Saturday, May 4, 2013

Richard Adler's Seven Grand Challenges of an Aging Society

Richard Adler, Distinguished Fellow, Institute for the Future
Researcher, technologist, gadfly Richard Adler has been laser focused on the intersection of aging and technology for more than two decades. In the 1990's, he pioneered research on the use of computers by older Americans while working at SeniorNet, a nonprofit that teaches computer skills to millions of seniors worldwide. 

Today as an independent consultant and "Distinguished Fellow" at the Institute for the Future, Richard evangelizes the concept that the aging of our population is not just an economic burden but also provides exciting opportunities for innovation.

Headlining a panel discussion in front of a packed audience at the UC Berkeley School of Social Welfare library recently, Richard entertainingly summarized the demographic trends that brought about the aging dilemma and presented what he calls the "7 Challenges of an Aging Society,"--along with some of the potential solutions to these problems. 

"One place demographically in the U.S. where the action is going to be," he says, "is in the older population." 

Up to age 64 there is going to be slow population growth over the next 40 years, while the number of people 65 plus is going to double and the number of people over 85 is going to increase over 200%.

"No matter what business you are in, if you don't think about older people, you're missing out," he continues.

Baby boomers are of course responsible for this trend. 

While there could not possibly have been a person in the room who didn't already know the 72 million American born between 1946-1962 represent an aging population bulge that now threatens to bankrupt the whole country, Richard's retelling of it was still insightful.

One of his slides showed 4 Newsweek magazine covers. The first, published in 1948, is one of the earliest recognitions of the baby boomer phenomenon. It's headline reads, "Boom in Babies. What it Means for America."

By 1964, the focus was on "The Teen-Agers." It is subtitled, "A Newsweek Survey of What They're Really Like." 

In 1992, the magazine presented a "Boomer's Guide to Health, Wealth and Happiness," important information for boomers who then represented "The New Middle Age."  

Fast-forwarding to 2005, Newsweek proclaimed, "Ready or Not, Boomer's Turn 60."

"Like this was a big surprise," Richard quips.

Life Expectancy Continues to Increase

Despite predictions that the increase in life expectancy would level off, he points out, "it never has and it never will, people are living a lot longer."

"People say boomers are the best educated, the most affluent segment of the population, but a large part of them are not," he continues. 10% of boomer households have a "net worth of zero of negative," and over 50%, have a "quite low" net worth.

Reality is inescapable. A huge number of people are going to need social and medical services and these are going to be impossible to support.  The current system of Social Security, Medicare, and related services such as congregate care retirement housing, senior centers, meals on wheels, and the like, just isn't up to the task. 

"The whole canopy of programs that truly have made a marked difference in the lives of older people," Richard says, "as good as they've been, they will not scale up adequately for this population which is going to double."

"Clearly the resources are going to be restricted. I believe we need to see a wave of entrepreneurial innovation, both in public and private sectors, mainly on the local, grassroots level instead of the top-down, bottom-up," he proclaims.

Challenge 1 
Reinvent Healthcare

There are 7 major challenges Americans need to face and find creative solutions for if we are going to "navigate our way" through the aging crisis. The first of these is "Reinventing Healthcare."

As the above slide shows, the annual healthcare cost in the U.S., Germany, UK, Sweden and Spain are similar until age 50, and then "suddenly, the U.S. breaks out." 

If life expectancy in the United States was much higher than these other countries, then our healthcare costs might be justified, but our life expectancy is in the middle.
Just Going to the Doctor is Not Enough

"More high tech procedures, more gadgets, just isn't going to dictate the help we need," Richard claims. "What we need is a broader view of health that includes social economics, the context of people's lives."

As a "great example" of what he means, he point to Kaiser Permanente's program of integrating social workers into its primary care practice. By addressing the social needs of patients, Kaiser has been able to better control costs and at the same time provide better care.

An expanded view of someone' health has to involve much more than the typical medical measurements, cholesterol levels and blood sugar counts. It needs to look at all the things on the chart shown above--lifestyle factors, living and working conditions, education, environmental standards, and the like. 

