Develop Technological Interventions to Overcome Barriers to Independence and Community Participation

TASK GROUP DESCRIPTION

Background

Technology has and will continue to affect people in different settings with different levels of functioning. The setting may be at home, providing personal support and help for daily living. It could be a neighborhood, where the systems help a person to engage in community activities. Or it could be more societal, where a person commutes to work and contributes to society through employment. In each setting, technology may provide different forms of functionality: enhancing dexterity and mobility, helping with some home chores, supporting aspects of memory, coaching through particular job functions, and helping to drive vehicles, for example. In other words, technology may touch almost all aspects of human living.

Initial Challenges to Consider

  • Identify technological interventions needed for people to continue to live active lifestyles and to support healthy aging with a disability.

  • What are the barriers (social, cultural, socioeconomic status, policy, clinical) to using current and future technologies?

  • Where can technology be applied most effectively for education, monitoring, health promotion, and to enhance quality of life?

  • How do we effectively build teams to create new technologies



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Develop Technological Interventions to Overcome Barriers to Independence and Community Participation TASK GROuP DESCRIPTION background Technology has and will continue to affect people in different settings with different levels of functioning. The setting may be at home, provid- ing personal support and help for daily living. It could be a neighborhood, where the systems help a person to engage in community activities. Or it could be more societal, where a person commutes to work and contributes to society through employment. In each setting, technology may provide different forms of functionality: enhancing dexterity and mobility, helping with some home chores, supporting aspects of memory, coaching through particular job functions, and helping to drive vehicles, for example. In other words, technology may touch almost all aspects of human living. Initial Challenges to Consider • Identify technological interventions needed for people to continue to live active lifestyles and to support healthy aging with a disability. • What are the barriers (social, cultural, socioeconomic status, policy, clinical) to using current and future technologies? • Where can technology be applied most effectively for education, monitoring, health promotion, and to enhance quality of life? • How do we effectively build teams to create new technologies 

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 THE FuTuRE oF HuMan HEalTHSPan to incorporate broad scientific and technological expertise and include consumer/caregiver participation? • What are the areas in which technology is most needed: personal assistance, caregiver assistance, mobility, cognition, perception, awareness, sensation, vocation? • How can universal design principles be applied to increase technol- ogy acceptance and diffusion? • How can advances in robotics, artificial intelligence, rapid prototyp- ing, machine learning, materials science, computing, activity monitoring, and modeling, etc. be adopted to benefit older people and people with disabilities? • Develop tools/measures/metrics to assess the impact of technology on activity, quality of life, cost, community participation, and health (be- yond morbidity and mortality). • What are the critical biological and biocompatibility issues that need to be overcome? • Develop technological innovations that promote independence, community participation, and healthful living. Initial References Chavez, E., M. L. Boninger, R. Cooper, S. G. Fitzgerald, D. Gray, and R. A. Cooper. 2004. Application of a participation system to assess the influence of assistive technology on the lives of people with spinal cord injury. Archives of Physical Medicine and Rehabilitation 85(11):1854-1858. Collins, D. M., S. G. Fitzgerald, N. Sachs-Ericsson, M. Scherer. R. A. Cooper, and M. L. Boninger. 2006. Psychosocial well-being and community participation of service dog partners. Disability and Rehabilitation: Assistive Technology 1(1-2):41-48. Cooper, R. A. 2004. Bioengineering and spinal cord injury: A perspective on the state of the science. Journal of Spinal Cord Medicine 27(4):351-364. Cooper, R. A., R. Cooper, M. Tolerico, S. F. Guo, D. Ding, and J. Pearlman. 2006. Advances in electric powered wheelchairs. Topics in Spinal Cord Injury Rehabilitation 11(4):15-29. Iezzoni, L., E. McCarthy, R. Davis, and H. Siebens. 2001. Mobility difficulties are not only a problem of old age. Journal of General Internal Medicine 16(4):235-243. Leuthardt, E. C., G. Schalk, D. Moran, and J. G. Ojemann. 2006. The emerging world of motor neuroprosthetics: A neurosurgical perspective. Neurosurgery 58:1-14. Odenheimer, G. 2006. Driver safety in older adults: The physician’s role in assessing driving skills of older patients. Geriatrics 61(10):14-21. Parasuraman, A. 2000. Technology readiness index (TRI): A multiple-item scale to measure readiness to embrace new technologies. Journal of Service Research 2(5):307-320.

