UC Berkeley ART Summit 2022 - Technology and Innovation: Emerging Technologies for Older Adults

UC Berkeley ART Summit 2022 - Technology and Innovation: Emerging Technologies for Older Adults

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We now turn to technology and innovation, a hallmark of the Aging Research and Technology Summit. We're looking at the next generation of technologies to benefit older adults as well as their family caregivers in the workforce that supports older adults. Today, you will hear from individuals not only in the University of California community, but some of our partners in industry and in provider space who have been working diligently, even through the pandemic to develop new ways to benefit our workforce and make sure that older adults can live well and be very engaged in our society going forward. I'm Gina Baik, I work for Amazon and I actually support Alexa Smart Properties.

So basically, Alexa focused in the senior living, senior care domain. So just a little bit of information to set the stage and what I'm going to talk about today, as we know with this pandemic and now we're verging on an endemic many things happen in tech adoption. We've never seen such acceleration, particularly around e-commerce, tele-medicine, streaming video, remote learning. And as we started to see this, we also started to learn a lot of lessons in the older adult space, particularly around the fact that in the United States, there wasn't as much wireless infrastructure. And what we realized is that was a must have and it needs something to be addressed across facility based living. We also found out that voice, particularly using any kind of voice powered speaker, was actually empowering a difference in both care and independence for older adults.

We also saw voice increasing the adoption of technology where folks that were maybe tech reluctant or not tech savvy, we're starting to find success by using their voice to deploy technology. As we all know, video chat, the fact that I'm doing a video right now talking about this became a validated alternative to live in-person meetings. And tele-health start finally launched to a level of scale in regards to changing the care with older adults. It's interesting, right now my daughter is actually in the hospital and she's been in there for about six weeks. So I've been doing a lot of kind of assessing, but also looking at technology as whole in the healthcare arena. And even though I'm talking about older adults, we all know there's a workforce shortage.

And this picture that you're seeing right now is an actual robot. It's on the bottom floor. And what's happening is that they're trying to optimize their workflows by having robotics bring meal trays to patients that are inside of the hospital itself. So this is a live picture of every morning I see these tugs moving around, shuffling these meal carts up and down the elevators. And we're going to start to see that more and more, and particularly in older adult, where senior caregiving and the workflow and the work staff, we're fighting for that health care worker to come and support that industry.

We're going to have to use some sort of robotics to supplement the massive caregiver shortage that's going on. With that all being said, as we start to look at the trends, I have to come back to Voice. And of course I'm a little biased and I do work for Alexa, but I think it's really important to understand why Voice is become the leader in this space.

If we do a little history lesson, if you look on the left side of my slides, you'll see that back in the day when 1970s we had the computers first come out and then the big graphic user interfaces where you have the large screens. And then obviously we started to go into where the Internet in 1990 started to become a big deal from dial up to now. What we have is obviously faster than what we've ever seen.

Also then we went down this path where everyone had smartphone and everyone had a tablet. And now in this day and age, what we're finding is the new user interface. Interface is actually called vui or voice user interface. And just to give you kind of an idea what that means, if you look on the right hand side and you look at the data so a typical keyword search where you're going in and you're looking for different information, we're about 300 billion in regards to keyword searches on any given day.

But if you're noticing in regards to Voice searches, that has actually increased from 2011 all the way to now, we're about 200 billion. And you're starting to see that voice interface or voice searches are starting to become the next thing beyond just keyword searches and the ease of use around that. So we are in an age where Voice will start to open up all kinds of things and I'm going to talk a little bit more about that. But particularly around older adults where touch experiences are very hard, particularly when their hands are drying, it's very hard to touch some devices and particularly if you have Parkinson's or any kind of arthritis. The success and the independence of tech deteriorates a lot with age, but with Voice, your voice truly doesn't change that much. So what we're finding in the US as of this year, there's about 40% of Americans that have installed some sort of smart speaker in their home.

And as we're starting to see this more and more, we're also seeing that the demographic that's adopting the Voice technologies are older adults. The other thing is I talked about video chat. We're also starting to see the speakers are actually with the screens, the show devices and Alexa or the Google Nest Hub Maxes, those are also starting to grow in adoption because what they're finding is the ease of video connect. Of course, there's always been some sort of video connections when you use your phones, but it becomes much easier when an older adult, all they have to say is the name of the device and then what they need to do, like Alexa, call my daughter. And immediately that action happens.

This slide just talks about an actual resident, older adult who's living at home. And it's funny because these devices have become not just voice devices, they're starting to actually support folks in regards to their loneliness. And this particular resident actually calls Alexa her roommate, which is really fascinating, but it's also really interesting. We're seeing more of this a little bit about Alexa. For those who don't know who she is.

She has a variety of devices, and she's also now being empowered, even in TVs and cars are seeing her all over, and she is considered the most popular voice service in the United States. I think it's really important to understand that these devices are like hardware, just like computers. Everything that Alexa does is in the cloud, and I think oftentimes people assume that the device is necessarily listening to them, but in actuality, it goes into the cloud, and oftentimes these recordings are not downloaded or kept.

