REPORT TO THE PRESIDENT

Independence, Technology, and 

Connection in Older Age

Executive Office of the President

President’s Council of Advisors on

Science and Technology

March 2016

REPORT TO THE PRESIDENT

Independence, Technology, and

Connection in Older Age

Executive Office of the President

President’s Council of Advisors on

Science and Technology

March 2016
About the President’s Council of Advisors on

Science and Technology

The President’s Council of Advisors on Science and Technology (PCAST) is an advisory group of the 

Nation’s leading scientists and engineers, appointed by the President to augment the science and 

technology advice available to him from inside the White House and from cabinet departments 

and other Federal agencies. PCAST is consulted about, and often makes policy recommendations 

concerning, the full range of issues where understandings from the domains of science, technology, 

and innovation bear potentially on the policy choices before the President. 

For more information about PCAST, see www.whitehouse.gov/ostp/pcast
v

The President’s Council of Advisors on 

Science and Technology

Co-Chairs

John P. Holdren

Assistant to the President for 

Science and Technology

Director, Office of Science and Technology 

Policy

Eric S. Lander

President

Broad Institute of Harvard and MIT

Vice Chairs

 

William Press

Raymer Professor in Computer Science and 

Integrative Biology

University of Texas at Austin

Maxine Savitz

Vice President

National Academy of Engineering

Members

Wanda M. Austin

President and CEO

The Aerospace Corporation

Christopher Chyba 

Professor, Astrophysical Sciences and 

International Affairs

Director, Program on Science and 

Global Security

Princeton University

Rosina Bierbaum

Professor, School of Natural Resources 

and Environment

University of Michigan

S. James Gates, Jr. 

John S. Toll Professor of Physics

Director, Center for String and 

Particle Theory

University of Maryland, College Park

Christine Cassel

Planning Dean 

Kaiser Permanente School of Medicine

Mark Gorenberg

Managing Member

Zetta Venture Partners
vi

Susan L. Graham

Pehong Chen Distinguished Professor 

Emerita in Electrical Engineering and 

Computer Science

University of California, Berkeley

Ed Penhoet

Director

Alta Partners

Professor Emeritus, Biochemistry and 

Public Health

University of California, Berkeley

Michael McQuade

Senior Vice President for Science and 

Technology

United Technologies Corporation

Barbara Schaal

Dean of the Faculty of Arts and Sciences

Mary-Dell Chilton Distinguished Professor 

of Biology

Washington University of St. Louis 

Chad Mirkin

George B. Rathmann Professor of 

Chemistry

Director, International Institute for 

Nanotechnology

Northwestern University

Eric Schmidt

Executive Chairman

Alphabet

Mario Molina

Distinguished Professor, Chemistry and 

Biochemistry

University of California, San Diego

Professor, Center for Atmospheric Sciences

Scripps Institution of Oceanography

Daniel Schrag

Sturgis Hooper Professor of Geology

Professor, Environmental Science and 

Engineering

Director, Harvard University Center for 

Environment

Harvard University

Craig Mundie

President

Mundie Associates

Staff

 

Marjory S. Blumenthal

Executive Director

Jennifer L. Michael

Program Support Specialist

Diana E. Pankevich

AAAS Science & Technology Policy Fellow

Ashley Predith

Assistant Executive Director
vii

PCAST Independence, Technology, and Connection 

for Older Adults Working Group

Working Group members participated in the preparation of an initial draft of this report. Those 

working group members who are not PCAST members are not responsible for, nor necessarily 

endorse, the final version of this report as modified and approved by PCAST.

