Age tech is changing the way older adults age in place

Baby boomers are entering their senior years in an unprecedented demographic shift, and the numbers are telling:

• By 2030, the entirety of the baby boomer population—all 73 million of them—will be 65 or older.
• Between 2015 and 2050, the proportion of the world’s population over 60 years old will increase from 12% to 22%.

Naturally with this trajectory, demand for services catering to the geriatric population will skyrocket. Coupled with the finding that older adults are adopting digital technology at rates comparable to their younger counterparts, it becomes even more relevant for tech companies to innovate and create digital solutions that are designed for seniors.

Dramatic advances in medical technology and treatment over the last few decades have increased survival rates and life expectancy corresponding to many conditions and diseases. This means that what may have previously been a fatal illness can now be managed as a chronic condition for many years through medication, physical therapy, radiotherapy, or surgery. Heart disease, cancer, and diabetes—all chronic diseases—are among the top ten leading causes of death in the US today, and advances in technology and medicine are helping patients more effectively manage and treat these conditions. For instance, from 2001 to 2017, the cancer mortality rate decreased by 1.8% and 1.4% per year among men and women, respectively.

Compared to other countries, more people over 60 years of age in the US are living solo or as couples. In fact, 73% of older adults in America live in this arrangement, compared to much lower numbers of 38% in the Asia-Pacific, 32% in Latin America and the Caribbean, 27% in the Middle East and North Africa, and 18% in sub-Saharan Africa. Without the social, emotional, cultural, and familial support that multigenerational households provided in the past, the kinship that humans need to thrive has dissipated: In 2018, the AARP reported that 35% of adults over 45 years old are lonely.

For decades, the nursing home has been the solution for children or relatives that were unavailable to care for their aging loved ones. The nursing home is deceivingly named—instead of the comfort that is associated with and integral to a home, the traditional nursing home features a much more clinical facility that is expensive and often understaffed and underfunded. In some cases, they don’t provide adequately stimulating levels of activity for seniors to feel engaged and independent. Instead, the ideal situation for many is to “age in place”—nearly 90% of people 50 years and older expressed a desire to age in place with caregiver support.

The US is woefully underprepared for the impending influx of seniors needing geriatric care. For starters, it is one of the few developed countries that doesn’t have a public, long-term care (LTC) insurance program. The only public program that covers LTC is Medicaid, but this is a need-based program that is largely limited to and biased toward institutionalized care, without standardized coverage for home- and community-based care. Many assume that LTC is covered under Medicare, but only Medicare Advantage plans contain coverage for long-term care. Navigating this coverage is a feat in and of itself. That people mistakenly believe that LTC is covered under Medicare is a problem because the high cost of LTC then comes as a surprise to them—the national daily average cost of nursing home care in 2020 was $255.

The diversity of living arrangements for older adults varies with age.

• 76% of those 65-79 and 68% of those older than 80 live in single-family homes.
• 17% of those older than 80 live in multifamily housing.
• In terms of multigenerational housing, adults ages 65-79 are more likely to live in their own house, while those over 80 are more likely to live in someone else’s.
• In 2016, 2.4 million older adults lived in group quarters, including in nursing homes.

Seniors want to age at home, but the reality of the situation is that their homes are often not built for the level of support and care that they need to be safe. Most individuals want to retain their independence, but physically, this is often challenging. Memory loss, feelings of isolation, and limited mobility hinder their ability to age in place without additional support. And additional support can be hard to come by: The mismatch between supply and demand is in part fueled by a shortage of in-home health aides, worsened by burnout from the low pay as well as physically and emotionally demanding work.

The pandemic has only exacerbated the shortage of both homes- and facility-based caregivers. Outbreaks in the first months of the pandemic hit nursing homes had—a combination of close living quarters and a vulnerable population. With the omicron variant, infections among workers led to staff shortages and a higher burden for workers, with reports of nursing assistants taking on 50 residents in one day, compared to the state-mandated staffing ratio of one nursing aide to eight residents. As a result of this shortage, the low appeal and high cost of nursing homes, and seniors’ desire to age in place, the burden falls to unpaid caregivers, often the women in the family, to bear this responsibility.