We're also finding that Alexa has a lot of AI, and so she's getting very smart in how she's addressing questions. If you look at this chart, it shows you what particularly Alexa is getting used the most. Number one, obviously, is music. I don't know if you knew this, but that is the most popular ask, the most popular query. The other is checking the weather, asking a question, setting an alarm, and not surprisingly, smart home controls. This is also becoming something that is unique because of the fact that the connection with older adults, particularly around the fact that the number one thing that happened with older adults inside of their homes or in a senior care facility is falling.

And that falling usually happens at night between the times of 09:00 PM. And 07:00 AM and during the night, if you can actually just use your voice to turn on the lights, that's actually a game changer, just going from the bedroom to the bathroom in regards to preventing falls. So we're starting to see more and more of this. And smart home technology is really becoming a game changer in the way that an older adult lives inside of their home. Anyone with disabilities, particularly the fact that all they have to do is use their voice, especially if they're not mobile, especially if they're not good with technology, especially if they're not tech savvy in general, they can just use their voice and they get some sort of instant success with technology, which is super important.

And when you can make that connection with family members and you can have that video connection without actually touching a device, it really does change the way not only older adult feels in regards to independence and purpose, but they start to understand that this technology is building, improving their quality of life and making that connection with family. Couple use cases just to kind of put it down the forum, this is a particular CCRC or a life path community in Cupertino, California. And this particular community is not only using voice, but they're really looking at, in general, how does an older adult live more independently with technology? They've deployed robots inside of their dining rooms, where the robots actually help with busing tables.

They've also deployed smart apartments, as I said, not only for fall mitigation, but also in general, the whole quality of life for residents have improved drastically by having things just beckoned by their voice. They've also done some things inside of memory care facilities. So those are cognitive decline, they're finding that by using voice, not only is it a great way to connect with other staff members, but residents with memory care are finding it helpful because sometimes they just want a question answered. And so when they can ask Alexa to answer a question, particularly what day is it? Or what the weather is, and they ask the same question over and over again, and Alexa always answers.

And it's finding some resident satisfaction, but can you imagine from a staff caregiving perspective, it also takes the burden of answering that question? Other projects that have also been growing inside of the older adult aging tech is around affordable housing. There is a program called the Lighthouse Program developed by CITRIS, as well as UC Davis and senior living providers Eskaton and Front Porch. And they've done some really fascinating things where they've installed not only tablets and WiFi, but they also created some sort of training programs to grow the adoption of technology, particularly those that are underserved in the California area.

What's really great about this is they've created a sustainability model, because one thing is, you can definitely train older adults on how to use it, but the question is, when you leave, will they use it again? And so they've created a really good program which allows they have ambassadors that train them, support them, and when other folks leave, those ambassadors are still there, and they're actually the residents themselves supporting one another. This is going to be something that will be a scalable model that can be leveraged for other affordable housing properties. Another interesting use case, when the pandemic hit really hard in the health care systems, obviously PPE was a really big deal because there wasn't enough of it. But what if you could replace PPE with just some way of using video chat? And in this use case, you actually see a nurse who is actually dropping in. And when I say dropping in, it doesn't require you to actually ask Alexa to go into someone's room with video chat. You just drop in on the patient's room.

And so that allowed the patient to get a check in by the nurse. The nurse didn't have to fully dress up in PPE and talk about optimizing workflow, but also the savings around PPE. By doing something like this, we've also seen technology help when someone will have a life alert or some sort of pendant system around their neck. And oftentimes the biggest problems that we see is that they don't wear those devices. So, again, if you can use your voice to call out that you need help, and that connects you to the right person at the right time, it does, and it has saved people's lives. And in this story, as you can see, this particular resident had that as an option.

And she believes that, in her own words, Alexa saved her life. As I mentioned, robots. We're seeing so many different robots. And in this particular example, Astro the robot. This robot is obviously an Amazon robot.

But what we're seeing is it's not just a friendly. Engaging robot where you have social engagement. But also it can be used to follow an older adult to actually do video chats in their space, so that the older adult doesn't have to get up to a particular location. We're also finding it's a great monitoring. Like, let's say that you were worried that something happened inside the house and you weren't home. You can actually use your robot to monitor maybe any kind of threats, security threats, or even the fact that if maybe mom has fallen and you needed to check where mom is, you can also use this robot for those perspective.

There's just so many use cases that we're finding around robots. And again, in this world where there is a caregiver shortage, it could definitely augment what we're seeing. I also wanted to put this out because often times when we talk about aging and tech, people are always asking, well, is there any money to help us support it? And there is a program called Broadband USA, which is called Bead, the Broadband Equity Act, which is allowing there's going to be some funding around those older adults that are underserved, and the Digital Equity Act, which is going to provide about $2.75 billion of grant funding.

Whether you're a for profit nonprofit doesn't matter, but this is actually allowing you to not only teach older adults how to use technology, but also provide support and adoption. So keep an eye on this. This grant is actually going to open up in Q four of this year to start competing and to get some opportunities to really serve older adults who need the tech because oftentimes they can't afford it. So this could fill that gap. And that's all I have for you. I hope this gave you a quick view of some of the different tech that is out there besides just what we do at Amazon Alexa.

