Julia Scott

Posts Tagged ‘Future of You’

Senior Tech Moves Beyond “I’ve Fallen And I Can’t Get Up”

Tuesday, September 19th, 2017

Berkeley resident Janis Bordeaux lost her dad to a fall this summer.

John wasn’t frail. At 84, he was still the kind of man who never stopped building and making things. The summer before his fall, he was sanding the floor.

But by the following summer, John’s health had declined. He was having problems with his heart and his weight, and he was taking 12 medications every day. He had no history of falls, but as Bordeaux watched her dad grow weaker, she became more and more worried that he could stumble or slip and hurt himself.

When her parents, who also live in Berkeley, decided to spend the summer at their second home on the New Jersey shore, John suffered his first fall. He wasn’t seriously injured, but a few days later, he fell again.

“I feel like falls are the thing that will take you out nowadays, because pharmaceuticals are extending your life into what seems like an unnatural range,” Bordeaux reflects. “That could just be someone trying to make peace with their dad dying from something that seemed preventable. But on the other hand, he was getting so weak that a fall was bound to happen.”

It wasn’t the second fall that killed her dad. Or the third. Bordeaux’s dad fell four times that week.

The last two falls happened on the same day. He died shortly after.

The saddest part is that, statistically speaking, John’s story is so common. More than half of all elderly falls happen in the familiar surroundings of home. There are often warning signs well in advance, such as muscle weakness or gait imbalance. When your muscles are weak, it’s hard to stop yourself mid-fall. And most older adults who have fallen, or feel unsteady on their feet, don’t tell their doctors about it, according to the CDC.

Advice on how to prevent these traumatic falls has not changed much over the years. Experts say seniors who are unstable on their feet should invest in some easy home renovations to minimize slipping or tripping, such as better lighting, fewer rugs and more handrails. It’s important to talk to your doctor about your symptoms and, if needed, have your medications adjusted. The National Council on Aging recommends several evidence-based fall-prevention exercise programs for seniors, including Tai Chi, which is proven to increase balance and strengthen leg muscles.

Seniors work out as part of a community-wide event on LaCrosse, Wisconsin. (CDC)

But that’s pretty much it. As any concerned caregiver who has Googled “how to prevent senior falls” on behalf of a loved one is aware, the preponderance of helpful online resources all cover similar ground – annual physicals,  eye exams, eating vitamin-rich foods, exercise and removal of safety hazards.

In spite of these efforts, 29 million Americans over 65 reported falling in 2014, with 7 million of those falls leading to injury, and direct medical costs of $31 billion annually. Falling once makes you twice as likely to fall again.  And falls are the leading cause of death by injury for older adults.

Cancer is hard. It’s a hard problem. Preventing falls should be easy. Right?

If it were easy, we would be doing a better job of it, says Sanjay Khurana, Vice President of Caregiving Products and Services at AARP.

“As a society, we recognize that falling has a huge impact on degradation in quality of life,” he says. “One in four older adults falls every year, and less than half actually tell their doctors about it.”

The whole world is getting older -– fast. And those demographics are about to make this crisis into a calamity. A 2007 report from the World Health Organization lays it on the line: “The economic and societal burden of falls will increase by epidemic proportions in all parts of the world over the next few decades.” If countries, governments and communities don’t develop a coherent strategy to combat senior falls “in the immediate future,” the WHO projects the number of fall-related injuries will be 100 percent higher by 2030.

Old-School Tech No More

The one thing none of the government reports and websites mention is technology. Which is odd, considering senior falls have always been associated with a certain personal medical technology still in widespread use today. It goes by different names, but the iconic brand is LifeCall, whose infamous 1980s TV advertisement — “I’ve fallen and I can’t get up!”-– has launched a thousand punchlines. Not to mention inspired countless satires, from Urkel to Pokémon.

Here’s how it works: You wear a pendant or a wristband that you push to call an emergency responder when you fall. When they pick up, you can talk to them through a speaker installed in your home (provided you’re close enough for them to hear you, and conscious enough to push the button).

It seemed like a pretty impressive innovation when it was introduced in 1974. But now, we have the technology to do better, says the AARP’s Khurana. Way better.

Khurana has been keeping an eye on wearable and home-based sensors. Some can “see” through walls and discern whether an elderly person may be in distress, or allow you to check in on your parent or grandparent remotely by reporting on where they are and whether they’ve been having trouble walking lately.

Others can help you improve your balance with personalized exercises via smartphone sensing (or an at-home scale), or light the way to the bathroom at night – without requiring a verbal command.

Khurana has made it his mission to persuade industry there’s a financial upside to investing in fall prevention. He’s confident that when entrepreneurs and investors realize how big the market is –- the AARP says $2.9 billion for safety monitoring and fall-prevention tech alone –- the rate of innovation will kick into high gear.

The AARP did its part to goose the market this year with the Fall Prevention Innovation Challenge, a worldwide product search with some serious prize money attached. The first-time partnership with OpenIDEO and UnitedHealthcare attracted 205 design ideas from 90 countries. The competition launched in February and concluded in June.