The other option for aging in place is to do so in communities. There is development in this sector to create opportunities for more seniors to integrate into a community that is equipped to meet their needs. One such example is the Village Movement, a grassroots organization that coordinates critical services for the aging. Another model in play is known as Community Aging in Place—Advancing Better Lives for Elders (CAPABLE). This program offers low-income seniors regular visits from a nurse, an occupational therapist, and a home-repair person over the course of four months. These pilot programs, in contrast with widespread but costly nursing homes, have limited scope and funding. But work is underway to get such programs covered under traditional Medicare, which would open up eligibility and access to millions of adults.

The historical lack of investment in senior care coupled with booming demand in the coming decades sets the stage for business development in this sector.

This all amounts to an underdeveloped infrastructure, both in caregiver power as well as in supporting services, to satisfy the demands of the unprecedented wave of aging folks wishing to live out their senior years in place. The backdrop is set for business development: Tech-enabled solutions are expanding rapidly and making for safer aging in place, driven in part by the COVID-19’s shift toward more remote care. The sector is growing quickly—projections estimate that the age tech market will reach $2.7 trillion by 2025.

One characteristic of age tech is its nuanced and broad-ranging scope, a consequence of serving the extremely heterogeneous senior population. Individuals at the same age may have dramatically different experiences of physical and mental health, a result of the decades of influence from varying degrees of clinical care and condition management, as well as social factors that vitally influence health.

According to The Gerontechnologist, the age tech market spans 15 categories and even more subcategories. Stratifying by functional themes, there are companies specializing in health and wellness, autonomy and independence, staying connected and engaged, and future planning. Age tech spans such a diverse scope of services in order to support seniors at every stage as they navigate changes in their health, living situation, and relationships with others.

Additionally, companies that are designing for older adults are acutely aware of the terminology associated with this population. The connotations of frailty surrounding the terms “elderly” and “old” reflect a broader cultural stereotype against aging, and as long as ageist views pervade society’s lens on the older population, it’s unlikely that there will be a neutral term that encompasses this life stage and linguistically satisfies everyone. Interestingly, in a survey that posed the question of whether 65 is considered old or not, the majority of respondents in the 18 to 29 age range said yes, while only 16% of respondents ages 60 and over said so. Seemingly, the older one gets, the less likely they are to think their age is considered old. So how are age tech companies marketing themselves to a population that doesn’t identify as the target demographic?

Since older Americans are more averse to the label “old,” it’s helpful to omit this term entirely. Rather than focusing on arbitrary age brackets, effective marketing campaigns shift the emphasis to the specific need the product addresses, without mentioning age. For instance, a shoe designed for the older American may emphasize that it is for the slower runner, without explicit mentions of age. This is what Nike did with their CruzrOne shoe. This also opens up opportunities to reach people outside of the originally intended consumer group. In this case, that would be younger people who may benefit from this kind of shoe—for mobile, rehabilitative, or any other reason. This marketing tactic applies to other products as well. Door handles with levers (as opposed to knobs) may help anyone with poor grip strength.

The same concepts that guide health and wellness for the general population also apply to caring for older adults, with some additional, more specialized needs. Concerns about falling and cognitive decline increase with age. Patient monitoring and medical alerting are also increasingly common for older adults, especially if they do not reside with others. Transportation barriers may exist, including limited access to a car or reliance on others for transportation.