Co-Chairs

Christine Cassel

Planning Dean 

Kaiser Permanente School of Medicine

Ed Penhoet

Director

Alta Partners

Professor Emeritus, Biochemistry and 

Public Health

University of California, Berkeley

Working Group Members

 

Jo Ivey Boufford

President 

New York Academy of Medicine

Susan L. Graham

Pehong Chen Distinguished Professor 

Emerita in Electrical Engineering and 

Computer Science

University of California, Berkeley

Sara J. Czaja

Leonard M. Miller Professor

Department of Psychiatry and Behavioral 

Sciences

Scientific Director, Center on Aging

University of Miami Miller School of Medicine

Thomas Kamber

Executive Director

Older Adults Technology Services

David Dring

Executive Director

Selfhelp Innovations 

Selfhelp Community Services 

Jason Karlawish 

Professor of Medicine

Perelman School of Medicine

University of Pennsylvania 

S. James Gates, Jr. 

John S. Toll Professor of Physics

Director, Center for String and 

Particle Theory

University of Maryland, College Park

Arthur Kramer

Director

Beckman Institute

Professor of Psychology 

University of Illinois at Urban Champaign
viii

David Lindeman

Director 

CITRIS Health 

University of California, Berkeley

William Press

Raymer Professor in Computer Science and 

Integrative Biology

University of Texas at Austin

Michael McQuade

Senior Vice President for Science and 

Technology

United Technologies Corporation

Maxine Savitz

Vice President

National Academy of Engineering

Chad Mirkin

George B. Rathmann Professor of 

Chemistry

Director, International Institute for 

Nanotechnology

Northwestern University

Kai Stinchcombe

Chief Executive Officer and Founder

True Link Financial 

Craig Mundie

President

Mundie Associates

Charlotte Yeh

Chief Medical Officer

AARP Services Inc. 

Elizabeth Mynatt

Executive Director

Institute for People and Technology

Professor, School of Interactive Computing

Georgia Institute of Technology 

Staff

 

Marjory S. Blumenthal

Executive Director

Diana E. Pankevich

AAAS Science & Technology Policy Fellow

Jennifer L. Michael

Program Support Specialist

Ashley Predith

Assistant Executive Director

Technical Writer

 

Robert Saunders

Senior Advisor to the President 

National Quality Forum
EXECUTIVE OFFICE OF THE PRESIDENT

PRESIDENT’S COUNCIL OF ADVISORS ON SCIENCE AND TECHNOLOGY

WASHINGTON, D.C. 20502

President Barack Obama

The White House

Washington, DC 20502

Dear Mr. President: 

We are pleased to send you this PCAST report on Independence, Technology, and Connection in Older Age. 

It is the second and final installment of PCAST’s work on the topic of technology for graceful aging. The 

first was our letter report to you in October 2015 on technologies for hearing assistance.

The average age of the American population is increasing, and Americans want to continue to have active 

and productive lives as they age. The older adult population is diverse, made up of individuals with 

different economic circumstances, living situations, geographic locations, and language backgrounds, but 

predictable changes occur as people age.

Technology has played an important role in increasing life expectancy, but it also has an important role to 

play in increasing the quality of life, by maximizing Americans’ ability to function in their later years. 

Last year marked the 50th anniversary of Medicare, Medicaid, and the Older Americans Act. At the 2015 

White House Conference on Aging, discussions and new ideas inspired the direction of aging policy for 

the next decade. 

Building on these ideas, PCAST looks in this second report at three areas where older adults experience 

change: social engagement and connectivity, cognitive function, and physical ability. PCAST investigated 

technologies that promote individuals’ continued independence and productivity as these changes 

happen. 

The report includes four cross-cutting recommendations that span a wide range of technologies and eight

targeted recommendations concerning specific applications to improve mobility, cognitive function, and 

social engagement. Internet access, telehealth, monitoring technology, emergency preparedness systems, 

and intentional design are some of the technologies that will support healthy aging for all Americans. The 

report focuses on near-term Federal actions to advance these possibilities.

Older adults can bring the experiences and knowledge of their lifetimes to be vital, contributing, and 

productive members of society. Implementing these recommendations will help that happen, by 

ensuring that Americans now and in the future remain independent and connected as they age.