The $50,000 top prizewinner (which judges dubbed Most Viable Solution) was Luna Lights, an automated lighting system that is activated when someone gets out of bed at night. It wirelessly lights the path along frequently traveled hallways toward, say, the bathroom or the kitchen. When the user gets back into bed, the lights snap off. Over time, cloud-based analytics compile habit data to signal to a caregiver that the elderly user may be spending extra time in the bathroom or wandering the house at night, which could suggest an underlying medical issue.

The competition’s $25,000 Most Promising Idea winner was Path Feel, a smart insole that vibrates in several pressure points when the foot touches the ground. The idea is to help older adults (or people with neuropathy, Parkinson’s or multiple sclerosis) improve their balance in real time by helping them feel their feet on the floor. The company says it’s aiming to launch the product in 2018. Its built-in gyroscopes and oscillometers transmit data on gait patterns to an app that physical therapists and caregivers can use to measure progress.

Down the road, all that data could give rise to a new way to map the gait characteristics of, say, a 65-year-old diabetic against a larger dataset of “healthy walkers,” which could eventually help create algorithms for being able to detect certain symptoms and contribute to developing new diagnostic methods.

“As we age, we start changing our walking,” says Lise Pape, founder of Walk With Path, the UK-based company that invented Path Feel. “For instance, we start taking shorter steps. There’s indications in the literature that you can use walking to identify early onset Alzheimer’s and Parkinson’s.”

El Camino Hospital in Mountain View, California, is already using predictive technology to reduce falls. A system made by Qventus combines data from patients’ electronic health records with call-light and bed-alarm data to alert nurses that the patient is at high risk of a fall. The staff can then implement additional monitoring, including the use of video, and intervene if the patient is going to attempt to stand. In April, Chief Nursing Officer Cheryl Reinking said the hospital saw a 39 percent decrease in falls over the first six months the system was in use.

The Missing Ingredient: Dignity

One reason that more modern apps and gadgets aren’t on the market: When it comes to wearable tech, seniors are a challenging population to design for.

“The vast majority of products we look at have major flaws,” says Richard Caro, a San Francisco-based scientist/inventor. “They’re basically designed with some 20-year-old audience in mind, not an 80-year-old audience.”

Caro organizes the Longevity Explorers, an online and in-person community of people over 70, who meet up to talk about aging and test out new senior tech gadgets.

The Longevity Explorers test out different lighted canes. (Richard Caro)

The products typically fall into one of two categories, he says. Either they solve a problem users don’t think they have, or they solve a problem people do have, but the solutions are so poorly implemented they’re not that usable.

For instance, the products will come with instructions in tiny gray type or they’ll have buttons that don’t work well with shaky hands. On the other end of the spectrum, some products are so simple and dumbed down that they don’t offer the user interface and normal functionality people need.

“A lot of people buy them and don’t wear them,” says Caro. “While the devices are pretty useful, they are mostly rather ugly. They look like you’ve escaped from the hospital.”

Sanjay Khurana has heard those objections, too –- from his own mother, who lives in an independent living facility. He gave her an emergency pendant to wear, but she doesn’t like it.

“And I asked her, ‘Mom, why don’t you wear this?’ She goes, ‘I wouldn’t be caught dead with the device.’ Because it requires you to wear it around your neck, it signals to the rest of the world that you are in need of help.”

He says design could make the difference.

“If the same product could be designed with a little more dignity, you would wear them, right? Maybe if it was a better-designed pendant, or a wristwatch. A smartwatch could integrate that.”

At least two companies are attempting just that. One is GreatCall, which makes the Lively Wearable, a fitness tracker that looks like a sport watch with only one button –- an emergency button. It syncs to a smartphone but only works in an emergency if you’re carrying your smartphone with you.

Wellnest, a new wearable geared toward seniors. (Jonathan Ramaci)

The other one is Wellnest, which is a smartphone watch you dial by voice. It has built-in 4G LTE and you converse with it via an Amazon Alexa interface. It can guide you home, order an Uber for you, remind you to take your meds, and sense when you’ve fallen. It will notify your caregivers if you’ve missed your meds or have been slipping a lot as you walk. It also allows them to ping your location in an emergency. (Lively Wearable is  already available; Wellnest is due out by the end of the year.)

Finally, what about after you’ve fallen, but before you hit the floor? One prototype idea in the Fall Prevention Challenge was a Spanx-like pair of underwear with built-in hip protectors – and a motion sensor that calls an ambulance after a fall. In fact, the “senior airbag” concept abounds. One is a “smart belt” you attach around your waist that activates in milliseconds after a fall, theoretically before you hit the ground.

Of course, all this technology requires the elderly person to be willing to use it, which means acknowledging they are at risk. Marketing and design teams have a heavy lift to make fall prevention technology relevant to Baby Boomers, a generation distinguished more by rejecting aging than by accepting the limits it imposes.