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 TEcHnoloGIcal InTERVEnTIonS Pearlman, J., R. A. Cooper, E. Zipfel, R. Cooper, and M. McCartney. 2006. Towards the development of an effective technology transfer model of wheelchairs to developing countries. Disability and Rehabilitation: Assistive Technology 1(1-2):103-110. Talbot, L. A., J. M. Gaines, T. N. Huynh, and E. J. Metter. 2003. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: A preliminary study. Journal of the American Geriatric Society 51(3):387-392. Trudel, T. M., W. W. Tryon, and C. M. Purdum. 1998. Awareness of disability and long-term outcome after traumatic brain injury. Rehabilitation Psychology 43(4):267-281. Winters, J. M. 2006. Future possibilities for interface technologies that enhance universal access to health care devices and services. In Medical Instrumentation: accessibility and usability considerations, 1st ed., eds. J. M. Winters and M. F. Story, pp. 321-339. Boca Raton: Taylor & Francis, CRC Press. TASK GROuP DESCRIPTION—GROuP A Rewritten by noah Barron, Graduate Journalism Student, university of Southern california (As stated in the preface, “Some groups decided to refine or redefine their problems based on their experiences.” This Task Group Description was rewritten by Noah Barron to reflect Group A’s decision to redefine the challenge at hand.) background Imagine for a moment the senior citizen of the future. She lives in a smart home that’s tailored to her every need, engineered to keep her healthy, active, and independent. Sensors tuned to her specific biometrics read her mood and whereabouts. The flooring is ready to dissolve into a cushioning gel in case she takes a potentially hip-shattering fall. The appliances wire- lessly talk to one another to cook her meals and automatically order more milk when she’s running low. All of these technological marvels serve a common purpose: to keep our senior independent. A residence like the one above would allow her to live on her own longer and delay institutionalization, perhaps indefinitely. Once a person is committed to nursing care, health and mental aptitude tend to rapidly decay. Staying out of that system and aging in place seems to be the key to living longer, healthier lives, explain senescence experts who study the mechanics of advanced-age living.

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60 THE FuTuRE oF HuMan HEalTHSPan But what exactly does independence mean? The task group defined the necessities of aging in place along the following lines: assistive technologies for the augmentation of healthy aging, for cognition and mobility, for the activities of daily life (basic and instrumental), for chronic disease amelio- ration, to alleviate social isolation, to lessen the burdens of caregivers and family, and to increase personalization of care. Any technology of the future should do all of the above in a way that doesn’t simply replace human care with mechanized care; rather, it should enhance the ability of a few humans to care for many while maintaining the strong social bonds that keep seniors healthy and mentally alert. The task group began with specifics. What ends a senior’s indepen- dence? Surprisingly, the tipping catalyst for institutionalization isn’t senile dementia or Alzheimer’s. It’s loss of toileting independence. In America, where most senior care is provided by family members, worn-out offspring often draw the line at cleaning up after their own parents. A 2003 study by the School of Public Health in Tampere, Finland, found that urge incontinence was the most significant predictor of coming institutionalization. When seniors can no longer make it to the bathroom in time, get on and off of the toilet by themselves, and maintain hygiene, their caregivers and relatives ship them off to the home, where the downhill slide of mental and physical deterioration accelerates rapidly. The first suggestion—perhaps more as a mental exercise than a literal technology—was to create a toilet that helps seniors on and off, reducing fall risk and lifting/hygiene work by caregivers. Using the toileting problem as a jumping-off point, what sorts of flexible solutions to independence problems can future technology provide? Initial Challenges to Consider First, the group set out potential barriers to creating new assistive prod- ucts for the senior citizen’s smart home. Is the technology ready? If not, how far down the line is it? What will it cost? How will it be tested? How will its efficacy be measured? Will it end up unused in the closet? Is it danger- ous? How will it communicate with other technologies? If it malfunctions, who will fix it? The answers to questions like this will determine whether a technology is actually viable. One way of parsing the problem is to think about it in terms of replacement technologies versus disruptive technologies. A replacement technology would be a better wheelchair that takes the place of an existing