Challenge 2
Reinventing Senior Services

The next challenge on Richard's list is "Reinventing Senior Services." He shows us a photograph of a typical "nice senior center" where seniors can get a subsidized meal and points out, "most baby boomers don't want to go there."

I think to myself, wow, can I ever relate to this! Sitting around a ceramic card table, sipping hot tea through a straw, and sharing photos of the grandkids is not the way I invision my "golden years" and I'm surely not alone in this feeling.

One answer, Richard says, is to "package" senior centers in a more "comfortable way." 
Mather's Cafe Plus
An example of this better packaging is Mather's Cafe Plus, a senior center in Chicago disguised as a neighborhood restaurant.    
From outside, the cafe looks more like a "Starbucks for Seniors," than the typical, institutional based senior center. And inside is different too. More like a "nice restaurant" with the services for seniors hidden away in the back. 

At Mather's, the initial draw is the food, but benefits include classes and programs that provide older people with the information they need to age well, and opportunities to meet new people, to learn new things.

Richard's "favorite new example" however, is a Seattle based social service called  "Aging Your Way."  This program began its existence by spending an "entire year having dozens of neighborhood meetings," asking people about the ideal way they see themselves living as they age, the things they want to do and the people they want to associate with. 

Among its many activities, Aging Your Way organizes action teams that produce neighborhood walking maps and clean up neglected parks. A sub-program called "Timebank" encourages older people to exchange services through an online database that keeps track of everyone's hours--all services from dog walking to electrical work are valued the same. You earn credits by helping your neighbors. 

Aging Your Way reinvents senior services by making it easier for seniors to care for each other and this, in turn, reduces their need for government social services. 

Challenge 3
Reinventing Senior Housing and Long Term Care

Aegis Gardens Photos by Augie Chang
"All across the country we are developing culturally relevant senior housing for people who were probably born outside of the U.S. and want to age within their culture, but don't want to go back home," Richard continues.

A great example of this is Aegis Gardens in Fremont, California, where the focus is on Chinese culture. Here, residents can participate in activities such as tai-chi, mahjong, and calligraphy (shown above.) The staff speaks multiple Chinese dialects, the food is Chinese, and they even celebrate Chinese holidays.

A completely different example is the Burbank Senior Artist Colony, an "apartment rental community," for people who want to paint, participate in plays, write poetry, practice photography and other artistic pursuits. There is a community theater, art gallery, organized readings, art classes and related activities. 

And a "more dramatic example" is co-housing, where residents get together to create their own housing community. 

Co-housing communities are usually designed as attached or single-family homes along one or more pedestrian streets or clustered around a courtyard. They range in size from a few up to 50 households, where there are opportunities 
for casual meetings between neighbors, as well as for deliberate gatherings such as celebrations, clubs and business meetings.

The private homes contain all the feature of conventional homes, but residents also have access to extensive common facilities such as open space, playgrounds and a common house. 

Residents make all the decisions and can pool their resources to hire shared outside services. 

One such co-housing project that Richard cites is under construction in Mountain View, California, just a few blocks for the main downtown area. Here, they have an acre of land and an old farm house that will serve at the common house. 

Challenge 4
Reinventing Community

Richard points out the obvious--a lot of people simply do not want to move out of their homes at all. 

In 1999, a group of friends who live in Boston on Beacon Hill got together to discuss how life would be for them as they age. Each realized the time was coming when they would need caregiving support, but none of them wanted to move out of the neighborhood, which they love. 

The Beacon Hill friends were of a common mind--they didn't want to be "taken care of." So they decided to take steps to create the groundwork that would allow them to take care of themselves. They formed a nonprofit organization called Beacon Hill Village, which hires its own staff of service providers, and recruited volunteers.

Today, the residents of Beacon Hill Village take care of each other. They self-govern, make all their own decisions and live in their own houses and apartments, a true example of "aging in place." 

This idea has been so successful it has been replicated in Palo Alto, California and in at least 100 other locations. 

Challenge 5
Reinventing Retirement 

Retirement was "sold for decades," Richard says, "as this wonderful, endless vacation where you go sit on a beach somewhere and have a good time."

