver upon the promises of preventive care, early detection, improved compliance, and remote caregiving? How will our nation prepare for the epidemic of disability that will accompany the coming age wave?" I hope the rest of you will work with us to get the right answers to these challenging questions. Thanks. |
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