Sincerely, 

John P. Holdren Eric S. Lander

Co-Chair Co-Chair

xi

Table of Contents

The President’s Council of Advisors on Science and Technology........................................................ v

PCAST Independence, Technology, and Connection for Older Adults Working Group............ vii

Table of Contents .................................................................................................................................................. xi

Executive Summary and Recommendations ..........................................................................................1

Study Scope..................................................................................................................................................1

Social Connectivity and Emotional Health (Chapter 2) ..............................................1

Changes in Cognitive Ability (Chapter 3)...............................................................................2

Changes in Physical Ability (Chapter 4) .................................................................................3

Recommendations in Summary ...................................................................................................4

Cross-Cutting Recommendations ..........................................................................................4

Issue-Specific Recommendations ..........................................................................................5

1. Introduction and Cross-Cutting Issues .................................................................................................7

Study Overview.........................................................................................................................................9

Potential of Technology................................................................................................................... 10

Cross-Cutting Themes....................................................................................................................... 12

2. Technologies for Social Connectivity and Emotional Health................................................. 16

Improving Engagement through Technology ................................................................. 16

Social Participation...................................................................................................................... 16

Employment & Volunteerism................................................................................................ 17

Information & Resources......................................................................................................... 19

Technology Utilization and Adoption................................................................................... 20

Federal Actions to Improve Connectivity........................................................................... 22

Education & Training ........................................................................................................................ 23

Including Older Americans in Emergency Disaster Planning............................. 25

3. Technologies to Address Changes in Cognitive Ability............................................................ 29

How Technology Can Monitor Cognitive Function...................................................... 30

How Technology Can Protect Older Adults’ Economic Security........................ 32

The Promise of Technology to Maintain or Enhance Cognitive Health........ 38

Cognitive Enhancement............................................................................................................ 38

Cognitive Assistive Systems ................................................................................................... 40

4. Technologies to Address Changes in Physical Ability ............................................................... 42

Telehealth.................................................................................................................................................. 43

Promise of Telehealth................................................................................................................ 43

Federal Government Initiatives in Telehealth............................................................. 46
xii

Challenges for Telehealth Implementation................................................................... 48

Improving Telehealth................................................................................................................. 49

Designing Buildings to Ensure Independence in the Home ................................. 50

Role of Home Design and Modifications ......................................................................... 50

Role of Product Design..................................................................................................................... 52

Compensating for Mobility Loss................................................................................................ 53

Appendix. Additional Experts Providing Input................................................................................. 56

Additional Acknowledgments .................................................................................................... 66
Independence, Technology, and Connection in Older Age

1

Executive Summary and Recommendations

The U.S. population is getting older, and Americans are living longer, on average, than they ever have

before. As they age, people are healthier and more active than the generations before them and have

fewer functional limitations such as difficulty walking or blindness. Studies show that people are

happier on average as they advance into their later decades and enjoy high levels of accumulated

knowledge and experience. 

Getting older is a time of social, emotional, mental, and physical change. Retirement might change how

a person interacts socially every day, affecting a person’s mood and well-being. Cognitive aging—the

normal process of cognitive change as a person gets older—can begin, or a permanent change in

physical function may arise. Technology offers a path for people who are navigating these changes

potentially to prevent or minimize the risks associated with them and to enhance people’s ability to live

their lives fully. We, the President’s Council of Advisors on Science and Technology (PCAST), sought to

identify technologies and policies that will maximize the independence, productivity, and engagement of

Americans in their later years.

Study Scope

Advances in technology hold great promise for adding to the lives of older adults. Our study focused on 

four key changes older Americans often experience: hearing loss; loss of social engagement and

connectivity; cognitive change; and physical change. PCAST issued a letter report on technologies for 

hearing assistance in October 2015. The current report is the second and final report of the study and 

addresses the three remaining areas. In light of the many promising technologies that exist, this report 

is selective rather than comprehensive. It considers technologies important to the key areas, rather 

than specific diseases and situations, and it focuses on technologies that could have an effect broadly 

and in the near future. Chapter 1 introduces the three areas and cross-cutting themes. Chapter 2 

describes technologies for social connectivity and emotional health. Technologies to address changes in 

mental ability are discussed in Chapter 3. Chapter 4 describes technologies to address changes in 

physical ability.