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Post-Theranos, Can Silicon Valley and Biomed Get Along?

Monday, April 24th, 2017

Oil and water. Plaid and polka dots. Fish and peanut butter. We all know these things don’t go together.

It’s worth asking how well the “get in hard, cash out fast” tech ethos du jour fits in with the plodding, regulation-heavy culture of health care. It’s a valid question in the wake of the Theranos flameout, in which a Silicon Valley entrepreneur with no medical background, lots of hype and very little scientific scrutiny raised copious venture backing to  revolutionize blood testing, only to see the technology fail in market.

Tech culture rewards disruptors. And those who can pivot on a dime.

But the process of getting a new drug or medical device to market is long and convoluted, a necessary drag. There’s the academic papers subject to peer review, the many stages of clinical testing and government approval. Yes, it all takes years, but it makes the science transparent.

By contrast, Theranos CEO Elizabeth Holmes was secretive about how the company’s technology worked, and the venture firms that pumped millions into Theranos either didn’t have the details, or weren’t scientifically literate enough to ask the questions that might have raised red flags.

Stanford professor Dr. John Ioannidis saw the red flags early on –some that even non-scientists could have discovered.

“So the first thing that I did as a researcher, as a scientist, is check the scientific literature,” he recently told NPR.  “How much do we know about what they [Theranos] do? And I couldn’t find even a single paper.”

Dr. Norman Paradis is a  professor of medicine at Dartmouth College who works as a consultant for diagnostic startups. He has given presentations to venture firms, and he says the fact that Theranos got hundreds of millions of dollars and went to market without proving itself makes it “a Silicon Valley event, and not a biomedical event.”

“I think Silicon Valley is used to this kind of thing: take an idea that isn’t fully formed and get it out into the world without validation, and maybe it fails later on.” Whereas in the biomedical field you almost always need to have data early on.

So what happened? The wrong people were asking the questions, says Paradis. “If you look at the list of who invested in Theranos, none of the venture capitalists who regularly do biomedical diagnostics were investors,” he says. The firms with relevant medical expertise steered clear. “Normally you show up to present an idea to these firms,  they really know what you’re talking about,” he added.

At a conference it hosted in January, The Economist asked a panel of venture capitalists about the broader perception of a culture clash between scientists and Silicon Valley entrepreneurs … and the Theranos example, specifically. The panelists represented three firms that invest in life science and healthcare ventures: Lisa Suennen from GE Ventures, David Sabow from Silicon Valley Bank, and Emily Melton from DFJ Venture Capital.

Here’s the full video:

The panelists agreed that some of the accepted rules that govern much of today’s startup development and commercialization seem to run counter to those of science-based startups in medicine and biotech. And that there is a tension between the two sides.

“It’s a solution sell versus a product sell,” said Melton from DFJ. “Investors think of things as products, whereas people on the health care side think of solutions.”

Suennen from GE Ventures agreed. “On the tech side, people are practically allergic to providing services,” she said.  But in the case of health care, “You can’t take the people out of caring for people.”

And, said Suennen, the timelines involved are vastly different.

“In the health care world, the time horizon for investments to mature and exit is pretty long compared to other marketplaces – usually 7 to 10 years,” Suennen added.

Melton noted that won’t deter some venture firms from investing in health care. “We’re willing to be more patient if we feel like there’s a great opportunity at the end,” she said, adding that, “We do need to have a clear path to commercialization.”

Of course a startup can’t come to market without jumping  through the hoops — specifically, the FDA approval process. That’s why these panelists said regulation is a — gasp! — good thing. “You need regulation in health care, for the most part, to make the market grow,” Suennen said.

Everyone on the panel agreed that the next big thing in digital health or biomedicine will not emerge until tech innovators and medical experts work together: venture companies need  the new ideas from the tech side combined with the health care knowledge. And that’s starting to happen.

Since most biomedical startups are still in early funding stages, it will take a few years to see a new model of collaboration emerge and produce significant breakthroughs in biomed.

“You need that life sciences perspective to understand how has it been done, what works, what doesn’t — in order to totally revolutionize it,” said Sabow, from Silicon Valley Bank. “People who are trying to do it without that multidimensional perspective are going to spend a lot of money, get a lot of buzz, but not necessarily have the revolutionary impact they’re hoping for.”

There was some awkwardness when Melton was asked about Theranos. Her firm, DFJ, pumped $500,000 in seed money into the venture early on. Interestingly, she all but said that her firm did not have access to data from Theranos when they cut the check.

“I think transparency is critical. You can’t mess around with people’s lives and you can’t put products out there without being very transparent about what you’re doing. Data is very critical, and letting people have access to the data.”

The Theranos debacle has a “tragic” element that goes beyond hundreds of lost jobs and lost investment, says Paradis. For $750 million, you could have funded at least seven good startups, he says. “It’s almost impossible to get a complete new diagnostic test developed, because funders are so conservative [when it comes to medical products],” he says. “That’s even less likely to happen now.”

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