Because people are living longer and staying more engaged, this classic concept has lost its appeal, in fact, the very word "retirement" seems dated.

For myself, I hate it when some asks me, "Are you retired?" I feel like I want to punch them out, but I usually just say, "Retired? That word is not part of my vocabulary." 

Instead of doing less, older people want to do more, only they want to do the things they care about. Many pursue dreams they had to defer while working at a career and raising a family. Now they have the time, they get busy and often work harder than ever. 

No one really wants to sit on a rocking chair and do nothing. 

Challenge 6
Reinventing Life Stages

The old model of infancy, childhood, adulthood and old age has broken down. 

Citing the books, "The Big Shift," by Marc Freedman and "Composing a Further Life" by Mary Catherine Bateson, Richard notes that both authors write about an additional stage of life between adulthood and old age. Freedman calls it the "third age," while Bateson refers to a "Adult II." 

Adult II is a time when you are still healthy and engaged, but don't want to devote your life to a career. It is generally the 20 years from the mid-60's to the mid-80's.

"This idea has actually helped me," Richard says, "I celebrated my 70th birthday last year and was getting confused, was I 'old' or wasn't I 'old.' When I heard about Adult II, I thought 'oh, I'm in Adulthood II, problem solved."

Challenge 7
Reinvent Social Work

Projected # of Social Workers Need in Long Term Care
The challenge for many of the people in the audience is to reinvent social work to meet all the needs of the above.

Obviously the demand is real. It is growing, but there is a question about whether funding for the jobs will be there. 

Richard cites a government report that found the majority of social work students complete their studies with no courses in aging, no knowledge of services available for elders, or any understanding of the diversity of the aging population.

Social work students perceive that all work with the elderly involves caring for demented and bed-bound clients in unpleasant settings that inevitably leads to a poor outcome.

"Doesn't sound like a great job," he cracks, which evokes a nervous laugh. I wonder how many in the audience actually share this perception, or at least did before they came today. 

Despite an increasing needs for social workers trained to work with older adults, government sponsored training programs have declined. No significant national resource presently exists for supporting social work students interested in aging. 

"This is a truly grand challenge," Richard concludes.

Following his presentation, there were other speakers and a robust question and answer session. At this point, though, I felt I had a lot of information to think about and I hope anyone reading this agrees. There are big decisions ahead. 

--David Bunnell

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Tuesday, April 30, 2013

Japanese Caregiving Robots: Meet Paro, Riba and Hal

Link to Japanese Caregiving Robots Video

Are caregiving robots a good thing? 

There is no doubt that the last robot in this video, HAL, serves a very useful purpose. Not related to the HAL in the movie 2001 (as far as I know) this HAL is an "exoskeleton" designed to support and expand the physical capabilities of people who are otherwise disabled.

But what about Paro, wouldn't it be better to have a real pet? And Riba can pick you up but Riba is not capable of providing the warmth and assurance of human touch. 

However, there is a growing shortage of caregivers so maybe the Japanese are on to something.

What do you think? Post you comments here or tweet to hashtag #carerobots

Friday, April 26, 2013

Using Unfrazzle: A Sleep Diary for Aunt Millie

Part One

My Aunt Millie lives in Boulder, Colorado, a long distance from my home in Berkeley, California. She's 86, very sweet, and I'm attached to her in a special way. She provided me refuge during some turbulent times in my confusing teenage years. 

Independent and in good health, Aunt Millie lives by herself in a little house on Mapleton Avenue not fair from the Pearl Street Mall. She doesn't drive, most everything she needs is within walking distance. 

I did not used to be too concerned about Aunt Millie because my Uncle Bully, her brother, lived in Denver and my parents lived not far away in Western Nebraska. They were always in touch with her, but they've all passed away and now I am her closest relative.

If something goes wrong and Aunt Millie really needs someone to be with her, that would be me.

Recently, I began to worry about Aunt Millie when she told me she hasn't been getting much sleep, some nights none at all. So I called her primary doctor, Dr. Anna Fraiza, and we discussed the possibility of giving her a prescription to the sleep medication Lunesta. 

Lunesta might help Aunt Millie, but it can be addictive and there are numerous side effects including the possibility of short-term memory loss. 

