Aging is new. It demands and deserves new thinking. Only 100 years ago, life expectancy was about 47 years; what was the end of life then is considered by many as the beginning of midlife today. Longer life is an opportunity to invest, invent, and innovate for how we will live tomorrow.
The quest for longer life has fueled the imagination and the work of generations. Figure 1 illustrates the progress and strategic direction of longevity. Think of longevity as a series of progressive “versions”: Longevity 1.0, Longevity 2.0, and Longevity 3.0. As the figure shows, quality of life and longevity may be related but do not necessarily intersect—more years do not necessarily guarantee good years.
Longevity 1.0 Life
Longevity is an individual pursuit with little support from technology. Access to health care and medications may be limited or nonexistent. Simply stated, if you are able to find food and shelter—the very basics of life—you will live, albeit perhaps for a short time.
Longevity 2.0 Longer Life
The longevity that many of us in the industrialized world enjoy is the result of several independent but convergent interventions. Medical technology and health care delivery are among the greatest contributors to longer life. Effective public health practices, vaccinations, and nutrition and care of young children made it possible for many of those youngsters to become older adults. Less recognized is the influence of large infrastructure systems. Many years of life are owed to systems that provide clean water and remove sewage, ensuring environmental quality. Longevity 2.0 defines quality living or aging as managing disease and physical function: “If you have your health, you have everything.”
Longevity 3.0 Living Well
In Longevity 3.0, we seek to live longer and better. But what is “better”? Traditional measures of quality of life for older adults have focused on physical health and the ability to complete daily tasks. This approach is not incorrect; however, it is incomplete. The next step in longevity is well-being. Well-being refers to a holistic approach to living; it includes basic access to food, shelter, and functionality but goes beyond Longevity 1.0 and 2.0 to include healthy behaviors and environmental factors that have an impact on emotions, personal meaning, and life satisfaction.
The Gallup-Healthways Well-being Index defines well-being as a dynamic, multidimensional, yet integrated self-assessment of
> Life evaluation: How is your life today and what might it be like five years
> Emotional health: How did you feel throughout the day: happy, sad, amused, angry, stressed, etc.?
> Physical health: What is your experience with chronic disease and pain? How many sick days have you taken? What are your body mass index and disease history?
> Healthy behaviors: Did you engage in daily behaviors that contribute to better health (e.g., eating fruits and vegetables, exercising, complying with medication regimes)?
> Work environment: How does work contribute to providing an opportunity to use your personal strengths, and to feelings of worth, trust, and life satisfaction?
> Basic access: Do you have access to food, clean water, shelter, safety, and regular health care?
Longevity 3.0, the quest for well-being, requires the building and management of a complex system that aligns infrastructure, innovations, and institutions to support how we will live and age tomorrow. It includes:
> Rethinking everyday environments (e.g., transportation, housing, commercial and public spaces)
> Application of technology-enabled innovations to provide guidance and assistance with individual behaviors
> Development of new institutions and practices to advance the future of work, learning, care, and fun, as well as regulatory frameworks to address the new world of old age
Necessary and important work continues in the development of new medicines and creative approaches to health care delivery; however, three strategic areas require public-private focus to achieve the objectives of Longevity 3.0. These are mobility and community, aging in place and health, and work and education.
Integrate Well-being into Mobility and Community
Before you can do anything, you have to get there. Mobility is the glue that holds together all the big and little things that make up an engaged life. In highly motorized nations, this often means driving. Older driver safety is a perennial topic of discussion around the world: How old is too old to drive? Health, not age, is the threat to safety. In addition to developing better health diagnostics for people of all ages, how might the vehicle be improved to support driver well-being?
Many “intelligent” systems are available on cars to compensate for blind spots and to enhance collision avoidance and night vision. The Massachusetts Institute of Technology AgeLab, along with the U.S. Department of Transportation and the automobile industry, are developing the AwareCar. As shown in figure 2, the AwareCar detects the wellness state of the driver (stress, fatigue, distraction) by sensing a variety of indicators, including heart rate and eye movement. In addition, the vehicle will improve the driver’s performance with seat massage, aroma, lighting, and other interventions to reduce stress, fatigue, or distraction. The future of the car (and of all built environments, including homes, stores, and workplaces) is to be “intelligent”; that is, to sense the user’s state of wellness and intervene to improve performance.
Research on the healthy aging of centenarians in Blue Zones (regions of the world where people routinely live active lives past the age of 100 years) has shown that “livable communities” improve overall well-being. Livability is best defined as accessibility, density, and intensity. Streetscapes, retail centers, and public transportation systems must be more than just physically accessible; they must invite walking. New tools are necessary to inform standards and design. Figure 3 shows the MIT AgeLab’s Age Gain Now Empathy System (AGNES). AGNES is an instrumented suit worn by planners, engineers, and architects; it enables them to experience firsthand the friction points in the built environment by simulating the physical decline that often accompanies advanced age (e.g., reduced vision, strength, and flexibility). These personal insights translate into public design improvements.