What we're finding is this tech is not a replacement of people. It's an augmentation of care and other things to support and improve the quality of life of older adults. Thank you. Hello. My name is Veronica Ahumada-Newhart and I am an Assistant Professor at the University of California Davis Health. I'm the director of the Technology and Social Connectedness Lab, housed in the Center for Health and Technology.

Today I'm speaking to you about social robotics for older adults, which is part of my research here at the University of California, Davis. So for our first slide, just an intro to the topic, we have technology and innovation, Emerging Technologies for Technology and Older Adults: lessons Learned is the theme of our talk. so, as we look at social robotics for older adults, we have two categories. The first category are autonomous robots and these are robots that are capable of operating independently from human operators. In other words, the human doesn't have to do anything.

The robot is acting as an independent agent in the environment. And so these robots should be able to interact and communicate with humans, the environment within the social and cultural structure attached to its role. So when we think of these autonomous robots in social situations, we think of humanoid robots. And here we have the Pepper robot, which is interacting with an older adult.

There is a screen on Pepper to facilitate communication. However, Pepper is not a full humanoid robot. The software isn't there yet to where it can interact and have conversations. But it does provide a model of a human figure that could interact within a home environment. Another category of robot that we have for older adults are teleoperated robots.

And teleoperated robots are semiautonomous robots, meaning that they have some sensors, some artificial intelligent features. For example, they will have sensors on the bottom for obstacle avoidance. They have some remote navigation features to reduce the cognitive load of the user. This particular model, which is the double 3 on the user interface, there is a scan of the floor and you click, on the floor in your image on your computer screen and the robot will automatically drive itself to that location.

And that enables people who log in and are controlling a robot to be able to navigate a space without actually pushing the arrow keys and putting a lot of effort into, quote, driving the robot. So the teleoperated robots are operated by another human, mostly for socioemotional companionship. And here in this image, we have some grandchildren who are interacting with their grandmother at one of our study sites. So the applications of social robotics for older adults are for communication and companionship, as we just covered, whether it is an autonomous robot or whether it's a teleoperated robot, we want acceptance. We want the interaction to feel like a traditional human to human interaction. We also look at perception for both the local and the remote users.

And so we want the person who is controlling the robot to feel immersed in the experience, so that whatever they're experiencing via their robot feels like a lived experience and not as something that they saw on a screen. For the local users who are interacting with the robot, we also want them to feel that they actually interacted with someone and not some thing. And so we have two different areas where we have to look at perception. We also want to look at transitions.

For people who are using robots at adapting behaviors, what are they learning from the robot? For example, if we're looking at health behaviors, if we're looking at older adults who may have some issues with cognitive memory, et cetera. What role is the robot playing in that transition, whether it's from a health perspective or a physical perspective? And so in looking at the physical perspective, we look at assistance, the ability for these robots to help people age in place. So for assistive robots in the home, assistive robots can help older adults with walking in the home, simply getting around for safety. They can possibly help with lifting things and they may possibly help just with getting someone moving.

So kind of minimizing sedentary behaviors in the home if the robot can act as a motivator to get someone up and moving around. However, there are challenges with deploying robots in these environments. So when we look at the environmental context of where we want robots to operate, we may have to retrofit existing physical environments or design new physical environments for the robots. Here we have an image of a robot that is kind of straightening up with toys.

And if we look at this very busy environment where children are playing and you look at the base of the robot, you see, like, there's different floors, there's a wood floor, there's carpet, there's blocks. And we all know with children, there are other tiny little toys that may be littered all over the floor. And so the robot needs to have the capability of moving around in this space, a space that is designed to facilitate this robot. Homes have very complex environments because the humans in them leave thiinigs lying around. Public spaces also are a challenge for getting robots to move around. As we have new delivery robots moving about in public spaces, there are challenges that are coming up with the curb cuts, with things that are on the ground.

Hospitals also promote, not promote, but provide some challenges. And then we also have workplace environments where robots may be expected to move around. So on top of the physical environments, we have human behaviors.

What are the beliefs that older adults may have about robots? What is their motivation for using a robot? Are they using it for socialization, and can they socialize with an autonomous robot? Do they believe this is someone that they can interact with? If we have a tele-operated robot, do they believe that the engagement and the interaction they're having with another human via the robot is of value to them? And do we trust the robots? In some studies, we have found that older adults prefer for the robot to be parked facing the wall. There are issues of privacy and trust in who is controlling the robot and what data the robot is collecting. And so that was actually an interesting experience that we had. Most people just park their robot in the docking station, but in one particular environment, we had the older adults preferring to park the robot with all of the cameras facing the wall.

Also, what emotions do the robots bring about? If we are using social robots for older adults to address feelings of loneliness, does the robot minimize those feelings of loneliness, or does it increase those feelings of loneliness? So, really, evaluating the human behaviors that are tied to social robotsis important in this space. So now we look at robot behavior. So what features contribute to anthropomorphizing? The robots and anthropomorphization, refers to ascribing human qualities to an object. So what features can robots have that would increase acceptance of a social robot in a home or a public or a work environment? How does the robot move? That matters. In one of our studies, we found that silent robots were not accepted.

They were viewed as creepy. The robots need to make a sound of some kind, because as humans, we make sounds when we enter a space and move around in a space. The appearance of the robot also matters. We have several studies on the uncanny valley when a robot tries too hard to look like a human and comes across also as creepy, not easily accepted by the people in the environment because it's trying to look like a human, but it doesn't quite look like a human.

