How Do We Protect Agency in Aging?

January 31, 2022

A few years ago, my great aunt needed extra care, and the decision was made to put her in an assisted living facility.

At 97 she was mentally acute, but her physical strength had declined. She needed some assistance with everyday activities such as getting dressed and being escorted to meals. Despite that, she was very healthy—and relatively strong—for a 96-year-old woman.

Shortly after being admitted to the facility, she saw an ophthalmologist for a routine exam. The doctor, unfamiliar with her physical abilities, told her she needed a walker because of her age. He told her she could fall and break a bone, and that would be the beginning of the end for her. He scared her, and that week she got a walker.

Using a walker led to decreased muscle strength, which caused falls. In a few months, a walker turned into a wheelchair, which quickly turned into being bed-ridden. Within a year, she passed away, still having her mental faculties but no autonomy or physical ability.

Falls indeed are the leading cause of injury-related death for older adults. It’s possible without the walker, my aunt would have fallen, and her injuries, in-turn, could have become life-threatening. However, it’s also possible that she wouldn’t have fallen with the proper care and maintained some strength and independence to live her life with more agency.

The question we’re faced with is how to protect older adults from the fear of life-threatening incidents without stripping them of control over their own lives.

The balance between autonomy and safety is exceptionally tricky to navigate with legacy technology, limited budgets, and a decreasing pool of available staff. Losing autonomy to dated aging infrastructure doesn’t have to be a reality.

At Sage, we’re using technology to strike a better balance. We believe that getting older shouldn’t require a choice between being safe and being autonomous.

Agency and Aging: A Delicate Balance

Our need for assistance increases as we age. Once autonomous activities such as climbing stairs, carrying heavy shopping bags, driving, and even walking may require additional support. Our society often lacks nuance when approaching these issues.

Protecting one’s agency over their life as they age generally comes down to understanding and respecting personal preferences and empowering people to do what they can while giving them tools for help.

Agency is largely a function of human resources. We rely on people to understand our needs and help us with not too much but not too little assistance. Unfortunately, caregivers can be scarce or lack bandwidth. Even when caregivers are available, they have little understanding of what level of care the person requires. This results in a lack of nuance with care, which can result in poor health outcomes.

An older adult who needs help, but isn’t able to get it, may try to do something themselves that can result in injury. Alternatively, when caregivers are available, they often provide too much assistance to limit the risk of injury. How can we create a balance?

Existing products

To assist older adults, many families and facilities explored (now-legacy) technology such as pull-cord and call-light systems and emergency necklace pendants to automate or alleviate some of the workloads. More recent technology includes a camera or sensor-based products that help put “eyes on” older adults. Not only are these solutions intrusive, but they don’t provide a personalized approach to care.

Legacy products miss three key opportunities in improving care for older adults and helping maintain autonomy.

First, legacy systems don’t consider the caregiver. They often trigger an alert that might turn on a light or ring a bell, but this is not an effective method to alert caregivers and can create “alert blindness” which contributes to staff fatigue and burnout, leading caregivers to question the alarm’s utility.

Caregivers need to be met where they are, which is commonly on phones—either personal or company devices. More products and systems create more noise. And with more noise comes less efficiency.

Secondly, these products don’t provide nuance. Most of them generate a binary signal that something happened or didn’t. They don’t consider the individual, their history, or preference.

Lastly, these products don’t provide actionable insight, so care managers can’t make informed decisions about health, or—in the case of facilities—have visibility into what care is being given and make adjustments to staffing or process.

Empowering Agency with Tech

At Sage, our mission is to develop a platform for modern aging. We believe that aging should be dignified and no one should need to give up autonomy to feel safe.

1. Real-time alerts

There is much to gain from studying the the pain points in the caregiver experience,  such as alert-blindness and the burden of interacting with multiple devices.

We learned that by making alerting more convenient for caregivers with a web-based app that’s accessible to anyone on any smart-device in real time, we’re able to build the caregiver response system in a way that works with a much greater accuracy.

At facilities, a notification gets sent to all on-call care staff when someone needs help. This results in faster response times, which in turn helps older adults receive help when they need it rather than trying to do something on their own, which could result in a fall or other injury.

2. Personalized information

The concept of care is rooted in the individual—what’s right for me may not be right for you. And yet, too often care is given uniformly. This is often because access to key information isn’t available when someone needs it.

Sage makes it easy to understand at-a-glance what amount of care needs to be given to allow people to maintain independence where possible. We also highlight preferences so care can be given in a way that respects one’s personal wishes.

3. Operational Data

Care is a team effort—especially in facilities. Data helps us understand the granular aspects of an individual’s health and the best courses of action.

In facilities, the documentation of care and incidents often happens at the end of shifts, which can lead to lapses and errors and can go unnoticed by care managers.

Unlike legacy products, Sage removes the friction of resolving and finalizing alerts in a quick three-step process. By removing the steps needed to go from alert input to output in charts, we can provide a much cleaner and accurate set of data for the next caregiver or medical personnel. Sage can also identify anomalies that may indicate health issues that require preventative help before a situation escalates into an emergency.

Final Thoughts: Modern Aging Innovation

Our hope is that Sage will empower older adults to live life on their terms and without fear. To address these needs, we started with the needs of the caregivers.

By creating an experience that meets caregivers where they are and gives them easy access to information on how best to care for an individual, we help olders adults maintain autonomy and simplify the tedious and often unrecognized work of caregivers.

We make it easier for facilities and care managers to operate efficiently and make decisions backed by data.

Aging with agency should be a right afforded to everyone. With the right technology and tools, we can ensure that older adults don't have to give up independence to live securely.