The ranks of older and frail adults are growing rapidly in the developed world, raising alarms about how society is going to help them take care of themselves in their own homes. – The New York Times / Herald-Tribune [1]

 

MonteHall-Let'sMakeADeal+Amana660

Perhaps you remember the TV game show Let's Make A Deal with Monty Hall? For years Monty gave away Amana Radaranges before we got our first microwave oven. Why did it take so long? Microwave ovens are certainly convenient innovations. Most American homes have them now, but it took over a quarter century to achieve high adoption. Compare that with Smartphones that have become pervasive in less than a decade – without Monty’s help. Why is this comparison between Smartphones and Radaranges important to understanding the adoption of gerontechnology for aging-in-place?

Professor Everett Rogers defined the Diffusion of Innovations [2] as the process by which a new idea or invention spreads throughout society, how it is communicated and who influences its spread. These curves depict how consumers quickly adopted Smartphones and slowly adopted Radaranges over time:

AdoptionCurves-Smartphone&Radarange

See how the curves rise slowly until the number of Early Adopters reaches the critical mass, at which time they climb toward 100% adoption. Most innovations like the Radarange take a long time to spread. Some, like the Smartphone, rise rapidly once the number of early adopters reaches critical mass. What accounts for this difference in their relative rates of adoption?

 

INTERDEPENDENCE – some innovations provide the means to connect people together, such that every new adopter adds value to the social network. When I buy a new Smartphone, I add value to the whole network – including you – if you own one too. The Smartphone adoption rate was much faster thanks to the power of interdependence. How does this apply to the adoption of gerontechnologies for aging-in-place?

 

The fundamental law of human beings is interdependence. A person is a person through other persons.

– Archbishop Desmond Tutu

 

The key factor is whether the innovation is used as an end or a means. Some innovations, like the Radarange, are just ends. When I buy a microwave oven, it does you no good. End of story. Most gerontechnologies are also sold as ends, but some of them may be cleverly repurposed as the means to connect people into social health networks, empowering us to practice interdependence by caring for each other. This practice will drive higher rates of adoption, which is very important now, given the great necessity to expand care resources in time to meet the needs of our expanding elder population.

For example, a dozen companies have entered the market selling in-home communication and monitoring systems to families with elders who are aging-in-place, promising to provide them with peace-of-mind. Most have failed in the marketplace, not because these systems don’t work, but because they fail to provide real peace-of-mind. The reason is fundamental: they have been sold as ends that objectify the monitored elders rather than as the means to empower people to keep connected in mutually supportive relationships.

Many studies [3] have shown that people benefit from meaningful connections and thrive on feeling needed, while isolation breeds loneliness and the associated co-morbidities including: self-neglect, substance abuse and attempted suicide. We take better care of ourselves when we share responsibility for taking care of each other. In this way we can all live more independently by choosing to live more interdependently. This is the essence of enlightened self-interest.

 

Within the context of our interdependence, self-interest clearly lies in considering the interest of others.

–The Dalai Lama

 

In The MetLife Report on Aging in Place 2.0 [3] Independent Living Strategist Louis Tenenbaum describes the importance of Connections to the Outside World and defines three types:

A. Technology - Devices and sensors connect clients in their homes to the world outside. …The system will easily recognize changes, generating alerts before the fall, illness, or other risk.

B. Community Resources - One reservation expressed about Aging in Place is the loneliness and isolation many older adults feel when they are confined to their homes. …Programs using older citizens in the framework of “civic engagement” as community assets…are growing everywhere.

C. Transportation and Community Infrastructure - Rideshares, programs that match volunteer drivers with those who need rides, …older people are viewed as resources. …Most importantly these approaches recognize that many of the needed resources, both individual and organizational, are already available…

 

How can we harness these Connections to the Outside World? One proven method is TimeBanking [5], which regards people as assets who can provide mutually beneficial services. TimeBanking is a kind of social software that lets people exchange services based on hours instead of dollars, providing a community credit system that completes the circle of giving and receiving. It offers an efficient method for people to co-produce mutual support services, build social capital and rebuild community.

Participation in Time Banking has proven to be a very positive experience for elders. For example, the Visiting Nurse Service of New York Community Connections Time Bank [6] reported that 41% of their 2333 members are age 60 or older, 26% live alone and 19% report fair or poor health.  In response to a member survey, 79% reported that the TimeBank had given them adequate support to live in their homes and stay in their communities as they get older.

CareBanking extends the TimeBanking model by harnessing in-home communication and monitoring technologies as the means to build Interdependent Care Networks of mutual support – by and for elders who choose to use these systems to support their shared desire to age-in-place. With a CareBank, we can repurpose gerontechnologies that were originally developed as ends and use them as the means to connect people into social health networks, driving adoption and empowering ourselves to live more interdependently by caring for each other.

 

Allegory of the Long Spoons [7]

The Sage Rabbi Haim traveled from town to town delivering sermons that stressed the importance of compassion and respect for one's fellows. He told of a dream where he found himself in hell and described the horrifying vision:

Row after row of tables were laden with platters of sumptuous food, yet the people seated around the tables were pale and emaciated, moaning in hunger. As he came closer, he understood their terrible plight. Every person held a four foot long spoon, full of delicious food, but their arms could not bend to bring it to their own mouths. So they suffered in vain.

Next the Sage's dream found him in heaven where, to his surprise, he saw the same setting he had witnessed in hell: row after row of tables laden with delicious food. But in contrast to hell, the people here in heaven were sitting contentedly, feeding each other across the tables with their four foot long spoons, enjoying their sumptuous meal in good company. Suddenly he understood: heaven and hell offer the same conditions. The real difference is whether we choose reach out and help each other.

The low-hanging fruit of Interdependent Care are within our reach to serve us today. The table is set, the essential ingredients are all present. When we choose to use what we have, we will have what we need. So, let's make a deal to reach out and take care of each-other and thus take better care of ourselves!

 

References:

 

[1] Markoff, J. (2015) Robots to the rescue? The New York Times, Herald-Tribune

    http://health.heraldtribune.com/2015/12/22/robots-to-the-rescue/

[2] https://en.wikipedia.org/wiki/Diffusion_of_innovations

[3] Study examples:

Gardner, P. J. (2011). Natural neighborhood networks — Important social networks in the lives of older adults aging in place. Journal of Aging Studies, 25, 263-271.

Boerner, K, and Reinhardt, J. (2003) Giving while in need: Support provided by disabled older adults.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 58, 5, S297-S304.

Liang, J, Krause, N, and Bennett, J. (2001) Social exchange and well-being: Is giving better than receiving? Psychology and Aging. 16, 3, 511.

[4] The MetLife Report on Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge

     https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-aging-place-study.pdf

[5] http://timebanks.org/what-is-timebanking/

[6] The Visiting Nurse Service of New York. (2009) Community Connections TimeBank: Impact of the TimeBank on its Membership – Research Study Results.

      http://www.vnsny.org/system/assets/0000/1267/VNSNY_TimeBank_study_results_summary.original.pdf?1273605850

[7] https://en.wikipedia.org/wiki/Allegory_of_the_long_spoons      http://carewheels.org/carewheels/about

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