Interview with Majd Alwan, Ph.D. and Senior Vice President, LeadingAge Washington, a state trade association serving not-for-profit and mission-driven organizations dedicated to providing quality housing and skilled long-term services. INTERVIEWED BY SCOTT MORRISON, CSA , PRESIDENT OF

BRIGHTSTAR CARE, DULUTH, ALPHARETTA- ROSWELL , AND NORTHE AST ATL ANTA

TRENDS IN TECHNOLOGY AND AGING: Views from an Industry Leader

Advances in science and technology play an important part in addressing the challenges of aging. Successful aging and remaining at

home can be substantially improved today by shar-ing information and creating links between partici-pants, with technology as a key player. According to the Center for Technology and Aging, we are at the dawn of “connected aging” in which the growing ar-ray of internet-based technologies and mobile devices increasingly will support older adults to age in place (www.techandaging.org, 2/28/2018). As technolo-gies geared toward the health and well-being of older adults increase, what are the opportunities? Issues of trust, privacy, credibility, interconnectivity, and afford-ability are at the forefront of thought leaders in tech-nology and aging. Where are new technology trends headed and how are these issues being considered?

Majd Alwan, PhD and senior vice president of technology at LeadingAge Washington and ex-ecutive director of LeadingAge Center for Aging Services Technologies, is a noted researcher and au-thority on aging-services technologies. He founded

WellAWARE, Inc. (alternate name WellAWARE Systems, Inc.) and served as its director. In addition, he serves as a director of the Center for Aging Ser-vices Technologies (CAST), a division of the Ameri-can Association of Homes and Services for the Aging. Dr. Alwan is responsible for creating and leading a network of technology companies, providers, and re-search institutions focused on technology solutions for an aging society.

In the following dialog, Dr. Alwan imparts his perspective on the trends in technology and aging while sharing resources for technology planning and selection.

1. In your opinion, are older adults more accepting of the idea of technology to assist with aging in place than they were in the past? Why or why not?They certainly are! Older adults are the fastest-grow-ing population segment on the Internet and they are increasingly using technology in general, especially iPads, tablets, and eReaders. Please see: http://www.

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pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults/. Moreover, the desire to remain independent for as long as humanly possible is still going strong at about 90 percent of those 55 or older according to the latest statistics from AARP (https://www.aarp.org/content/dam/aarp/livable-communi-ties/learn/research/the-united-states-of-aging-sur-vey-2012-aarp.pdf ).

The reasons include a few important factors: First, the population who are 65 today, were 55 years old a decade ago, and are already familiar with, competent in, and even dependent upon the use of technology. Second, technology infiltrated all aspects of life in some cases completely replacing previous modalities, from the way we hitch a ride, to booking vacations, to shopping, or buying movie tickets, all the way to how we communicate and socialize with family and friends. Third, with touch screens, well-designed and user-friendly graphical user interfaces, rich accessibil-ity features including text-to-speech and advanced voice recognition, and voice commands, technology has become much easier to use universally. This is

true even for older cohorts of seniors who were not as familiar, competent, or comfortable with older technologies that required learning input device modalities and operating systems instructions. I am particularly excited about the opportunities offered by voice capabilities.

Finally, the technology is not only getting better, it’s getting cheaper, and hence more broadly acces-sible to older adults on limited incomes. For example, Google Mini Voice Assistant is under $30.

2. Please list and describe proven, market available products that you are aware of in each of these categories: fall prevention, dementia care, home monitoring, tech-enabled homecare, and wellness and medication management.I prefer not to get into naming specific products, as there are many and each address a specific root cause, or may be a better fit for a certain living setting or cir-cumstances. Let’s take falls, for example. They could

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be due to a neurological condition, side effects of a medication, or environmental factors like lighting or throw rugs! I prefer for your readers to get educated and identify first the condition or issue they are try-ing to find a technology for, the main root causes that need to be addressed (whether by technology or some other intervention, like change of medications, reha-bilitation, exercise regimen, etc.). Only then can they decide which technologies might help support the older adult and/or notify the appropriate caregiver, whether that is a family member, a care provider, or emergency services personnel, in the worst-case scenario.

To help aging services providers, older adults, and caregivers alike, we have developed a number of tech-nology planning and selection portfolios of tools that are publicly available for free at: http://www.leadin-gage.org/technology-selection-tools. These tools ad-dress common and costly care issues, like:

• Functional decline, wellness and activity moni-toring (including falls): http://leadingage.org/functional-assessment-and-activity-monitoring-technology-selection-tool

• Telehealth and remote patient monitoring of chronic conditions: http://www.leadingage.org/telehealth-and-rpm-selection-tool

• Medication management issues, which include technologies designed for older adults with dementia in mind: http://www.leadingage.org/medication-management-selection-tool

• Shared care planning and care coordination technologies: http://leadingage.org/shared-care-planning-and-coordination-online-tool

• Communications, social connectedness and engagement technologies, which include engage-ment technologies for older adults with dementia: http://leadingage.org/social-connectedness-and-engagement-technology-online-tool

Each portfolio includes a comprehensive white-paper discussing nuances of the issue, available tech-nology categories, published evidence of efficacy and cost-effectiveness, and the most important planning steps one should consider before choosing a technolo-gy solution. We then have interactive online selection tools that help you narrow down a list of candidate products based on the care setting, and the functional-ities and features you determined to be key to address

your requirements. If we have a case study from a provider who has used that technology, you will see it linked in the results, and you can read about their experience with the technology. You can check the capabilities of the technology in the detailed products matrix, which usually includes tens of products and allows you to compare between them based on 200 to over 300 functionalities and features. Finally, we created interactive guides that make these portfolios easy to use.