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6 TEcHnoloGIcal InTERVEnTIonS wheelchair technology, whereas a disruptive technology would be one that fills a niche that was previously vacant and rapidly diffuses throughout so- ciety (e.g., iPod, BlackBerry, GPS). The group chose to focus on disruptive technologies because they offer the greatest opportunity for innovation as well as more complex responsibilities as the conceptual level for creating something that’s a genuinely beneficial idea (e.g., health benefits) weighed against ethical and privacy concerns. Additional References Collis, G. M., and J. McNicholas. 1998. A theoretical basis for health benefits of pet ownership: Attachment versus psychological support. In companion animals in Human Health, eds. C. C. Wilson and D. C. Turner, pp. 105-122. Hidler, J., and G. Hornby. nd. Gait restoration in hemiparetic stroke patients using goal- directed, robotic-assisted treadmill training. NIDRR project overview. http://www. smpp.northwestern.edu/MARS/Project2descII.htm, accessed Feb. 14, 2008. Krebs, H. I., N. Hogan, B. T. Volpe, M. L. Aisen, and C. Diels. 1999. Overview of clinical trials with MIT-MANUS: A robot-aided neuro-rehabilitation facility. Technology and Health Care 7(6):419-423. MacDorman, K., and H. Ishiguro. 2006. The uncanny advantage of using androids in cognitive and social science research. Interaction Studies 7(3):297-337. Matari´, M., J. Eriksson, D. Feil-Seifer, and C. Winstein. 2007. Socially assistive robotics c for post-stroke rehabilitation. International Journal of NeuroEngineering and Rehabilitation 4(5). Mori, M. 1970. The uncanny valley. Energy 7(4):33-35. Nuotio, M., L. Teuvo, J. Tammela, T. Luukkala, and M. Jylha. 2003. Predictors of institutionalization in an older population during a 13-year period: The effect of urge incontinence. Journals of Gerontology A—Biological and Medical Sciences 58:M756- M762. Stiehl, W. D., and C. Breazeal. Forthcoming. Affective Touch for Robotic Companions. Presented at First International Conference on Affective Computing and Intelligent Interaction, Beijing, China. Stiehl, W. D., J. Lieberman, C. Brezeal, R. Cooper, L. Knight, L. Lalla, A. Maymnin, and S. Purchase. 2006. The huggable: A therapeutic robtoic compational for relational, affective touch. Consumer Communications and Networking Conference, CCNC 2006. 3rd IEEE 2(8-10):1290-1291. Wada, K., T. Shibata, T. Saito, and K. Tanie. 2002. Effects of robot assisted activity for elderly people at day service center and analysis of its factors. Presented at 4th World Congress on Intelligent Control and Automation, Shanghai, China. Due to the popularity of this topic, two groups explored this subject. Please be sure to explore the other write-up, which immediately follows this one.

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6 THE FuTuRE oF HuMan HEalTHSPan TASK GROuP MEMbERS—GROuP A • Stephen Abramowitch, University of Pittsburgh • Rory Cooper, University of Pittsburgh • Clifford Dasco, Methodist Hospital Research Institute • Cristina Davis, University of California, Davis • Arun Hampapur, T. J. Watson Research Center • Maja Matari´, University of Southern California c • Hunter Peckham, Case Western Reserve University • Jonathan Wanagat, University of Washington • Mike Weinrich, National Center for Medical Rehabilitation Research • Noah Barron, University of Southern California TASK GROuP SuMMARy—GROuP A Summary written by noah Barron, Graduate Journalism Student, university of Southern california One possible disruptive tech solution for the problems of isolation and lack of independence for seniors aging at home would be assistive robotics. Enter our futuristic live-in nurse robot, the hypothetic centerpiece of tomorrow’s smart home. Picture Rosie, the Jetsons’ automaton maid, but specially programmed to care for older people. Instead of struggling to get in and out of bed unassisted, the robot could lift the old person in carefully. Changing sheets? Help up onto the toilet? No problem. Autonomous assistive robots could take the place of human live-in caregivers. And if something were to go truly wrong, such as a fall or a stroke, intelligent robots could give first aid and contact emer- gency services. But the value goes deeper than that, say scientists. One of the most deadly and tragic parts of aging is social isolation. Countless studies have shown that the more people and interactions you have in your life in its later years, the longer and healthier you live. For many, a wide social network of humans is not an option. Intel- ligent social robots could provide the interaction that old people need to stay sharp. Currently there are several robotics rehabilitation projects in develop-