Although this report is split into chapters, the concepts are inter-related. For example, lack of mobility 

can affect social engagement that can affect cognitive decline. This means that these areas cannot be 

addressed successfully independently; rather, a systematic approach is needed for to increase 

independence. This observation underlies our strong recommendation that the Federal Government 

create a standing cross-departmental, multi-agency council with responsibility and meaningful authority 

to address all these issues.

Social Connectivity and Emotional Health (Chapter 2)

Three common ways older adults engage with the world include social participation, employment and 

volunteerism, and accessing information and resources. Interacting with family and community groups 

and being active in organizations can increase a person’s health and reduce the risk of disability or 
Independence, Technology, and Connection in Older Age

2

death, and technology can assist with promoting such engagements. Social participation can be 

enhanced through social media, interactive online games and collaboration tools, or websites that 

introduce people to others with common interests. People may find new employment and volunteer 

activities with online job training and volunteer-networking websites, or they may increase or maintain 

their productivity and skills by taking advantage of universal design elements of software or by 

teleworking. A number of websites give people access to curated information targeted for older 

audiences and to government services.

In 2013, over half of older adults reported using the Internet—mostly to buy things, email, or seek out 

information such as the news. Those who are not accessing the Internet cite a lack of interest or need, 

perceived level of difficulty, and inability to access the technology. There are large socioeconomic 

differences in populations who use the Internet and have access to and can afford broadband 

connection and those who do not. In addition, one factor that can be especially important to older 

adults is the need for training on how to set up and use information technology and the Internet. PCAST 

recommends Federal actions to expand affordable access to broadband in the homes of seniors and to 

provide support for training. Internet access at home should not be a luxury for those who can afford it; 

it has become like the telephone—a utility necessary to function in the modern world. Internet access 

and use underlie many of the technologies in this report.

In addition to helping with daily needs, older adults’ connections to their families and communities are

never more important than during emergencies. Superstorm Sandy descended on New York City in

2012 and showed how vulnerable older adults can be when the power goes out and cell towers are

down. Mobility and cognitive impairments can inhibit people from getting the help they need, and

those who are not tech-savvy may not find alternative sources of information during an emergency. We

recommend that technology for current and future emergency communication systems be developed

with the needs and capabilities of older adults in mind. 

Changes in Cognitive Ability (Chapter 3)

In addition to changes in social connectivity and emotional well-being people may experience as they 

age, older adults are likely to experience mental or cognitive changes. Cognitive aging happens to most 

humans as they age and may affect a person’s attention span, memory, and speed of processing. This 

phenomenon is separate from specific diseases like dementia. Monitoring systems are one set of 

technologies that can help a person remain independent longer as he or she experiences cognitive 

change. By unobtrusively recording the level of activity or whether a senior falls, monitoring can inform 

a trusted caretaker about the well-being of an adult with cognitive limitations without needing that 

adult to leave home. PCAST believes the National Institutes of Standards and Technology (NIST) should 

take an active role in addressing the privacy, security, and validity of monitoring technologies.

Because of changes in mental ability, older adults also can be targets of financial fraud. Whether victims 

are people who have spent their lives saving for retirement or older adults with little savings and 

working to make ends meet, fraud can be devastating. Financial exploitation of older adults is massively 

underreported, in part because of shame or the older adult’s fear that their independence will be taken 

away. PCAST believes that technologies common in the credit-card industry should be readily available 

in the banking industry to detect fraud in bank and deposit accounts and that steps should be taken to 
Independence, Technology, and Connection in Older Age

3

ensure that—when desired by seniors—trusted caregivers can have appropriate levels of information 

about older adults’ financial activity or health.