Physically, falling and its associated health implications comprise many of the health concerns for the aging—it is the leading cause of injury and injury-related death in adults aged 65 years and older, with 28.7% of seniors in 2014 reporting falling at least once in the preceding 12 months. Health conditions associated with aging, such as weakening physical condition and impaired vision, further increase the likelihood of falling. The consequences of a fall can be dangerous. Take hip fractures, for instance: Each year, over 300,000 seniors are hospitalized for a hip fracture, of which 95% are caused by a fall. This can lead to serious complications that jeopardize health, and by extension, mobility and independence. There are opportunities at each stage—from the physical, cognitive, and social factors that affect the chances of falling, to monitoring and alerting loved ones and emergency personnel of the event, to recovering from the fall—to improve the care continuum for seniors.

For instance, Nymbl is an app-based fall prevention program for older adults, retraining reflexive balance through dual-tasking, or stimulating both the cognitive and physical aspects of balance. Companies specializing in fall prevention and safety also use AI-enabled real-time monitoring using cameras to assess causes of a fall (SafelyYou) and wearable belts that sense high-impact falls and deploy airbags to reduce impact on the hips (Tango).

Though age-related changes to the brain are considered normal, there are lifestyle factors that can mitigate cognitive decline. Companies like MindMate are designing to combat cognitive decline, using a multidisciplinary technique combining mental exercises, nutrition, physical exercise, and social interaction to promote healthy aging. This follows the holistic approach that the pillars of health are closely connected. Other companies for cognitive care include Mentia (dementia care) and Effectivate (memory strengthening).

In the event of a fall, the first priority is to alert both medical personnel and loved ones. Ideally, these systems are accurate at differentiating between high-impact falls that cause injury and low-stakes falls that don’t require emergency attention. FallCall Detect is an app that is paired with an Apple Watch, combines fall detection technology with an emergency response system, and is equipped with voice activation. Nobi’s smart lamps double as a functional, everyday item and a fall monitoring and alerting device. It also monitors air quality, detects smoke and carbon dioxide, and has an alarm system for burglaries. Safety monitoring technologies can also utilize motion detectors and video cameras that affirm if the senior is adhering to their daily routine. This brings a level of consolation to loved ones that may not be able to be present to check in with their older relatives. Also relevant here are general medical alerting technology, like Chirp and SmartWatcher.

These monitoring technologies fall under a larger umbrella known as remote patient monitoring. As its name suggests, the advantage of remote patient monitoring is that it tracks the patient’s health even outside the traditional doctor’s visit, providing uninterrupted longitudinal data about the patient and thus a baseline status to compare unusual incidents too. It is a continuous source for clinical data collection, such as blood pressure, heart rate, and blood sugar, which can be translated to functional data by looping in artificial intelligence and machine learning. This is especially relevant for patients managing chronic conditions—over 85% of adults 65 and older manage at least one chronic condition, and nearly a quarter manage more than one. Chronic conditions require ongoing medical attention, and the ability of RPM to capture ongoing data points is beneficial for identifying trends, recognizing abnormalities, and subsequently alerting the patient’s healthcare provider.

With technology and policy shifts brought about by the COVID-19 pandemic, virtual care (and specifically telemedicine) has become a popular and safe alternative to in-person appointments. It is a natural extension of the remote patient monitoring sector, by connecting patients to their healthcare provider from the comfort of their own homes. It also removes additional logistical barriers to accessing care, such as limited transportation options. Tembo Health is one such company focusing on providing virtual care for seniors, by serving senior care facilities, long-term care facilities, and retirement homes.

Transitioning into old age, whether gradually or suddenly—as may be the case with an unexpected health change—is jarring in many aspects, one of them being waning independence. Cognitive decline, which ranges from mild impairment to dementia, affects people to different extents and can complicate a person’s relationship with their autonomy. Someone with dementia, or the loss of cognitive function to the point of interfering with daily activities, may experience memory loss and psychological changes that make it difficult to care for themselves. Older adults with other limitations or situations, such as with their physical health, mobility, or social well-being, may also benefit from varying levels of support for their independence. Focusing on the social determinants of health, Papa is a company that connects seniors with other people for social connection and for everyday assistance. By partnering with employers as a benefit, also facilitates access for employees’ older relatives to these connections, recognizing the common generational duty in regard to caregiving.

