Is tech inventing for the inventors? Gil Bashe, Health Tech World special correspondent, examines the issue of the digital divide
To be digitally left behind is the new loneliness. Most of us use mobile communications technology for banking, shopping and social contact. But more and more, seniors struggle. If it is a bit of a puzzle for them to figure out their television remotes, just think how difficult it is for seniors to use the features of the new Apple iPhone or Samsung Galaxy, swiping up or down and double-clicking to download. For many, it’s mission impossible, but failure to master these portals to digital connectivity is to be shut out of online commerce, prevented from accessing your money and information, and out-of-touch with family and friends.
More than being lonely, being stuck on the wrong side of the digital divide is also dangerous. Seniors who enjoyed a social outing to their bank or pharmacy prior to COVID-19, were unable during lockdown to access money, medical records or insurance; interact with their pharmacy to renew prescriptions; or talk virtually with their healthcare providers and family members. Suddenly, they were finding their health and wellness at risk.
It is estimated that some 80 million U.S. citizens will join the ranks of those 65+ by 2040. The worldwide numbers are staggering; the elderly community is projected to double globally to 1.5 billion in 2050.
According to the Pew Research Center in 2019, some 41 per cent of people 65 or older – that’s 22 million people out of 56 million in the U.S. – do not even have wireless broadband access at home, a figure confirmed by the US Census Bureau’s American Community Survey, conducted just before COVID-19 rocked our lives. Even if infrastructure legislation ushers in more accessible broadband, lack of computer literacy and digital disparities among the elderly will continue to grow wider and hamper their ability to connect.
This problem is common among developed nations. In their report for the Cambridge Centre for Housing and Planning Research (CCHPR) at the University of Cambridge, Drs. Hannah Holmes and Gemma Burgess, researching digital exclusion, write:
“Digital exclusion is yet another manifestation of the profound inequality which casts its shadow over the United Kingdom (UK). For the people on the wrong side of the digital divide, the disadvantages associated with being unable to access or use IT have never been more pronounced. The pandemic has already changed the way we interact; it looks set to have a lasting effect on the way we communicate. Unless digital exclusion is taken seriously and addressed, millions… will yet again suffer the consequences.”
Not-for-profit advocacy groups have entered the scene to champion seniors’ digital literacy cause. Groups such as OATS (Older Adult Technology Services) are in the forefront of helping seniors learn how use technology to live more engaged lives in the digital age. It’s a positive step, but not enough. We may be rushing to reboot our face-to-face connections, but must not forget the frantic urgency of the pandemic’s earlier days, when ordering household essentials or securing food-delivery timeslots was all digital – and digital it has stayed for millions. Being tech savvy is now connected to survival, and ensuring that seniors have digital literacy is among the looming challenges that payers, pharmaceutical companies, policymakers and third-party patients advocacy organizations must overcome in order to improve seniors’ health outcomes.
Keeping the elderly well is not only the right, compassionate thing to do, it’s also a matter of mutual self-preservation. In North and South America, non-communicable diseases —including cancer, cardiovascular disease, chronic respiratory illness and diabetes—result in seven out of 10 deaths among people aged 70 and older and cause untold suffering. The cost of managing these controllable and often preventable conditions results in runaway spending. Digital communication is the bridge that connects the healing system with people seeking to avoid illness. If you cannot make that connection, you lose both that link to the system, and, likely, your life.
While smart phones have become a portable lifesaver for most of us, especially during COVID-19, seniors living on planned budgets and already having access to a home computer see cellular bills as a household expense to avoid. For many older people, smartphones are daunting – the screen and text are too small, the interface too complex, and the leap from flip phone and desktop computer to smartphone is not as intuitive as tech UX professionals believe it to be for seniors. The tech industry needs to do a better job of increasing accessibility for the elderly; it feels at times that technologists are inventing for the inventor, not the seniors who find it increasingly challenging to use their inventions.
But seniors who cannot transition to smart phones now find themselves trapped in a world where even being moderately tech illiterate is to be disconnected. Both health-ecosystem and health-tech innovators need to up their game when it comes to instilling tech competency among seniors.
A recent Monitor on Psychology article,“Optimizing Tech for Older Adults,” includes prophetic words from Wendy A. Rogers, PhD, head of the Urbana-Champaign program CHART (Collaborations in Health, Aging, Research and Technology). Rogers reminds technology leaders: “I can’t emphasize enough that technology’s purpose is not to do away with human support, but rather to enhance what is possible.”
Since COVID-19 swept into our lives, we have seen the rise of telehealth as an essential pathway to patient-physician interaction. The boom of companies such as VyTrac Health that offer access remote patient monitoring mean that providers can easily track peoples’ emotional and medical vitals. Smart technology such as SafelyYou can monitor physical stability, analyze movement using artificial intelligence to prevent fall risk. But technology is never a replacement for human touch, compassion and care.
It’s a given that older adults were more likely to get very sick from COVID-19. Real concern about them led to recommendations that created more distance between seniors and their families. While social distancing, hand washing, masks and, eventually, vaccinations, enabled many of us to maintain outside world contact, older citizens stayed on high alert and behind safe walls, even if they were vaccinated.
Recognizing COVID-19 risk to the elderly, many senior care facilities quickly locked down, limiting outside visitors and installing plastic shields in order to protect residents. But for too many seniors living independently, social distancing meant isolation from friends, family and their extended healthcare team. While COVID-19 risks are very real, social isolation leads to cognitive decline, mental health risk and reduced access to timely medical care. It’s not enough to have digital technologies at hand; care communities and families must recognize that tech innovation must match people’s abilities to tap into its potential.
Post-acute care and senior-care sector leader Alex Markowits, founder, president and CEO of Spring Hills, a 35-site care facility, says:
“Yesterday’s technology is old technology, so we’re always seeking to upgrade. A decade ago, we used sensors to evaluate residents’ personal care patterns. The data would offer a baseline on their behavioral health, and that helped us engage quickly if something changed. Now, we’re expanding into population health, the force multiplier for making sure we support people who need us, to anticipate risk. Whether it’s artificial intelligence or wearables, treatment approaches and technology used for those needing post-acute care and long-term residents needs to be state-of-the-art. At the same time, we need to be state-of-the-heart. Technology must support care. It’s never a replacement.”
Lack of digital access and literacy is a social determinant of health among the elderly, and we must recognize that it’s a health disparity as real the racial, gender-based and economic health disparities that we already see and must commit to tackle. As the developed world seeks to leverage technology to ensure greater remote diagnostic power and access to care, lack of both residential broadband and uncertain digital literacy among the elderly is a gap in care that deserves our full attention. Regardless of our age now, we all hope to be counted among the elderly at some point. Only by committing to prioritize this public health issue now will we ensure that old age is healthier for all of us. As the adage goes: “You reap what you sow.”