Density is a high concentration of activities that engage older adults in daily activities, from workplaces to eating places. Intensity refers to the variety of activities to choose from that are accessible and provide a context-rich and satisfying life. Together, mobility, accessibility, density, and intensity support living well across the lifespan.
Clearly, policy work is needed to achieve livability. Most North American communities built around the car do not offer these characteristics. Megacities in rapidly developing economies, such as China, offer density and intensity but not necessarily safe accessibility. Older European towns and villages may offer accessibility, but as younger people move to cities, much of the density and intensity is lost as a result of reduced economic activity.
Develop Technology-Enabled Services to Age-in-Place
The capacity to age in place is key to our emotional well-being. But the home is more than where we live—it is an evolving services platform to keep us independent, connected, and healthy. New technology-enabled services are emerging to manage disease in the home, monitor our safety, and motivate healthy behaviors.
For example, video-enabled telemedicine is enabling older adults to connect with clinicians anywhere in the world to manage chronic disease at home. Cisco has piloted programs in California and Scotland that have a 95 percent satisfaction rate with older consumers.
Numerous service providers (e.g., Philips, ADT, and General Electric) are already monitoring the safety of older adults. These services do more than just detect a fall; they regularly collect data to predict that an event might happen. Soon your home may have mini-cameras, motion detectors, and even a “smart” teapot to sense changes in your well-being (e.g., changes in sleeping patterns, gait, or nutrition), prompting you, a loved one, or a physician to intervene before a catastrophic event occurs.
Healthy behaviors are key to well-being at any age. The MIT AgeLab is developing systems to enhance home-based behaviors such as diet and medication compliance. Figure 4 shows AgeLab’s Personal Advisor, which provides kitchen and in-store advice on healthy food choices given the person’s diet and disease profile. But behavior is the product of more than information; it has a social element. The AgeLab’s Pharm Animals, shown in figure 5, are toy pets that connect grandparents and grandchildren. If a grandparent forgets to take his or her medicine, the grandchild’s pet changes color, indicating sadness. If the grandchild does not do his or her homework, the grandparent’s pet becomes “sad.” This technology creates a contract between grandchildren and grandparents, prompting behaviors that lead to better outcomes for everyone.
The kitchen has always been the social hub of the home. It will soon be the access point for pharmacies, grocers, and health and disease managers to provide services to older adults living alone or to caregivers. The AgeLab’s Social Kitchen builds on MIT-NASA technology to manage the logistics of the space station. In partnership with Nippon Telephone and Telegraph, AgeLab is developing a kitchen that will facilitate delivery of food and management of medications, prompt healthy nutrition choices, and provide virtual social connectivity with friends and family.
Reengineer Work and Education
Management sage Peter Drucker observed more than a decade ago that people would be working well into their seventh decade. Whether the work is for pay or as a volunteer, it contributes to our assessment of life satisfaction and social impact. In fact, a study by the Organisation for Economic Co-operation and Development reveals that while income is important, social meaning offered by the work environment is critical to overall well-being. However, while we may be willing to work longer, the workplace may not be ready. The physical workplace, employee education, and human resources management must be redesigned.
Older workers mean a new workplace. Aging eyes require better task lighting. Everything from cubicle chairs to manufacturing floors must be redesigned to reduce physical strain. Creative use of technology can extend work life and productivity. For example, BMW is using cobotics (assistive robotic systems) to help assembly line workers. Cobotics compensates for workers’ changes in strength and reduces the chances of injury while allowing older workers to apply their years of experience to production—the difference between an assembly worker and a craftsperson.
Work cannot be separated from education. The pace of technology and knowledge is so rapid that even a 30-year-old has to run to stay current. Working longer requires lifelong learning, and education contributes to productivity, personal growth, and meaning. Redesigning how, where, and what we learn across the lifespan will be critical to workers and aging societies. The future of education may include knowledge management systems that provide a former employee’s experience in the form of an avatar, point-of-task job instruction, and even a required midcareer education sabbatical.
Improvements in the physical and educational dimensions of work will require an emphasis on redesigning human resources policies to enable a four-generation workplace to address pay and promotion. After all, tomorrow’s junior trainee is likely to be an older person embarking on his or her third new career.
Longevity 3.0—the quest for well-being—is about more than longer life and health. It is about creating systems that strategically align technology, environments, institutions, and behaviors to enable personal meaning, life satisfaction, and contribution across the lifespan. It is life tomorrow.
For more information visit http://agelab.mit.edu
Dr. Joseph Coughlin
Joseph F. Coughlin, PhD is founder and Director of the Massachusetts Institute of Technology AgeLab at http://agelab.mit.edu. His research addresses the translation of demographic change, behavior and technology into business and policy innovation. Dr. Coughlin conducts research, speaks and consults to companies and governments worldwide. He teaches strategic management & policy innovation and publishes www.disruptivedemographics.com.