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6 TEcHnoloGIcal InTERVEnTIonS ment that could bring robotics to the forefront of old-age care and reha- bilitation. It’s a surprising menagerie of robotic healthcare workers. What follows is by no means a comprehensive list of current assistive technologies; rather, it is a cast of potential characters that may populate the smart homes of the future. At this point we can only imagine the possibilities; an over- view of what is available today is helpful for that speculative exercise. The Massachusetts Institute of Technology (MIT) created Manus, a robotic physical therapy machine that rehabilitates stroke victims. Manus instructs them on how to perform hand exercises and assists them in moving their muscles if they cannot do so unaided. However, patient questionnaires from the project indicate that people liked working with Manus but would have preferred guidance from a human therapist. Over in Switzerland, medical robotics engineers are developing Lo- komat, a sort of mechanized lower-body robot suit that helps stroke and semiparalyzed patients relearn to walk by putting their legs and torso through the motions of a natural stride. Again, this technology exists pri- marily to replace the hard physical labor that rehab therapists do, lifting and manipulating patients’ bodies. University of Southern California social robotics researcher Maja Matari´ hopes that robotic integration in the home will be more personal c than lifting, washing, and helping. She imagines a world where robots pro- vide social and emotional encouragement as well as physical assistance. But we’re not there yet, she said. For one, Matari´’s autonomous robots have a strict no-touch policy c because their control software isn’t reliable enough to ensure they won’t hurt anyone. In other words, they can’t be trusted to follow Isaac Asimov’s first law of robotics: “A robot may not injure a human being.” “We have a no-touch safety rule because a robot strong enough to get you out of bed could crush you, could kill you,” said Matari´. c Matari´ and other social robotics engineers are keeping their robots c small so they can’t injure humans. “Why do you think all those toylike Japanese robots are tiny?” she said. “It’s to keep them weak.” Honest researchers admit that robotics and human interaction is still not terribly advanced. “Talk to anyone in robotics when they are not drunk and they will tell you the same thing,” Matari´ said. c For now, diminutive droids can offer encouragement, challenge pa- tients to rehabilitate themselves, and offer sensory stimuli to folks who would otherwise be shut in without anyone interesting to interact with. The current goal of social robotics, especially in the context of com-

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6 THE FuTuRE oF HuMan HEalTHSPan panion caregivers for the aged or the disabled, is to figure out exactly how to inspire that feeling of empathy in people. Ironically, the less convincingly humanoid the robot, the more likely people are to feel affection for it. In the words of Cliff Dasco, director of the Abramson Center for the Future of Health, Methodist Hospital Houston, “It’s the R2D2 effect— everyone likes him more than C3PO.” (In case you slept through Star Wars, R2 is the lovable garbage-can droid and C3PO is the annoying humanoid one.) One theory that was advanced in the 1970s is that there is a point where humanoid robots stop seeming like cute automata imitating people and start seeming like people with something hideously wrong with them. This point was called “the uncanny valley” by Japanese robotics engi- neer Masahiro Mori. The “valley” is the massive dip in the chartable empa- thy response people feel toward androids as they become more lifelike. The more human, the more we like them, until suddenly the robots start really creeping us out. He argued that the tipping point happens when a robot gets so close to humanlike that we stop focusing on its similarities to us and become fixated on its differences. It tilts its head strangely, speaks with a certain lack of warmth or has no ephemeral sparkle in its eyes. We stop thinking of it as an advanced robot and start to feel like we are chatting with an animated corpse. Mori thought that the uncanny valley is an evolutionary response that’s designed to tell us to steer clear of people with diseases or disabilities that could harm us. As such, some therapeutic robotics developers have moved away from near-human robot design to avoid falling into the valley, choosing to focus on assistive bots that are furry and cuddly. MIT’s Huggable robotic companion is a furry teddy bear intended for children’s therapy. It’s well studied that petting a kitten or puppy can lower your heart rate, reduce stress, lift your mood, and rehabilitate your social skills, but pet therapy often isn’t available because many patients have al- lergies, institutional or hospital rules may forbid pets—or simply because a troubled or motor-impaired patient would harm the animal. Huggable conceals an advanced set of instruments housed in its fuzzy exterior. Beneath the fur and silicone of Huggable, sensate skin sensors analyze the temperature and electric field of the patient who’s holding it, as well as how much pressure he or she is putting on the bear—indicators of health and stress. Cameras in the eyes, microphones in the ears, and an onboard wireless