Financial independence also contributes greatly to what those later years look like, but the preparation begins decades before retirement and old age. Silvur helps people over 50 years old navigate retirement by predicting how to present financial choices will impact future income and providing education about Medicare and social security. Though it is a generalization, researchers have found associations between cognitive impairment and low scam awareness. This presents yet another opportunity for age tech to fill a gap: EverSafe and Carefull protect against fraud in financial accounts and identity theft of older adults.

At their core, people are relational beings, thriving off of connection with others. Not surprisingly, quality of life in old age is in part reliant upon staying connected and engaged with others. In instances where older adults are uprooted from their homes and placed in assisted living facilities, nursing homes, or long-term care facilities, the challenge is transforming that new space into a safe and comfortable environment.

Robots are becoming increasingly common contenders for companionship. Cutii, Tombot, and Intuition Robotics have all developed their own robots to keep seniors company. Some of these digital advancements include features for engagement with the user’s health care team. The technology in this department has advanced tremendously; in fact, Tomboy has created the first FDA-regulated medical grade robotic animal for emotional support. For a more traditional approach, companies like Stitch connect members to each other through building online community and facilitating in-person activities.

As much as planning for old age dominates the discourse surrounding aging, there is still one more transition to arrange, one that doesn’t fully take effect until after death—wills, estate planning, and advance care planning. Clocr is a digital legacy planning company for online accounts and digital assets, helping users organize a plan for who can access and manage their accounts when needed. For those looking to familiarize themselves with the topics as a first step, Cake is a resource for navigating these momentous decisions, providing guidance on end-of-life planning, going through loss and grief, and exploring mortality.

Companies for other categories, including technology built for senior living, home care providers, healthcare providers, home caregivers, and housing arrangements, are listed in the airtable below.

With a number of startups achieving unicorn status, as well as the mergers and acquisitions in the past year, 2021 was a year of movement and growth for the age tech landscape.

• Honor’s recent acquisition of Home Instead is a pioneering move that pools together the largest senior care network with a leading home care technology platform to drive innovation for senior care. This move involves acquiring access to a hub of seniors, and thus, their expertise and perspective on all things related to age tech. Relevant to this is the push toward designing for seniors, with seniors in mind. Besides putting seniors in the spotlight, good design here must also closely consider their support circle, which could include their spouse, their children, and/or their paid caregiver. Just as accessible homes are physically designed for this population, intentional design during the formative stages of software development helps with uptake and usage down the line.
• Honor, Papa, and Alaya all achieved unicorn status. With factors on the population level colliding to create an opportunity for age tech companies to serve the needs of the senior population, these investment dollars point to a fast-developing marketplace, and this is just the beginning.

These digital solutions are not a full replacement for home- and community-based care. A person’s companionship is more than what a robot or a screen can provide, but at the very least, age tech is a cushion of sorts for older Americans dealing with the common structural challenges that society has imposed.

With a growing prevalence of monitoring technologies being implemented, questions about privacy and consent are extremely relevant. Especially in the situation that a family member installs a motion sensor and/or video monitoring device in the senior’s home, is it possible to verify that the person has consented to being monitored in that way? On one hand, installing a camera provides some level of solace to family members that aren’t able to always be present, but the tradeoff is the sense of privacy that seniors retain in their own homes. Similar concerns regarding data security are prominent for both personal health data and sensitive advance care planning documents.

Nevertheless, age tech is creating a safer, more prepared environment for our parents, ourselves, and future generations. Its development calls for a corresponding increase in vigilance and methods for securing data privacy. Caregiving, understood in the past from the perspective of multigenerational households and more recently through building communities for seniors, will continue to play a substantial role in the relationships we have with older adults, and it will now also be understood through the perspective of a digital lens.