The voice of the robot also matters. And for this, you can think of your Alexa, your Siri, any of the chatbots that we use ascribing some attachment or some human quality to that. It's a voice that you are familiar with and so also appropriate physical and auditory responses.

How the robot moves in the environment and how the robot responds in the environment and to certain commands or questions also matter. And that's it for my presentation today on social robotics for older adults. Thank you so much for listening. If you have any questions, you may follow up with me via my email address, vahumada@ucdavic.edu or

or you can visit my website, which is VeronicaAhumada.com Thank you so much. Hello, my name is Misha Pavel and I'm Holly Jimison Both Misha and I are professors at Northeastern University and also visiting professors with UC Davis Health, working on healthy aging in a digital world. Today, we'd like to talk to you about technology for older adults, the challenges, the opportunities, and a little bit about what we've done in the past. To get started, we first want to look at why it's so important to have new models of care that could be facilitated by technology.

Given the aging demographic, rising healthcare costs and health disparities, we have the opportunity with several approaches based on technology.Given now we see ubiquitous mobile health technologies taking over even with older adults and with underserved communities on the sensor front, sensors are now much smaller, cheaper. We see them everywhere wearables, the battery life is improving. And finally, advances in big data is something we really want to be able to take advantage of.

We see that there are so many sensors available for monitoring health in the home. Some are unusual Apple Watches and wrist devices, or rings like the aura ring. Many sensors are in the phone itself, the GPS, the step counts that you can get, but also temperature, volume, light levels. Many of these can be adapted for health. There's a variety of tattoos that are being worked on weight scales, blood pressure cuffs.

So many opportunities here. But we're not going to focus today on the sensors themselves. But rather, what can you do for an older adult living at home? An individual creating sensor data from the home, it may be wearables, it may be on the bed, a variety of locations. But the streaming data is so important. And our job right now is to think about inference algorithms that can help us learn about the patient and give feedback both to the individual in the home, but also through family caregivers, professional caregivers, and clinicians themselves. Projects that we've worked on in the past have had to do with cognitive monitoring and intervention through casual computer games, where it's not just the performance on the game itself, but rather our embedded metrics to extract information on memory, divided attention, executive function and planning.

These are things that are of great concern to older adults. Another that you see on the upper right is our interactive video exercise work. And here the computational modeling comes from the skeletal images that are coming back from, for example, a connect camera. And we're able to monitor performance both in strength, endurance, variety of information that would be important to give feedback not only long term and how well they're doing with their exercise, but also giving just in time feedback, stretch higher, good job counting the repetitions and then recording how well they adhere to their goals. We've had medication management projects with video cameras, web cameras underneath the medication device that can take pictures at any time and relay them to family members or have real time video. Sleep management is another important area.

You'll notice that many of these are important with regard to cognitive functioning and health, which is of utmost importance to older adults. One thing that's often not brought into the clinical situation is how important socialization is. We know that socialization is on par with smoking as a health hazard, loneliness. In fact, one thing that's not really well addressed in typical clinic visits is the importance of socialization on the health of older adults. Loneliness is on par with cigarette smoking as a health hazard. And some of our applications have gone from simple scheduled video conferencing visits.

For example, a zoom and group activities through video to self navigating robots that can connect the individual with families and friends that are remote. And one current project has to do with self navigating robot. You'll see in the lower right here, there we're bringing remote family members.

The robot transitions to the individual in a nursing home and able to connect and reduce loneliness. Now, one of the most important areas is how to take all of this information, give it back to the individual with tailored messages of encouragement and feedback on how well they're doing, but also to give meaningful connections with family caregivers. So the display on the right here on the phone is a way of giving overview of how well your older adult is doing. And this all requires heavy use of computational modeling. So we'll switch to Misha to describe that. Development of this closed loop coaching system, a combination of humans and machines requires us to address a number of challenges.

For one, raw sensors produce streams of data that are very difficult to interpret by the clinicians. We need to be able to take the phenomenon that we are interested in, see how it transforms the observations, and then transform it back to the estimates of the phenomenon. That way, we can help clinicians to understand the state of the individuals. Intensive long now, health data monitoring requires long term engagement on the part of the participants.

What we know about using monitoring devices is that people buy a fitbit and then a couple of weeks later, stop using it. Another problem is that assessing and predicting human behavior is very difficult and requires computational modeling and AI. Finally, caregivers ability, availability and burnout are huge issues for building this kind of approach. The approaches that we are takingto address these issues include computational modeling or based on the computational modeling, engagement enhanced by continuous monitoring and appropriate coaching has been shown to extend the longterm engagement of individuals.

AI and machine learning and computational monitoring is essentially interpreting and using the data appropriately. And finally, AI based optimization of personalized coaching and rehabilitation is necessary in order to optimize the closed loop system. This is a representation of the framework in more or less engineering terms.

Ideally, we'd like to understand the state of the brain of the participant, but we can't get to that directly. But we can observe our behaviors, physiological sensing and potentially other measurements such as voice and gestures. Using those streams of data, we use AI and machine learning to monitor and then provide inference about the brain state. That information that can be used to optimize the intervention messages and achieve the desired goals and outcomes. This is just to give you some flavor of the complexity of the type of modeling that is necessary in order to make the predictions and assessment of the individual.