3. What do you feel are the pros and cons of voice-enabled technologies?I see many pros, including the following:

• Speech is a natural way of communicating and interacting with others for almost all of us, unless there is a hearing or speech impairment. Speech technology is extending this natural communica-tion modality to interact with and control ma-chines and other technologies.

• The accuracy in recognition and natural language processing capabilities have come a long way. Now, these technologies work well for everyone, including people who are not comfortable using regular computers, tablets and smart phones, and individuals with significant visual limitation. So the rate of misinterpretations/misunderstand-ing have gone down, and many devices can be trained/customized for the individual to cater to variations in accents, utterance and some minor speech impediments.

• The customization allows the technology to work with multiple individuals, recognize who is talk-ing, and correctly use their personal profile to, for example, pull appointments from the appropriate personal calendar.

• Many of these technologies have open Applica-tion Program Interfaces (APIs) that makes their integration with other technologies possible. These technologies include other software, appli-cations (apps), and hardware, such as smart-home and home automation solutions.

The cons may include the following:

• Some of these technologies may require adding application-specific keywords or commands in the skills for the technology to recognize it is being summoned, wake up, and respond. This

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feature may be limiting if the person forgets one of the keywords or commands, unlike a dropdown menu on the screen.

• The older adult needs to be comfortable with the technology. For example, the technology may not be suitable for individuals with certain mental health issues or advanced dementia, who may be startled or have anxiety as a result of hearing the disembodied voice from the speaker.

• Finally, some people may have privacy concerns that the microphone is on by default, and that the device is “listening” to be able to identify the key-word and respond. You can turn the microphone off by a button, or in device setup.

So you really need to gauge the situation of your loved one, to make sure they’re comfortable with it.

4. With so many products and platforms out there on the market, how do you see the integration of different technologies coming together efficiently? How do consumers choose a product from the wide array available, not knowing if it will integrate with future products they may want or need?We are seeing many vendors who are open to inte-grating with other products, mainly through open APIs, apps, and system development kits they are making available to other technology and application developers. They recognize that this approach actually increases opportunities for their products to be used in areas and applications that were not on their radar screens, and leads to additional sales and licensing revenues to multiple parties.

5. How do the care partners afford these technologies?As I mentioned earlier, technology is getting substan-tially cheaper as a result of mass adoption. Provider and care partners are recognizing the increasing de-mand for these technologies, and are baking in the cost of technology as part of the overall cost of op-eration or service. In some cases, they are using the technology to offset and reduce other costs, like trans-portation costs, for example.

In each one of the portfolios I mentioned above, we identify revenue opportunities for providers who use that particular class of technologies, along with potential subsidies for low-income individuals, and reimbursement streams for technology-enabled

services under certain care delivery and payment models. Then, we walk them through the correct at-tribution and calculation of the technologies’ potential return on investment (ROI). We even provide a link to an ROI calculator for person-centered care, devel-oped by the Scan Foundation, that they can download for free. •CSA

Majd Alwan, PhD, serves as senior vice president of technology at LeadingAge Washington and execu-tive director of LeadingAge Center for Aging Services Technologies. Dr. Alwan is responsible for creating

and leading a network of technology companies, providers, and re-search institutions focused on technology solutions for an aging society.

He is a noted researcher and authority on aging-services tech-nologies. He founded WellAWARE, Inc.(alternate name WellAWARE Systems, Inc.) and served as its director. He serves as a director of the Center for Aging Services Technologies (CAST), a division of the American Association of Homes and Services for the Aging. Prior to CAST, Dr. Alwan served as an assistant professor and the director of the Robotics and Eldercare Technologies Program at the Univer-sity of Virginia›s Medical Automation Research Center. His research interests there included passive functional and health assessment, biomedical instrumentation, and medical automation, as well as el-dercare and assistive technologies.

As a volunteer, he chaired the Funding Aging Services Technolo-gies committee and the Pilots committee for CAST. He is a Senior Member of the IEEE’s Engineering in Medicine and Biology, and Robot-ics and Automation Societies, and a member of IEEE-USA’s Medical Technology Policy Committee and the Geriatric Care Workgroup. Alwan also serves on the Alzheimer’s Association’s Work Group on Technology. Dr. Alwan received his PhD in intelligent robotics from Imperial College of Science, Technology and Medicine, University of London, a Master’s of Science degree in control engineering with distinction from Brad-ford University, and a bachelor’s degree in electrical engineering from Damascus University.

Eleven years ago, Scott Morrison became the own-er/president of BrightStar Homecare in Johns Creek, GA. BrightStar is a national franchise and Atlanta’s trusted, premier provider of private duty, in-home

healthcare. Services range from companion care to skilled nursing. Scott is a Certified Senior Advisor (CSA) and is a ready reference resource for all things “elder.” He is a charter member of Design and Technology for Healthy Aging (DATHA) and is a frequent guest lecturer on a variety of aging issues at Georgia Tech, Georgia State, and Kennesaw State Universities. Scott is an active member of the National Aging in Place Council (NAIPC), Atlanta Chapter, and is on their speaker’s bureau. He frequently councils elders and adult chil-dren on what it takes to “age in place” and how to finance care in the home.

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