adequate treatment. At the personal level, they contribute to preserving older adults′ health and well-being and support their oft-stated preference for remaining independent as long as possible. At the population level, their value lies in helping to compress morbidity, in keeping with the goal of Healthy People 2010 (U.S. Department of Health and Human Services, 2000) to increase the quality and years of healthy life.

Just as advances in science and technology converged to spawn invention of the health clinic in the 1700s,1 contemporary developments in these same arenas may herald the birth of a new era in which healthcare is increasingly based in the home and community, enabled by a range of pervasive, embedded computing and communications technologies. This evolutionary—if not revolutionary—shift from clinic-centric to community-centric healthcare will move us away from infrequent exam room encounters to everyday activities of health and wellness that put the burden of responsibility on an informed, proactive citizenry. This shift will likely coincide with revised notions of healthy aging. Traditionally associated with regular visits to the doctor to keep body parts and functions in working order, healthy aging may evolve into a more holistic process through which optimal function and life quality are achieved using an array of health-related technologies that augment human interaction and support.

But how will we get there? What kinds of problems need to be solved? How should we be conducting research to bring forth a new way of thinking about healthy aging? This chapter is about provoking questions more than providing answers—questions about how next-generation technologies should be designed and developed to support the needs of the next generation of elders. Here we express a perhaps extreme position in arguing for a shift to primary healthcare in the home—for a deep focus on aging-in-place technology research—as an antidote to the historical naturalization that put the clinic and the health professional at the center of our health and wellness universe. We ask, how can we develop evidence-based technologies for the home to enable better prevention, detection, adherence, and caregiving for the “age wave”? How can these tech-

1  

According to cultural theorist Michael Foucault (1973), the invention of the clinic in the eighteenth century changed the way we conceived of the body and its care. At that historical moment, biological science, the architecture of the clinic, and the treatment of health problems became mutually reinforcing cultural forces that mapped the human body into a divide-and-conquer grid of classified tissues, organs, and systems. This nosological carving up of the body—this “way of seeing” in John Berger′s (1991) terminology—was evident in the division of academic departments (cardiovascular, neurological, etc.), was reified by the architecture of medical clinics (cardiology wing, brain unit, etc.), and became the normal way of doing the business of caring for one′s health.



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