It includes coaching and social support as input. It includes internal motivation and long term integration of the behaviors and finally it produces probability of walking that is then used to optimize the coaching notifications. So, just to summarize, now it's so important to think about how technology can support healthy aging. We now have a scalable approach to delivering these kinds of health interventions for older adults and thinking about the fact that most older adults do have multiple chronic conditions, usually at least two. We need to be able to provide tailored, person specific, just in time and continuous care to the home to address these issues.

To do this well,we want to be able to incorporate what's known about health behavior change. And this kind of technology can be used to integrate lower cost personnel to address issues like coaching or a particular physical therapy approach. Most of this work needs to focus on helping engage older adults to adhere to their own health goals. And the most important part actually, is integrating, by providing this kind of feedback, integrating the family and informal caregivers as well as the patients themselves into the whole health care team.

It's certainly an untapped resource right now. We thank you for your attention. Goodbye for now and if you have any questions, feel free to get in touch with us. Hi, I'm Jim Furman. I'm a senior fellow at the Citizens Institute, and I'm thrilled to be here to tell you about my career capstone project, a project that draws on 45 years of experience I've had in the field of aging, the Robert Wood Johnson Foundation, the Consumer Organization, and for the past 25 years, as the CEO of the National Council on Aging. While I was at NCOA, I was really troubled and intrigued by the fact that there wasn't innovation going on at a level that I thought was commensurate with the problem.

And so, as part of my next chapter, I decided I wanted to work with others to see what we could doto change that situation. And the first thing so I started in March 2020, in the height of the pandemic, we started a new company, BellAge. Our mission is to help millions of people to age well one by one. And we have two cost strategies which I'm going to describe today. One is fostering an ecosystem for innovation, research, and learning about aging well.

And two is to develop and provide collectively intelligent guidance systems to help many, many people make meaningful and measurable improvements in their health and well being. As I studied the issue first at NCOA and then after I left, was I started by looking at Bell Lab, the powerful force for innovation. What made it so special, and what could we learn from that? Well, first of all, Bell Labs was working on a wicked problem, a problem for which there's never an end. You think of Alexander Graham Bell in that iconic moment of watching, I need you, that was the beginning of the first attempt to improve telecommunications and information processing.

But that work goes on constantly and repeatedly. So we had Bell Labs and a research and development organization that was inventing things. You had Western Electric, a company that was producing the solution, and all of that tied to distribution network of AT&T,and then the Baby Bells, etc. And so it's an ecosystem of RND, manufacturing, distribution, connected to each other, working on a wicked problem and fueled by national imperatives, and in this case, primarily World War II and the Korean War. So we decided to invent an analog of that for aging well.

The wicked problem that you are all familiar with is how do we improve the health and well being of millions, if not billions, of older adults? The analog to Bell Labs is not a physical lab where we're doing chemistry and physics experiment, but a network of organizations that are working together with Universities and others to develop and test solutions. The solutions, some of them are being produced by Bel Aid manufactured, collectible, intelligent system, and will be distributed through government, non profits and businesses. So this is the big vision of what we're working on. The challenge that we are facing is, and I love this slide from Eric Verdom of the Buck Institute. Two cars off the same assembly line the same year. One of them still functioning, the other in the junky metaphor.

For many of us who are older on 71 myself, there is no magic bullet. There is no pill. It's many maintenance and repair avoiding accidents. You can't ignore any piece of it. It's a matter of series of daily and weekly and annual practices and maintenance that go into aging well.

And we know that there are huge gaps between what people can be doing and should be doing in health and finances virtually every aspect of wellbeing. And we also know there are many, many resources that people are not taking advantage of. Not just money, not just community services and programs, but one of the most important ones, perhaps your time. The Bureau of Labor Statistics says the average person 65 to 74 spending almost 6 hours a day watching television. You could spend a little less time watching television, a little more time doing things that would improve health and well being. We know it could make a big difference in people's lives.

Well, why aren't people doing what they ought to do or what would help them? Because first of all, it's scary being old. We don't know what to do. It's confusing being old.

We're not sure of all the things we could do, what really matters, where to overload too much information from every source telling us what we should do. And we have people trying to sell us every kind of service and product under the sun claiming that will help us to age well. But how can we really trust these people? Why? What's the basis for their advice? And most of the advice is generic. It's not personal.

They don't know me. So the result of all of this for most of us is inertia. We continue to do what we did last year. We don't take steps and actions that we know could make a difference.

At the same time, organizations, whether they're aging organizations, the policy makers are lacking essential information about consumer wellbeing. If we don't know how well people are doing, how can we manage to improve it, either in an individual or a population level? How do we know what are the best interventions and policies to achieve our goals? And how do we even know where the disparities are, much less how to address them? That's why we decided to work on our solution that we're now developing the name of it the Adult Well Being check up. We call it a collective intelligent guidance system for aging.