The third set of technologies relevant to changes in mental ability are cognitive enhancement or 

cognitive assistive systems. “Brain games” purported to increase a person’s cognitive ability are an 

enticing prospect for a person experiencing unwelcome cognitive decline. Many of these technologies 

have not been scientifically proven. The Federal Government has an important role to play in protecting 

consumers from paying for training services that advertise promises of increased cognitive skills that are 

not proven. 

Changes in Physical Ability (Chapter 4)

Changes in physical function present some of the visible chronic changes an older adult might 

experience with age, but they are also changes that can be readily met with technological intervention. 

The foundation of ensuring that older adults or anyone with declining mobility can age in place is the 

design and updating of homes and other buildings with appropriate accommodations for universal 

access. The Department of Health and Human Services and the Department of Housing and Urban 

Development have important roles to play in stimulating the public and private sectors to adopt 

minimum design standards that will maximize people’s ability to age in their homes. Diseases like 

arthritis also can impede a person’s ability to manipulate objects in the home or in hospital and care 

settings and to take care of himself or herself on a daily basis. Changes to manual dexterity can make 

opening food packaging or using can openers or scissors an unbearable task. Guidelines for product 

design friendly to older adults can ensure that meal packaging does not require additional tools or 

significant hand strength to open them. The Consumer Product Safety Commission is the critical Federal 

lead in ensuring the safety of older adults in this space.

Wheelchairs, walkers, and scooters are vital technologies that can compensate for mobility loss and are 

a critical part of maintaining or restoring a person’s ability to move about the home, community, and 

beyond. Wheelchair users over decades have experienced changes in the durability, cost, and features 

of wheelchairs. These changes are driven in part by Medicare payment policy. Given advances in 

materials, electronics, manufacturing, and more, improved features such as weight, strength, battery 

life, and comfort in wheelchairs should be within reach of consumers. The Veterans Administration and 

the Centers for Medicare and Medicaid Services should lead a multi-agency task force with industry and

users to create a roadmap for improved wheelchairs within the next decade.

For those people with limited physical function, Internet access provides an increasingly popular avenue 

for ensuring patients obtain necessary medical care from home. Telehealth, the process of providing or 

obtaining health care by telephone, videoconference, email, monitoring technologies, or web interfaces, 

provides many services. Hospitals are running pilot programs to understand how telehealth can help 

ensure follow up care is complete. Mental health professionals are able to provide services to remote 

patients. Health-insurance subscribers can call nurse help lines to check if their symptoms require 

medical attention. Broadband access at home provides the basis for video conferencing and web links 

to care providers, and changes to reimbursement policies from the Centers for Medicare and Medicaid 

will help older adults get needed services at home. 
Independence, Technology, and Connection in Older Age

4

Recommendations in Summary

Cross-Cutting Recommendations

Recommendation 1: Integrating Federal Action

Optimizing Federal support for independent aging requires coordinated action in health, housing, 

transportation, communications, energy, education, environment, and public safety.

1. The Office of Science and Technology Policy (OSTP) should create a one-year Task Force of 

the National Science and Technology Council that will identify technologies vital to an aging 

population, focused on enhancing work between agencies.

2. The Department of Health and Human Services (HHS) should support a standing privatepublic council, with private-sector leaders from industry, academia, and advocacy 

organizations to advise on sector-wide ways to advance technology in the service of 

improving quality of life for older people.

Recommendation 2: Engagement and Social Connectivity

Access to Internet communications is essential to health, social engagement, and well-being.

1. The HHS Administration for Community Living (ACL) and the National Telecommunications & 

Information Administration (NTIA) at the Department of Commerce (DOC) should create a 

national plan to ensure all older people have broadband Internet access.

2. The Federal Communications Commission (FCC) should ensure that older adults are 

included, as are school children, in all negotiated agreements for Federal 

telecommunications approvals.

3. FCC and NTIA should create a plan, including a matching program with private support, to 

support training centers in accessible distance for all older people.

Recommendation 3: Monitoring Technology for Frail and Vulnerable Elders

Monitoring holds great promise for predicting problems and enhancing safety of people at risk, and 

the Federal government could promote the needed frameworks and standards to encourage 

innovation and access to this service.