An Alternative Approach

Before going this route, Dr. Anna and I agreed we should first see if we can discover the underlying cause of Aunt Millie's insomnia, perhaps we can correct it in a more natural way and avoid using a sleep medication. 

To get started, Dr. Anna suggests we ask Aunt Millie to keep a "sleep diary."  

Right away I thought of Unfrazzle, I wondered if could I use it to create a useful sleep diary for Aunt Millie that both Dr. Fraiza and I could monitor. 

Aunt Millie doesn't have a smartphone, but last Christmas I bought her an iPad which for her is even better. The screen is larger, easier for her to read and the keys are larger too. She loves it, uses it frequently. 

While I find Unfrazzle user friendly, it is unrealistic to think Aunt Millie can download the app, create an account, and set up her own sleep diary.

I do want Aunt Millie to eventually manage her own account. However, to make sure she understands how her Unfrazzle sleep diary works, I decide to not only set it up for her, but to actually call her every morning for a few days and make the entries myself. 

Once Aunt Millie is familiar with the sleep diary, I will "walk her through" the procedure for downloading the Unfrazzle app onto her iPad and the logging into her account. 

At least, that's my plan. 

Aunt Millie's Unfrazzle Account

Setting up an account for someone else on Unfrazzle is simple. After logging into your account, you first navigate to the "Family" section by tapping on the Family icon which is 1-of-the-4 choices on the bottom navigation bar of each Unfrazzle screen. (below) 

Once in the Family section, you tap the "+" sign. 

You are now at the "Add to Family" screen. Obviously, Aunt Millie isn't already an Unfrazzle member, so I tap on "New Member" (below).

When you add a New Member to your Unfrazzle Family you can give them different levels of access to your account. There is no need for Aunt Millie to have access to any information on my own account, so I leave the check mark beside the None designation. 

As you can see, the next step (below) is to fill in a sign-up form. I enter Aunt Millie's formal name "Mildred," which I also use as her Username, and enter a password.

Press Done and ViolÄ!, Aunt Millie has her account.

Aunt Millie's Sleep Diary

To create the sleep diary I log out of my own account and log into Aunt Millie's new account. As you can see, when you first log into an Unfrazzle account, the "Journal" screen pops up and is already populated with three sample journals: Coffee, Miscellaneous Notes, and Mood Journal. 

The word Journal in "Unfrazzle Speak" can be any activity or task you want it to be. This may seem confusing at first, but in reality it makes perfect sense. Because Unfrazzle keeps a history of all your entries, the dates, listings and notes you make related to any specific activity become a "journal" of that activity. 

The sample journals above are only there to show you what journals look like and demonstrate what they do. You can use them if you want, or you can simply ignore them or delete them.

I choose to delete these sample journals because I think they might distract Aunt Millie. To do this I simply tap on the journal name to get to its edit screen, scroll to the bottom of the page and clicked on "Delete Journal." (below)

Having deleted the three sample journals, I click on the "+" symbol on the top of Aunt Millie's Journal screen to add a new journal, which will be Aunt Millie's Sleep Diary. (below)

An "Add Journal" form appears (below). I enter the name "My Sleep Diary" on the Title line and leave the Description line blank. 

Tapping on the word Schedule (above) I am given the choices: None, Once, Daily, Weekly and Monthly. 

I choose Daily and set the time at 9 a.m. (above)

I leave "Ends" set at "Ongoing." The alternative setting for "Ends" is a specific date. If Dr. Anna had only wanted Aunt Millie to keep her Sleep Diary for 6 weeks, Unfrazzle could accommodate this.

After clicking on "Done" Unfrazzle takes me back to the "Add Journal" screen (below) where I turn the "Reminder" ON. Next, I click on "Add Attribute."

The first entry (Attribute) I want Aunt Millie to make into her Sleep Journal every morning at 9 a.m. is "How Well?" did she sleep. Note that Attributes can be "amounts, lists, scales, or text fields."