Well for people who know me personally, they can think of it as a benefit checkup on steroids for aging well. But it's essentially a system connected to experts around the world that will do three things. First of all. Measure what matters 1. Using holistic validated measures of well being

2. Provide each person with personalized guidance about what they can do. What actions they can take, why it matters, and connect them to specific resources that will help them improve their health and well being. And simultaneously providing new data and insights about population. Health and wellbeing to inform interventions and policies and even funding request.

So, the three core steps of this the first of all, measurement. And for this piece, we are relying on the great work by the Institute for Healthcare Improvement, the nation's leading healthcare innovation source, which about five years ago made two important points. Number one, we weren't measuring what really matters overall holistic, health, physical, mental, financial, social,well being, meaning and purpose, et cetera.

It's more than just what healthcare was measuring. And secondly, even more profound from the healthcare organization was if you want to know how people are doing, you ask them. There are in fact validated, self reported measures of well being which can be used to both a learn how people are doing and also measure improvements over time. This piece is fundamental to our check up and to the ecosystem that we are building.

The second piece is to draw on the greatest experts from around the country and around the world. Experts in gerontology, public health, social work, psychology, medicine, on and on, to help each individual understand what they can do. That is based on not only the logic of the science, but on case experience.

And all of it filtered through the preferences of individual circumstances, learning style, behavioral support, etc. Or what can they do, why can they do it? And then connecting them to all of the resources that are available to them specifically to address their concern. We're very pleased to be working with the Greater Good Science Center, for example, at Berkeley, and graduate doctoral students who are helping us develop the algorithm for recommendations about improving overall well being. Positive aspects, negative aspects.

We're working with experts from eight different universities right now who know what the science says about what can be done to improve different aspects of wellbeing. It's very exciting work. It's growing over time, the system gets smarter and we're able to harness this knowledge and deliver it to each person at the moment they need it.

At the same time, it's very exciting that we're generating data for community organization, for health system, for age friendly communities. I don't know how you have an age friendly community or an age friendly state or an age friendly health system if you're not measuring how well people are doing. It's got to be more than the inputs and the output, which are the current metrics people rely on.

Having this wellbeing data longitudinally over time is not only potentially a framingham study on steroids, but a quick and innovative and inexpensive way for many more people to study the impact of interventions that ideas that they may have about improving wellbeing. So all of this work I mentioned from a Capstone project, it builds on a program called Benefits Check Up, which I developed first in 1988, and then helped more than 10 million people to access benefits. The Aging Mastery program, which has helped more than 35,000 people in community based settings break down this overwhelming task of aging well into specific actions that they can take.

The Wellbeing Assessment we talked about a COVID check up, which was the first application we developed, which helped 750 people in collaboration with four states, to understand their risk and what they could do to reduce those risk for COVID all of that work, plus other experiences leading to the Wellbeing checkup and to mention the ecosystem, we're bringing together now organizations from around the country who buy into this vision, who want to help people age well, who want the data, who want the learning. New York State is a major partner. Probably at least a dozen organizations across the state are part of the Wellmade Charitable Foundation large medical management group. The state of Washington is actively involved.

Many local, rural, and community based groups. UC, Davis, CITRIS, and Berkeley as part of our academic partners, and national organizations. NCOA, US Aging, Advancing State are all part of this network that helping us develop tests and bring these ideas to scale.

The way it works is just what we said. We're using the validated measures, combined with other data to measure well being, providing personalized guidance, decision support, and curated referrals drawn from domain expertise and apps, and calculators from many sources, partnering with university and community partners and scaling partners as well. So this is a fun project for a guy who's 71 who is excited about tilting at windmills. I think we're onto something really exciting. It's a pleasure to be partnering with the University of California, CITRIS Institute on this, and if you're interested, we welcome opportunities to discuss how we might work together. Thank you.

Hi. It's a real pleasure to be here today. I'm Alison Sekuler. I am the San Rottman Chair in Cognitive Neuroscience and the President and Chief Scientist at the Baycrest Academy for Research and Education at the Baycrest Center for Geriatric Center, as well as the President and Chief Scientist at the center for Aging and Brain Health Innovation, otherwise known as CABHI. And I'm also a faculty member at the University of Toronto and at McMaster University.

And today we're going to talk a little bit about remote and mobile health technology solutions and how they change where health care is being provided. And to provide you with a little bit of context, I'll tell you a bit about the organization where I spend most of my time, which is Baycrest Seniors Care. And Baycrest Seniors Care really is focused on changing the journey of aging worldwide. Our vision is to have a world where every older adult enjoys a life of purpose, inspiration, and fulfillment. And when you think about that, you can see that healthcare is really critical for this vision. And that's where we focus all of our energies.

Baycrest Seniors Care has a number of different entities within it, including the Baycrest Academy for Research and Education, which is one of the organizations I lead there, as well as Baycrest Continuing Care Hospital focused on geriatric care as well as the Appetechs Long Term Care Center, which is Canada's largest senior long term care home within the country. Almost 500 beds in that long term care center. We also have residential seniors living both specialized memory care as well as assisted living and independent living for older adults who want to make use of some of our services on the campus. We also have seniors outpatient clinics and everything imaginable and daycare for individuals living with dementia when, for example, their caregivers want a bit of respite and they also want to be socializing with other individuals. Bakers Global Solutions is an organization that advises groups across the country and around the world.

