The Dawning Age of "Silver Tech"

Networked devices that keep tabs on at-risk elderly patients living at home could soon provide better care -- and cut costs

At the end of June, 11 pairs of elderly adults from Portland, Ore., and from Las Vegas became lab rats. A team from the world's largest semiconductor maker, Intel (INTC ) descended on their homes and stuck special chips and sensors onto their chairs and beds. The sensors were then connected wirelessly to a laptop, which was loaded with solitaire, but was there to play a much more serious role in this game.

Over the next three to six months, the laptop will notify the retirees' caregivers and Intel researchers whether the seniors, who suffer from cognitive decline, have stayed in bed at night, have gone to the bathroom, and visited the kitchen. The idea is for the caregivers to know just when they need to intervene. The sensor network could, potentially, allow the seniors to live independently longer in their own homes, says Eric Dishman, manager of the proactive health research group at Intel. And that's something both these folks and their health-care providers want.

Welcom to the dawn of the "silver tech age," when chipmakers, software developers, medical-device manufacturers, and network suppliers focus their smarts and growth plans on helping the elderly where they live. Until now, most efforts have been aimed at improving care within hospitals and doctors' offices. Now the focus is shifting to the home -- and for good reason. Surveys show that 95% of older adults want to live in their own home for as long as possible.


  That suggests they would be willing to pay for technologies that can keep them out of senior residences and convalescent hospitals. Intel's Dishman says he has received more than 50,000 e-mails in the past six months from baby boomers wanting to buy Intel's wireless sensor network for their parents' homes.

Health-insurance companies support at-home care as well, hoping it will help keep medical costs from snowballing. The rule of thumb: Each additional year of life increases health-care costs by 3%, says Rich Ostuw, principal with management consultancy Towers Perrin. And the U.S. population is aging: The number of Americans aged 45 to 64 increased 38% during the past decade, according to the AARP.

Health-care costs already account for 15% of U.S. gross domestic product, and they could reach 20% within a decade. "It is clear that with the retirement of the baby boomers, the existing way of delivering health care is unsustainable," says Kent Larson, director of House_n: The MIT Home of the Future research project at the Massachusetts Institute of Technology. "The gravity of health care will shift from the hospital and clinic to the home."


  The idea is often referred to as "self-care." Essentially, the patient will use at-home medical technology and supplement that by getting help from their social network -- children and friends -- reducing doctor bills and hospital stays. Many studies by the likes of Kaiser Permanente show that at-home technologies can reduce health-care costs by 20% to 30%.

That's the theory, at least. Many of these technologies still have to be perfected. At-home monitoring could also raise a hornet's nest of privacy issues over who can access the medical data and when. Experts believe, however, that many older adults will be willing to opt for less privacy in exchange for living independently longer.

If they're right, that could prove to be a major market opportunity for a wide range of companies. Utilities and phone and cable companies could, potentially, offer remote monitoring services, says Larson. Consumer-electronics and components makers like Koninklijke Philips Electronics (PHG ) of the Netherlands are developing cell phones with embedded biometric sensors that can take their wearers' vital signs and beam them to their doctors. These might become commercially available within several years.

The total medical-devices market could jump from $293 billion in 2002 to $450 billion in 2007, figures analyst Bill Martineau of market researcher Freedonia Group in Cleveland. And at-home gear will be a major engine behind that growth.


  Innovative startups are already piling into the market. New-York-based Living Independently (LI) offers infrared motion detectors to accomplish what Intel has set out to do, if only a bit more crudely. Its systems report abnormalities -- such as no movement at the house for a prolonged period of time -- to a caregiver's pager, cell phone, or e-mail account. And though LI began selling its $59.95 to $89.95 monthly service (the initial cost to install the hardware is $298) only four months ago, it should turn profitable by yearend, says co-founder George Boyajian. LI already has hundreds of customers.

The home-monitoring technology will grow in sophistication and capabilities. LI's sensors also measure and report temperature within the house. By late 2004 or early 2005, the company plans to begin providing caregivers with readouts from the resident's glucose monitor, blood-pressure monitor, and scale, Boyajian says.

Companies like Intel and health-care instrumentation maker Siemens Medical, a division of Germany's Siemens (SI ), envision a smart home that will eventually collect and analyze data on its owner's well-being unobtrusively and automatically, while the user goes about his daily life. This smart home would sound an alert if its resident falls down and can't get up. During a favorite TV show, it would pop up a reminder for the patient to take a pill. Using voice commands, the system would walk an Alzheimer's patient through the process of preparing a meal.