For this first Attribute, I decide to use a "Scale." I want to know on a scale of 0-to-10 how well did she sleep the previous night, with "0" meaning "restless" or not at all, and 10 meaning "like a baby." (below)

I press Done and move on to the second Attribute. I want Aunt Millie to tell me how many hours she slept. For this I chose the "Amount" style Attribute, fill in the Name: "How Many Hours?," and fill in the Unit: "Hours." I leave Amount blank. (No need for "Default Amount" here.)

I press Done (above) and move on to the third question, which will be "Times I Woke Up?" As with the previous Attribute, I use the "Amount" attribute, filling in the Name and leave both the Unit and Amount lines blank.

The Final question for Aunt Millie calls for her to briefly describe any dreams she might remember having. For this I use a "Text" attribute (below):

Pressing Done I have now created Aunt Millie's Sleep Journal. Notice on the Edit screen below that Unfrazzle automatically adds an additional item for entering notes. With Unfrazzle you can always add notes to Journal entries.

What's Next

My plan now is to call Aunt Millie at 9 a.m. for a few days, ask her these four questions and enter the answers into her Sleep Diary. I'm going to also take advantage of these conversations to find out if there some things I can suggest that will help her sleep better. 

For instance, does Aunt Millie have a TV in her bedroom? If so, I'll ask her to move it out of the bedroom or at least agree not to watch it in bed at night. I'll suggest she do some reading instead. I might even suggest she try some deep breathing exercises or meditation before going to sleep. (See: 21 Tips for Getting a Good Night's Sleep)

If and when she adopts some of my suggestions I'll be able to tell if they make a difference. 

Once Aunt Millie is totally familiar with this routine, I am going to "walk her through" the steps of uploading the Unfrazzle app from the iTunes store into her iPad and logging into her account.

Before this happens, I will have added Dr. Anna to Aunt Millie's Unfrazzle Family network so she can also monitor her progress or lack thereof.

Check back in a few day for my next installment: Is Aunt Millie Get More Z's? 

More tips on using Unfrazzle, including videos, can be found on the User Guide pages of our website. 

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Monday, April 22, 2013

21 Tips for Getting a Good Night's Sleep

Fifty percent of the adults living in the industrialized world are chronically sleep deprived. over 30 percent of adult drivers polled admit to falling asleep at the wheel at least once. Roughly 24,000 people die each year in North America and Europe in accidents caused by sleepy drivers. 

Lack of sleep contributes to heart disease and weight gain and is even associated with dementia. Sleeping pills might provide a short-term solution, but they do not provide the kind of sleep you need to operate at your optimum level. To help you get more sleep, we’ve devised the following tips.

                                                                                Illustration by Timmy Kucynda
  • 1. Get rid of the TV in your bedroom.
  • 2. Turn your phone off. 
  • 3. Keep your bedroom cool.
  • 4. Close the curtains, the darker your bedroom the better. 
  • 5. Keep doors shut. 
  • 6. Avoid clutter, it wears on your mind and can contribute to stress. 
  • 7. Try a "white noise" machine
  • 8. Use quality bedding. 
  • 9. Have a firm mattress.  
  • 10. Use a neck pillow. 
  • 11. Don’t smoke for two hours before going to bed.
  • 12. Don’t drink for four hours before going to bed.
  • 13. Skip the caffeine, after lunch, not dinner. 
  • 14. Bathe or shower before bed.
  • 15. Try meditation.
  • 16. Avoid stress.
  • 17. Have a rule: No arguments before bed. 
  • 18. Read before sleeping.
  • 19. Do some deep breathing. 
  • 20. Try the natural hormone melatonin.
  • 21. Keep pets out of the bedroom unless you have a cozy dog. 
This chart was originally published in Eldr magazine. For your very own downloadable copy, click here
New Post: Using Unfrazzle to Create a Sleep Diary

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Tuesday, April 16, 2013


"Caregiving is a tremendous responsibility that not only impacts the lives involved, but the health of the caregiver as well. Unfrazzle is taking on this challenge. It is a simple app that could make a profound difference."

Matthew Holt, Co-Chairman
Health 2.0 Conference

In the United States alone, there are an estimated 65 million family caregivers, who on average spend 20 hours per week on their caregiving responsibilities. As the aging of the U.S. population continues to accelerate, this number will rapidly grow.