And in fact, we'll be opening our first collaborative senior care center in Thailand in the coming year. And I also run the center for Aging and Brain Health Innovation, also known as CABHI. I'll speak a little bit more about that now. The vision of CABHI, consistent with Baycrest vision, is a world in which people age and also thrive in the setting of their choice so they can maintain their cognitive, emotional and physical wellbeing and independence for as long as possible.

And we think it's really important to highlight that setting of their choice because although Baycrest does run, as I said, one of the largest long term care homes in North America and certainly in Canada, we actually would love it to see a day where nobody needs to be in a longterm care home, but everybody can age in their community, in their own homes. And that's really where we're focusing on the independence, for example. But even people who are living in long term care, we want to make sure that they're thriving as well. So to do that, CABHI tries to accelerate the development and the validation and commercialization dissemination and adoption of innovative products, services and best practices to support aging and brain health. And in this case, what we're working on is a set of solutions across the entire innovation pipeline all the way from the beginning stages of design and develop through the intermediate stages where you're validating and refining. You're really testing things in large scale in real world settings and then you're using that to come up with a final solution that you're going to be implementing and spreading and scaling, having adopted into different organizations and making a difference in the world.

So we work across the entire innovation value chain and we bring into that innovation value chain people from all of these different kinds of what we're calling the community of innovation end users, innovators, care delivery organizations, innovation and distribution partners. And putting them all together across this value chain is where we see the amplified impact and how we can really make the most in terms of turning ideas into innovations and into impact the impact that we've had to date so far, these are just some of the numbers that you can see. We have funded about $140,000,000 directly toward advancing healthcare innovations over the last seven years. And we're just finalizing another contract with the federal government for another $30 million over three years.

So we'll be adding that to the investments. Companies that we've invested in and or supported have raised over now 530,000,000 on top of our initial investment. So there's a really good return on investment. And we've launched over 350 projects.

130 have been introduced really into the broad world of seniors care across Canada and around the world. So these are some of the numbers. But if you think about what's at the heart of what we're doing, it's not the heart, it's not the dollars, it's the brain. We really care about what's happening in the brain.

And how do we make sure that we're taking these ideas from foundational science through clinical trials into innovation. And we think of that as this really sort of virtuous cycle, so that innovation leads to more foundational questions and so on. So this is really at the heart of everything we're doing.

And you might say, well, why do you care so much about the brain? And in particular, why do we care about people who are at risk for and living with dementia? And the reason is that right now in Canada, over 700,000 Canadians live with dementia. And that's expected to double within the next decade. And if you think about the numbers around the world, obviously it's a very large number. Once every 3 seconds, someone somewhere around the world is diagnosed with dementia. That's the state of where we are right now.

And with COVID having come on the scene, there's a huge concern that this already giant public health issue around the world of dementia is going to just continue to grow. And that's because from work that's going on in my lab and other labs that we collaborate with, we know that there is both a direct effect of COVID on the brain in terms of changing the cognitive function. And you will have heard about brain fog. You've heard of post COVID condition. There's a lot of neurological symptoms with that, some of which mirror early mild cognitive impairment.

And there's also quite a lot of indirect effects of COVID, certainly in countries like Canada, where we had a lot of social isolation to keep people safe from acquiring COVID,which is really critical to do. But in the process of doing that, we increase their isolation, we decrease their access to services, we limited their ability to exercise at gyms, for example. And so all of those sorts of things that got limited are risk prevention approaches for dementia. And so there's this direct and an indirect effect of COVID on the brain that we are concerned is going to be leading to an even increased dementia risk in the years to come.

And what that means is that the costs of dementia care is going to really skyrocket. In Canada alone, the cost for the direct care of dementia is $10 billion. When you combine the direct and the indirect cost, it's already exceeding $30 billion. When you consider the world situation, it's of course even higher.

It's in the trillions of dollars already. So if dementia care were a company, it would be one of the largest companies in the world in terms of dollar by dollar, almost as big as Apple for example. So, this clearly is not something that is sustainable, it's not something that we would like to see. We'd like to see the numbers of individuals living with dementia decrease, we'd like to see the cost of dementia care decrease and we'd like to see older people living their best possible lives. And so we desperately need a new approach and that's where remote and mobile health technologies come in. They are more important right now than ever.

And the other thing that we need to do is to focus on prevention of dementia and early detection of dementia and other neurodegeneration as well as the treatment of it. So that it's not just sort of once people have gotten to the final stage of having dementia, we deal with it, but let's cut it off before it even gets there. So that's the approach that we take a Baycrest Seniors Care, that's the approach we take within CABHI.

And what I want to do is just give a couple of examples of how we are doing it and how colleagues of ours and friends of ours and companies that we've worked with and partnered with have been doing it as well. And one of the most obvious ways that you can be moving into this mobile and remote testing sorry, care space is thinking about the transition from in-person care to virtual care. And in the Canadian context that's incredibly important because in Canada we're a very geographically large country, but the vast majority of people, something like 90% of people, live within an hour or two of the border with the United States. So there are big swaths of the country, rural areas, northern areas, indigenous reservations where there is very limited access to health care. And over the years it's been quite difficult to be able to get the virtual care model going.