1. The National Institute of Standards and Technology (NIST), in collaboration with the private 

sector, should develop guidelines for marketing and instructional materials to ensure that 

consumers understand the operational requirements, benefits, and risks of various 

monitoring technologies.

2. NIST, in collaboration with the private sector, should develop guidance to identify privacy 

and security risks in a way that does not pose undue barriers to innovation and adoption.

Recommendation 4: Research is Needed to Spur Further Innovation

The National Institutes of Health (NIH), HHS Agency for Healthcare Research & Quality (AHRQ), the 

National Science Foundation (NSF), the Veterans Health Administration (VHA), the Department of 
Independence, Technology, and Connection in Older Age

5

Defense (DOD), and the Defense Advanced Research Projects Agency (DARPA) should support 

interdisciplinary and translational research including robotics, advanced mobility technologies, 

communications technology with special emphasis on emergency situations, cognitive training, and 

home monitoring.

Issue-Specific Recommendations

Recommendation 5: Education and Training in Online Technologies

The Administration should support ongoing reauthorization of the Older Americans Act and build on 

the provisions in Section 415 to ensure access to online services and protection from scams and 

fraud, tailored to the learning needs of older adults. Corporation for National & Community Services 

(CNCS) should expand Senior Corps to include older people with literacy and skills in technology use.

Recommendation 6: Emergency Response and Communications

Older people are especially vulnerable in disaster and emergency situations.

1. The Federal Emergency Management Agency (FEMA) at the Department of Homeland 

Security (DHS) should advance national strategies to create effective communications 

systems that reach isolated and vulnerable older people.

2. Within HHS, the Office of the Assistant Secretary for Preparedness and Response (ASPR), the 

Office of the National Coordinator for Health Information Technology (ONC), and the 

Centers for Medicare & Medicaid Services (CMS) should promote more rapid 

interoperability of medical information to ensure timely access whenever and wherever a 

patient may appear.

3. FEMA, ASPR, and CMS should advance policies that make medical device interfaces more 

consistent and interoperable to ensure timely access to people who depend on these 

devices.

Recommendation 7: Financial Services

The Federal Government should encourage the banking and financial services sector to offer 

monitoring services to protect assets from fraud and exploitation. 

1. Signatories to the 2013 Interagency Guidance on Privacy Laws and Reporting Financial 

Abuse of Older Adults should accelerate expectations of banks to offer a range of available 

protective services.

2. The Executive Office of the President should convene State governors to ensure that reports 

of suspicious activity are reported to relevant adult protective services agencies.

Recommendation 8: Cognitive Training

The Federal Trade Commission (FTC) should continue to enforce regulatory review and guidelines 

for commercial cognitive training products.
Independence, Technology, and Connection in Older Age

6

Recommendation 9: Improve Regulation and Payment to Reflect Innovation in Telehealth

HHS should convene the Federation of State Medical Boards and the National Governors Association 

to accelerate reciprocal state licensure policies. CMS should use the full capacity of the Innovation 

Center to advance payment policies that support innovation in telehealth.

Recommendation 10: Home Design to Sustain Independence

HHS should work with the Department of Housing and Urban Development (HUD) to streamline and 

strengthen regulations and payment policies that govern home accessibility standards in order to 

promote uniform standards allowing efficient use and changes in technological support systems. 

This is especially important for retirement communities.

Recommendation 11: Improving Product Design for Older Adults’ Needs

The Consumer Product Safety Commission (CPSC) should work with AARP and other relevant groups 

to accelerate better design guidelines for senior-friendly packaging, especially of technology and 

essential products like food and medical supplies.

Recommendation 12: Future Role of Assistive and Robotic Technologies

Advances have been made in wheelchairs and other mobility-necessary technologies, but Medicare 

payment policies inhibit access and market innovation.

1. CMS should examine current payment policies and implement changes that allow people to 

buy higher-functioning products with some Government support.