  In the future, all devices within the home will also adjust to their users' special medical needs. Already, Intel has developed a phone for Alzheimer's sufferers that displays a photograph of the caller, shows an explanation of the caller's relationship to the patient, and offers a brief summary of a prior conversation with that person. For these patients, who are often embarrassed to pick up the phone because of their memory problems, "it's the difference between going into deep isolation and social interaction," Dishman says.

Some at-home medical devices will actually simulate interaction. In early July, 15 elderly adults in South Boston will begin a trial of a virtual exercise adviser. The animated adviser's name is Laura, and she looks a bit like Cameron Diaz but has dark hair, eyes, and skin. Developed by Tim Bickmore, assistant professor at Boston University School of Medicine, Laura resides on a computer. In synthesized voice or text, she asks questions, like how much the patient walked today. The user responds via a touch screen. Eventually, Laura will learn to recognize speech, and she might also consult users on, say, which food to pick at a restaurant.

What's special about Laura is that her responses are based on an empathy software program. The animated figure shifts her eyebrows and smiles appropriately. So if you keep beating yourself up for not walking yesterday, she'll murmur an encouraging word. In the South Boston trial, Bickmore is trying to find out if Laura can improve the elderly's sense of happiness and reduce their loneliness.


  The smart home also could help prevent medical crises. Nowadays, many people don't go to the doctor when they aren't feeling well, and then they become seriously ill and wind up in the emergency room -- with a big bill. Today, 3% of patients with serious health conditions account for some 40% of total health-care costs.

One way to reduce hospital visits is by monitoring patients at home who are at risk. For instance, health-care powerhouse Abbott Laboratories (ABT ) is developing a special monitor for the parents of children with diabetes. The monitor, likely to become available within a year or two, will amplify a warning set off by another device that's on the patient's arm, monitoring glucose levels. That way, if a parent is in a different room, they can still be alerted to any problem.

Another approach is telemedicine, which involves providing health-care services over the telecom network. Some hospitals are starting to implement special scales, which measure a heart patient's weight and report it to a nurse daily because when heart patients get worse, their bodies begin retaining huge amounts of water. In case of a weight spike, the nurse would call up the patient and recommend, say, an adjustment to the dosage of a drug to avert a heart attack.


  Besides benefiting the patients, this approach can drastically reduce demands on a doctor's time. Here's an example: Patients who carry implantable defibrillators, which normalize the heart rate, have to visit their cardiologist four times a year. But a reader from medical-device giant Medtronic (MDT ) allows the patient to run the test in his home and then e-mail the results to his doctor. By avoiding unnecessary chit-chat, the doctor can handle three times as many patients, says Dave Scheffler, director of Medtronic's remote-sensing device management business.

It's not just data that doctors can view remotely, but images too. Brigham & Women's Hospital in Boston runs a special videoconferencing program for post-operation breast cancer patients. The hospital now releases the patients a day or two earlier than before and gives them a PC with a video camera. While at home, they can show their wound to their nurse and consult with the nurse online, live -- reducing health-care costs in the process, says Joseph Kvedar, vice-chairman of dermatology at Harvard Medical School and president of the American Telemedicine Assn.

The key here is to keep the communication with the doctor two-way. Brighton (Mass.)-based PatientKeeper has developed special software allowing patients to use their cell phones and PDAs to access their medical records at the doctor's office. Problem is, today the vast majority of medical records are available only on paper. But that's expected to change as soon as various agencies agree on a definition of what constitutes an electronic record and figure out how to ensure its security.


  For all this medical technology on the market and in the labs, the health-conscious home is still a work in progress. At-home devices need to become smaller and easier to use, says Ben Schneiderman, an interfaces expert at the University of Maryland in College Park. Already, biotechnology giant Roche is developing a next-generation CoaguChek device -- which tracks the thickness of a patient's blood -- that's half the size of the existing gadget and contains only one button instead of several. And the smart home has yet to become clever enough to differentiate between the movements of a patient and, say, a pet.

However, the biggest roadblock may be that patients will prefer the personal touch and feel they can't do without talking to their doc face-to-face. As health-care costs keep mounting, though, patients may be forced to change, turning instead to the helping hand of silver tech. "Things are definitely moving in that direction," says Robin Cisneros, director of technology and products for Kaiser Permanente. Indeed, high-tech at-home care could soon become a fact of life.

By Olga Kharif in Portland, Ore.

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