This is if there is any kind of a silver lining to COVID, this is one of the silver linings is that it necessitated a shift in the way that we were delivering care instead of doing it in person all the time, as the default, it opens the doors, including funding opportunities from our government payers and other insurance companies to be able to support virtual care. And I show here in the middle one of Baycrest's neurologist, Dr. Morris Friedman, who we have dubbed the Virtual Dementia Whisperer because he's able to work with very difficult cases of people who have all kinds of behavioral issues due to dementia and using a virtual care approach, help them live better lives in their own homes. And he's now working with another team at the Rottman Research Institute at Baycrest Academy on tying that in with AI based triaging systems so that we know who is it that needs the care most urgently, who needs to be seen in person, who could be seen virtually, and so on.

And this provides greater care as well as greater access to care. So this is a real savings and benefit for society. It's supported these kinds of virtual care systems with the fact that there now are also an increasing number of remote assessment tools. So what you'll see on the right hand side where it says I am a patient or parent, is a place where you might use Sonovi's New, Felix at Home Smart Stethoscope. They've got three different versions. There's Felix. There's Felix Pro, and there's Felix at home.

And this is an example of both a remote and a mobile system because if you're a global health worker. For example. You can use the tool that you can see the woman using on the left and it has all kinds of noise cancelation systems in it.

So that even in noisy environments like you're seeing here. You can get the right kind of information about how the person is breathing and can use it then to be able to assess how someone's treatment is going. And obviously clinicians can use it in their own offices and there's a pro version that lets you do all kinds of extra things. And the Felix At Home is really for people who want to be monitoring their own health care or the health care of others as they're being treated in different ways.

And it can also be used for prediction and I'll come to that a little bit later. Another kind of treatment, and this is one that CABHI is supporting, I Regainied, has a device called My Hand, which is a home stroke rehabilitation system. So basically it helps with the very major problem that stroke survivors have where they may be perfectly fine, except they've lost the ability to move the fingers or move one hand. This has happened recently to a friend of mine and he's very excited to be able to see that these kinds of systems are coming out.

He won't necessarily have to go to the hospital or to a rehab clinic to be able to do his rehabilitation. He can now do something with My Hand or other kinds of devices that are coming out in the comfort of his own home and know that he's getting more access to that treatment and better treatment as a result. There's also for people who want to be doing other kinds of rehabilitation, for example, you don't have to go to a physiotherapist in person anymore. XR Health has tools where you can be working virtually with a physiotherapist in the Metaverse, which is just fancy code for virtual reality in this case.

And basically the therapist is there with you in virtual space and telling you exactly how to be doing things. And it tracks your movements to make sure that you're doing things safely again in your own home. So it's providing additional treatment options in people's homes. And this is just another example of a VR based remote treatment option from another company that we work with called ReactNeuro. And in this case they've got treatment for concussion, for stroke and for neurocognitive decline. So there are all sorts of brain training systems that are in place there.

The thing that's interesting, I think, about React Neuro is it also has a remote assessment or remote detection element to it. So it can use the information about how your eyes are moving and your brain pattern when you are doing some of these kinds of tasks to be able to tell in advance when you might be headed toward a decline of some sort. So this is another example of a tool to be used not just to say help you with your therapy, but also to do screening in advance, to let you know in advance when you might need different kinds of therapy. Another kind of remote detection tool is seen here. This is Cognicity and this is a tool that came out of the Baycrest Research enterprise and moved into a spin off company called Cognicity. And the element I want to focus on here is the Brain Health Assessment which is just a 20 minutes validated tool that helps people who are concerned about their brain health and their memory make sure that they are on track in terms of being able to do certain kinds of tasks and you can track it as you go and if you see changes, it gives you information about how you might want to be able to access different physicians or doctors and it gives you tools to manage any kind of those changes in your brain health. So you can see early

before there's any kind of change that's too significant, you can catch it. And the other thing that is a personal interest of mine because it's something that we do in my research lab, we're working with a company called InteraXon and they've got a device called the Muse2. If you can see me in the little box, you can see this is what the muse looks like. It's just a headband, you put it on over your ears.

It's actually a portable, mobile and potentially remote electroencephalography system or EEG system. So it's reading the electrical potential of your brain, seeing what is the activity like in your brain. And they originally designed it for mindfulness meditation training that's shown on the right there of one of our participants in our labs using the Mindfulness meditation system. We have been working to also see if we can use the system to detect changes in the brain when people are doing really basic vision tasks and use that to predict years and years and years before they have any memory problems. Who is headed toward the path of Alzheimer's disease or Lewy body disease or frontal temporal dementia or any of the other sorts of dementias? Because we think that each of them may be affecting the brain in slightly different ways.

And we also believe that vision is maybe sort of the window, the canary in the coal mine, if you will, for dementia. And so we're working to look at the combination of neural signals and brain behavioral signals in these really early visual tasks to be able to predict and detect dementia as early as possible. And the reason that's important is because you want to do whatever you can to keep any sort of amyloids or tau proteins from accumulating in the first place, because once they're in there, even if you get rid of them, we have not yet found a cure for what we can do to stem the tide of dementia. So the earlier you can get in for intervention, the better. So that's why remo

2022-10-21 00:30

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