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6 TEcHnoloGIcal InTERVEnTIonS PC connected to teleoperated controls allow remote therapists to observe how the patient is acting, talking, and petting it and servos in the face and neck give Huggable the ability to gently and silently move its head and make expressions in response. In short, it is nonthreatening, extremely cute, soothing, and can simulate affection toward the patient while relaying valu- able diagnostic information to the doctors. The Road Ahead Technologies such as those described above are just the beginning. As- sistive robotics is simply one avenue among many. The task group set out a rough chart of available assistive technologies for senior independence and plotted where they are now and where each is likely headed in the years to come, as well as obstacles faced and criteria for measuring success (Table 1). TASK GROuP MEMbERS—GROuP b • Lazelle Benefield, University of Oklahoma Health Sciences Center • Leon Esterowitz, National Science Foundation • Stuart Harshbarger, Johns Hopkins University • James Kahan, RAND Corporation • Russell E. Morgan Jr., SPRY Foundation • Margaret Perkinson, Saint Louis University • Thomas Zimmerman, IBM Almaden Research • Jane Liaw, University of California, Santa Cruz TASK SuMMARy—GROuP b By Jane liaw, Graduate Science Writing Student, university of california, Santa cruz As we catapult into the 21st century and beyond, it will take a village not only to raise a child but also to keep that child healthy into old age. Our neighborhood is no longer the few blocks or miles we traverse every day between work and home—it is the global society to which we belong, a world whose fabric is woven tighter every day. That we live in this ever-diminishing world is not news. We are re- minded of it constantly, as we read globalization and outsourcing stories. Yet it is not enough to recognize our changing universe; scientists must

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66 THE FuTuRE oF HuMan HEalTHSPan TABLE 1 Assistive Technologies for Senior Independence Technology Current Status Near Future Walkers, scooters, Automated cars, powered Adaptability aids motorized wheelchairs, exoskeleton iBot Socially assistive robots Demonstration, Robotic assessment of motivating rehab, patient health exercise, petlike toys Robotics and sensor Controlled No-contact autonomy, technologies environments, teleop caretaking teleoperation, surgery Biosensors Smart toilet, miniature Ubiquitous computing, mass spectrometer mobile diagnostic lab on a chip Cognitive augmentation Reminders (as on pill Unknown box), cognitive orthotics, text-to-speech Activity monitoring Motion sensors, cameras, Lightweight, wearable, radio freq identification, real-time behavior data extraction and recognition, alerting pattern recognition respond to it, and respond quickly. The scientist’s training is usually the antithesis of a global approach—the more scientific education one has, the more likely one is to be a God of Small Things, specializing in one tiny area of knowledge. While experts are of course necessary, the problems we face in the new world require us to zoom out and see every issue in its entirety. Aging is an especially ripe challenge for a multidisciplinary approach, since it cuts across many fields and affects everyone. Our group was charged with putting our collective minds and disparate backgrounds to a topic that let us dream far and dream big: How could we use technology to overcome barriers to independence for the aging? Before we could jump into discussions, we first had to define the scope of our question. If we are to talk about how technology might help the dis- abled, for example, what do “technology” and “disability” mean in this con-