An estimated 20 million of these caregivers are in the "high burden" category. They spend an average 50 hours per week on their responsibilities, taking care of seriously impaired family members. These are a diverse group - caring for older people with Alzheimer's, children with Autism, friends or family with cancer, etc.

NEW POST: How to Create a Sleep Diary with Unfrazzle

Family caregivers are frequently overwhelmed by the never-ending torrent of their caregiving tasks. Organizing tasks and ensuring they are completed is enormously stressful. Sharing tasks with co-caregivers is oftecomplicated.

Many caregivers report feeling alone and unsupported - so much so, their own physical health and mental well-being suffers.

Determined to "uncomplicate and de-stress the lives of family caregivers," Rajiv Mehta, a veteran Silicon Valley technology developer, has created Unfrazzle, a smartphone app to help caregivers remember, keep track of, and share their caregiving tasks.

Kathy Kelly, Executive Director of the National Center on Caregiving and the Family Caregiver Alliance, who has been following the development of Unfrazzle, says:

"The caregiving community has a tremendous need for a smartphone app like Unfrazzle. I believe it has the potential to unburden caregivers from much of the stress of keeping track of all the tasks they need to do every single day. It will also make it possible for them to easily share some of these tasks with others."

Unique in the caregiving market, Unfrazzle focuses on easing the mental burden of everyday caregiving. It provides unprecedented flexibility to help users remember and track their day-to-day caregiving tasks; and connectivity, with rich privacy controls, with co-caregivers to keep everyone in-sync.

Unfrazzle users can invite family members and others to join their Unfrazzle network and they can assign different tasks to their co-caregivers.

"Unfrazzle takes a big mental load off your mind as you're not stressed about whether you're going to forget to do something," say Mehta, "and you'll always know what's going on with your family members." 

A more indepth look at how Unfrazzle works can be found on this blog:

The iPhone version of Unfrazzle is currently undergoing a rigorous beta-test and will be released in the Apple iTunes App store in May. An Android version will soon follow.

About the Unfrazzle team

Rajiv Mehta, founder and CEO, is a former NASA scientist with degrees from Princeton, Stanford and Columbia with experience leading innovation for Apple, Adobe, Interval Research and Symbol. A board member of Family Caregiver Alliance, and a leader in the Quantified Self movement, he created the apps Zume Life and Tonic, ground-breaking products that led to Unfrazzle.

Rajiv leads all Unfrazzle business, business developments and product development efforts, and participates extensively in various public forums and institutions.

David Bunnell, Media Chief, founder of PC Magazine, PC World, Macworld, BioWorld and numerous other media properties, is responsible for Unfrazzle's marketing, public relations and content development. He is the winner of the Lifetime Achievement Award from the Computer Press Association and The New York Times Fellowship award.

Hugh Dubberly, award-winning designer and educator, whose firm Dubberly Design Office advises some of the world's leading technology, media and health companies. Hugh, who has worked closely with Rajiv for many years, is collaborating on the design and development of Unfrazzle.

Ashvin Radiya, PhD, is at the forefront of multi-platform, hybrid app development. His firm, AvantSoft, develops software and provides development training on cutting-edge technologies for leading corporations around the globe. His team is providing software development services for Unfrazzle.

About The Unfrazzle Company

The Unfrazzle Company is an online media and smartphone app development company. We address the growing needs of tens of millions of family caregivers. Our task management and coordination tools and educational support are designed to make life easier for them--easier to provide quality care for their loved ones, easier coordination with co-caregivers, and most importantly, easier to maintain a reasonable level of sanity and personal wellness in their own lives.

Unfrazzle has been presented at the San Francisco Health 2.0 Conference (October, 2012) and in the AARP EngAGE Pavillion at mHealth Summit (December, 2012).


Unfrazzle is developed by Bhageera Inc, led by Rajiv Mehta. Bhageera Inc provides consulting services to help companies evaluate and commercialize radical innovation, with a focus on consumer health innovations.

Photos and screenshots available by request

Background material:
The Future of Healthcare, Rajiv Mehta (slides)