A Whole New Way of Being Old: Book Review of The New Mobile Age

Posted on March 15, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The recently released overview of health care for the aging by Dr. Joseph Kvedar and his collaborators, The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan, is aimed at a wide audience of people who can potentially benefit: health care professionals and those who manage their clinics and hospitals, technologists interested in succeeding in this field, and policy makers. Your reaction to this book may depend on how well you have asserted the impact of your prefrontal cortex over your amygdala before reading the text–if your mood is calm you can see numerous possibilities and bright spots, whereas if you’re agitated you will latch onto the hefty barriers in the way.

Kvedar highlights, as foremost among the culture changes needed to handle aging well, is a view of aging as a positive and productive stage of life. Second to that comes design challenges: technologists must make devices and computer interfaces that handle affect, adapt smoothly to different individuals and their attitudes, and ultimately know both when to intervene and how to present healthy options. As an example, Chapter 8 presents two types of robots, one of which was accepted more by patients when it was “serious” and the other when it was “playful.” The nuances of interface design are bewildering.

The logical argument in The New Mobile Age proceeds somewhat like this:

  1. Wholesome and satisfying aging is possible, but particularly where chronic conditions are involved, it involves maintaining a healthful and balanced lifestyle, not just fixing disease.

  2. Support for health, particularly in old age, thus involves public health and socio-economic issues such as food, exercise, and especially social contacts.

  3. Each person requires tailored interventions, because his or her needs and desires are unique.

  4. Connected technology can help, but must adapt to the conditions and needs of the individual.

The challenges of health care technology emerged in my mind, during the reading of this book, as a whole new stage of design. Suppose we broadly and crudely characterize the first 35 years of computer design as number-crunching, and the next 35 years–after the spread of the personal computer–as one of augmenting human intellect (a phrase popularized by pioneer Douglas Engelbart).

We have recently entered a new era where computers use artificial intelligence for decision-making and predictions, going beyond what humans can anticipate or understand. (For instance, when I pulled up The New Mobile Age on Amazon.com, why did it suggest I check out a book about business and technology that I have already read, Machine, Platform, Crowd? There is probably no human at Amazon.com or elsewhere who could explain the algorithm that made the connection.)

So I am suggesting that an equally momentous shift will be required to fulfill Kvedar’s mandate. In addition to the previous tasks of number-crunching, augmenting human intellect, and predictive analytics, computers will need to integrate with human life in incredibly supple, subtle ways.

The task reminds me of self-driving cars, which business and tech observers assure us will replace human drivers in a foreseeable time span. As I write this paragraph, snow from a nor’easter is furiously swirling through the air. It is hard to imagine that any intelligence, whether human, AI, or alien, can safely navigate a car in that mess. Self-driving cars won’t catch on until computers can instantly handle real-world conditions perfectly–and that applies to technology for the aging too.

This challenge applies to physical services as well as emotional ones. For instance, Kvedar suggests in Chapter 8 that a robot could lift a person from a bed to a wheelchair. That’s obviously riskier and more nuanced than carting goods around a warehouse. And that robot is supposed to provide encouragement, bolster the spirits of the patient, and guide the patient toward healthful behavior as well.

Although I have no illusions about the difficulty of the tasks set before computers in health care, I believe the technologies offer enormous potential and cheer on the examples provided by Kvedar in his book. It’s important to note that the authors, while delineating the different aspects of conveying care to the aging, always start with a problem and a context, taking the interests of the individual into account, and then move to the technical parts of the solution.

Therefore, Kvedar brings us face to face with issues we cannot shut our eyes to, such as the widening gap between the increasing number of elderly people in the world and the decreasing number of young people who can care for them or pay for such care. A number of other themes appear that will be familiar to people following the health care field: the dominance of lifestyle-related chronic conditions among our diseases, the clunkiness and unfriendliness of most health-related systems (most notoriously the electronic health record systems used by doctors), the importance of understanding the impact of behavior and phenotypical data on health, but also the promise of genetic sequencing, and the importance of respecting the dignity and privacy of the people whose behavior we want to change.

And that last point applies to many aspects of accommodating diverse populations. Although this book is about the elderly, it’s not only they who are easily infantilized, dismissed, ignored, or treated inappropriately in the health care system: the same goes for the mentally ill, the disabled, LGBTQ people, youth, and many other types of patients.

The New Mobile Age highlights exemplary efforts by companies and agencies to use technology to meet the human needs of the aging. Kvedar’s own funder, Partners Healthcare, can afford to push innovation in this area because it is the dominant health care provider in the Boston area (where I live) and is flush with cash. When will every institution do these same things? The New Mobile Age helps to explain what we need in order to get to that point.