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6 TEcHnoloGIcal InTERVEnTIonS Far Future Barriers Metrics Slim form-factor Cost, acceptance, safety, Market, the “thrown in exoskeleton miniaturization, power the closet” factor, other source pernicious outcomes Multifunction Cost, acceptance, the Market, closet factor, health technologies, human uncanny valley outcomes, quality of life contact Autonomous Cost, acceptance, the Market, closet factor, health manipulation, toilet uncanny valley outcomes, quality of life care/hygiene, moving people Nanotech, cellular Cost, acceptance, safety, Market, closet factor, sensors, autonomous miniaturization, power pernicious outcomes function source Neural implantation Innovation, lack of basic Cognitive performance, knowledge, interface quality of life issues, ethics Long-term trending Privacy, cost, acceptance, Health outcomes, market prediction, identifying data interpretation and value health risk predictors mining text? Are we thinking of technology as sophisticated engineering products like robots that can automate many tasks for the elderly? Or is it more? “Where does disability exist?” asked Margaret Perkinson, a medical anthropologist and associate professor of occupational science and occu- pational therapy at St. Louis University. “Disability is an interaction with a particular environment and the challenges that particular environment provides.” Russell Morgan, president of the SPRY Foundation, preferred a broad focus of disability. “In most minds disability is physical, but it could also be economic or cognitive. Low socioeconomic status is a disability, and technology can pull disabled people together.” The group ended up deciding that both disability and technology were flexible concepts best defined as broadly as possible. Technology would not just be robots and complicated machinery but also many tools—even sim-

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6 THE FuTuRE oF HuMan HEalTHSPan ple, existing tools such as pill grinders that promote easy pill swallowing—or health measures not typically considered technology, such as vaccines. Next, we asked what constituted a barrier to independence. Again, we decided the word could mean many things. The aging may deal with not only physical barriers such as hearing, vision, or physical dexterity losses but also barriers caused by poverty, lack of political clout, or lack of awareness about options. Often overlooked are societal attitudes that might create bar- riers, such as ageism, or prejudice against older people. This prejudice leads some seniors to avoid using devices that would advertise their disabilities, such as hearing aids. We concluded that technology developers should be sensitive to the need for their clients to maintain dignity. If the elderly do not want to let the world know they need hearing aids, then designers should create less conspicuous hearing aids, perhaps by making them look like cell phone earpieces. Older people are sometimes afraid of new technologies, and this atti- tude can also be a barrier. They might fear computers, for example, as being too complicated or impersonal. “A key point is making the products friendly for end users,” said Lazelle Benefield, a professor of gerontological nursing at the University of Okla- homa Health Sciences Center. We kept Benefield’s words in mind as we divided the technologies into three horizons—currently available, in development, or still a dream. We allowed ourselves to talk about both the practical and the far-fetched. The first horizon is full of what our team leader, Thomas Zimmerman, called “low-hanging fruit.” Zimmerman, an engineer with IBM Almaden Research Center, categorized these currently available solutions as generally low-tech, and not as widely used as they could be. In this group are the vaccines and pill grinders, as well as sensors to monitor falls or wandering, computer literacy, and so on. “With any technology there’s a real issue of access,” said James Kahan, an adjunct behavioral scientist at RAND Corporation. These first-horizon technologies are often not accessible to or are un- derutilized by seniors, an indication that experts in different fields should be communicating and sharing knowledge more. When he looked at our first-horizon list so far, Stuart Harshbarger asked, “Where in horizon 1 is active disease management?” Harshbarger, a system integrator with the National Security Technology Department at

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6 TEcHnoloGIcal InTERVEnTIonS Johns Hopkins University, added automated remote monitoring of blood pressure, weight, and glucose levels to the list. Zimmerman suggested repurposing existing technology for use by aging populations. Video games, such as Dance Dance Revolution or Wii games, that require players to be physically active could be tweaked so older players could enjoy using them for exercise. The group thought the idea of reappropriating technology was an efficient solution and could be applied in other situations as well. The second horizon comprises technologies that are right now in trial phase. The challenge with these emerging works is in picking and support- ing the winners and then paving the way for their distribution. That path requires jumping through hoops such as streamline testing, Food and Drug Administration approval, marketing, and liability issues. Some suggestions in this horizon are relatively straightforward to implement. Screening tests can be improved—such that colonoscopies are prep-free and comfortable, or diseases can be detected through the breath—and community areas can be designed to promote healthy lifestyles. Leon Esterowitz, program director of the Chemical, Bioengineering, Environmental, and Transport Systems Division at the National Science Foundation, suggested machines to assist patients with balance problems and robots to help the elderly exercise. Other second-horizon solutions face more complicated journeys to mainstream acceptance; before we can use nanotechnology and stem cells for cartilage rejuvenation, for example, there may first be years of policy debates. The third horizon of dreamscapes and science fiction lets us discuss high-risk, high-reward ideas without concern for their immediate feasibility. This was the realm of artificial intelligence brain implants to offset cognitive decline, artificial retinas, regenerated limbs and organs, robotic caretakers, and behavior-changing technology. In the last example the technology could be used with young people also, to eliminate addictions, reduce obe- sity, and increase exercise so they grow into healthy old age. As we got into the meat of the discussion, it became clear some people were more focused on specifics, some more on big picture generalities. Simi- larly, some leaned toward taking advantage of low-hanging fruit and some wanted to concentrate on projects that now exist only in the imagination. It took some time on the first day for the dialogue to meet in the middle. Kahan brought in the concept of the innovation cycle, which then be- came the basis of our brainstorming. In this cycle, science is only one piece,

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0 THE FuTuRE oF HuMan HEalTHSPan neither the beginning nor the end of the process. From the science we create products and technology that are then produced for public consumption. For the public to get their hands on the products, they must be aware of and have access to them. But the innovation process doesn’t end with the user. As Kahan re- minded us, “We have to consider all six points of the innovation cycle” (Figure 1). An important step that is sometimes neglected in the real world is user feedback that would improve the product so that it better meets consumer needs. And that feedback must be taken into account as scientific research continues. If feedback is so important in our model, how should it be collected? We segued naturally into a discussion of tools and measures. There were several possible measures, we concluded. User opinions could be solicited via websites, interviews, studies, and certifications similar to the Good Housekeeping Seal of Approval. Demand in the marketplace has always been a measure of success. Yet market forces need to be balanced with social justice needs, especially when health issues are in question. Gov- ernment policies would be an avenue to protect those needs. With our innovation cycle still in mind we envisioned the technology FIGURE 1 The innovation cycle.

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 TEcHnoloGIcal InTERVEnTIonS creation team as much more than just biological scientists and engineers. An innovation model that puts a premium on user feedback would include advocates for older adults, social scientists who study how people incorpo- rate technology into their lives, ethicists, policy experts, business people, and end-user evaluators, among others. It would be a team that looks at aging solutions from all angles. On the second day we gathered with group A. Zimmerman and group A’s representative took turns presenting our results so far. It appeared that we had taken a different tack from them—they focused mainly on informa- tion technology and robotics, while our broader definitions of disability and technology meant we were looking at many other areas. We agreed that the two groups would complement each other in the final presentations. From our brainstorming and flights of fancy came two concrete recom- mendations to push barrier-removing technology forward. The first was a Web-based clearinghouse that consolidates information on available tech- nologies for the aging and allows user input, a la Amazon.com or Netflix. This not only gives users a voice but also keeps the database current. The second recommendation was to organize and identify key par- ticipants for an international conference on creative ways of harnessing computer-based technology to achieve healthy aging. These technological tools would enable older adults (people 50-75 years of age) to improve their health and avoid diseases. Experts would share knowledge on cur- rently available technology, priorities for future developments, and fund- ing sources. Conference organizers could sponsor competitions for young scientists to develop innovative technologies. Our group gelled on the second day: though the atmosphere was still respectful, members were more comfortable in healthy debate. We had not expected, with just two days together, to build a miracle robot or even to delve deeply into any aspect of our challenge. We did, however, begin a conversation among scientists from various fields and practice harnessing knowledge from each participant to contribute to a greater whole. We de- fined a problem together and came to a consensus on approach. When Zimmerman presented our group’s findings on the final day of the conference, he referred to the “age tsunami” coming our way, due to the large group of baby boomers becoming seniors. It is a daunting challenge for researchers and policy makers, but perhaps there is a silver lining—perhaps we will finally expand our knowledge on aging and change perceptions of what aging should mean. In the 21st century we can no longer shunt the elderly to a corner and expect them to quietly fade away. As baby boomers

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 THE FuTuRE oF HuMan HEalTHSPan reach their golden years their voices will be heard loud and clear—and we must learn to listen and respond. Additional Reference Dethlefs, N., and B. Martin. 2006. Japanese technology policy for aged care. Science and Public Policy 33(1):47-57.