2. A multiagency and industry task force led by VHA, DOD, DARPA, and HHS should 

recommend a ten-year roadmap for improving wheelchair functional capabilities.
Independence, Technology, and Connection in Older Age

7

1. Introduction and Cross-Cutting Issues

The United States is an aging society, and most Americans can look forward to living longer lives than 

ever before. The average child born in 2013 can expect to live until 79 years of age, which is almost a 

decade longer than children born in 1960.1 As a result of the rapid increase in life expectancy, 46 million 

Americans—about 15 percent of the total US population—were over the age of 65 in 2014 (Figure 1).

2

Figure 1. Projections of the number of U.S. older adults.3

Increasing life expectancy has also been coupled with healthier aging. Many people can expect to 

remain active well into their eighth and ninth decades of life. In fact, the number of older Americans 

dealing with functional limitations, like difficulty walking or blindness, steadily declined each year during 

the twentieth century.4 There have been broader improvements in the health of older adults, with more 

 1 Xu, J., Murphy, S.L., Kochanek, K.D., Bastian, B.A., "Deaths: Final Data for 2013," National Vital Statistics Reports, 

64(2): 1-118, 2016. 2 Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, 

Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2014.

Source: U.S. Census Bureau, Population Division, Release Date: June 2015.

3 See: www.census.gov/population/projections/data/national/2014.html. 4 Cosa, D.L., “Changing chronic disease rates and long-term declines in functional limitation among older men,” 

Demography, 39(1): 119-137, 2002; and Cuter, D. and Wise, D., eds. “Health at Older Ages: The Causes and 

Consequences of Declining Disability among the Elderly”, University of Chicago Press, 2009. See: 

papers.nber.org/books/cutl08-1papers.nber.org/books/cutl08-1. 

0

25

50

75

100

2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

Population (Millions)

Year

Adults Over 65 

Years Old

Adults Over 85 

Years Old
Independence, Technology, and Connection in Older Age

8

reporting excellent or very good health status (over 40 percent), declining numbers of hip fractures, and 

fewer preventable hospitalizations.5

People do face predictable changes as they get older. Some are challenging. These can include chronic 

diseases, depression, and difficulty completing routine activities without joint pain.6 Two-thirds of older 

adults have multiple chronic conditions, such as arthritis, diabetes, cardiovascular conditions, or 

depression.7,8 Chronic conditions and other health needs can lead to functional limitations. The

Congressional Budget Office estimates that one-third of people over age 65, and two-thirds of people 

over age 85, have some functional limitation now.9

Caregivers are critical throughout the course of Americans’ lives, and they can play an important role for 

older adults. One study estimated that two-thirds of people turning 65 will need some type of support 

for functional limitations during their lifetime, with an average need of three years of long-term services 

and supports.10 Other research suggests that future older adults may struggle with more chronic 

diseases and disabilities due to obesity and other risk factors (Figure 2).

11 Providing supportive services 

for older adults with functional challenges will affect how families, States, and the Federal Government 

use their resources.12

Many older adults would like to age in place, remaining in the home and community that they have lived 

in for years. An AARP survey estimates that almost 90 percent of older adults would like to stay in their 

homes for as long as possible.13 In some areas of the country, older adults are aging in place at such a 

scale that “naturally occurring retirement communities” have formed. In addition to improving people’s 

quality of life, keeping people healthy in their homes can reduce Medicare and Medicaid expenditures. 

 5 UnitedHealth Foundation, “America’s Health Rankings: Senior Report. 2015 Edition.” See: 

www.americashealthrankings.org/senior. 6 ibid.

7 Centers for Medicare and Medicaid Services, "Chronic conditions among Medicare beneficiaries, Chartbook, 2012 

edition," 2012.See: www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronicconditions/downloads/2012chartbook.pdf. 8

Centers for Disease Control and Prevention (CDC), "The state of aging and health in America 2013," Atlanta, GA: 

Centers for Disease Control and Prevention, US Department of Health and Human Services, 2013. See: 

www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf. 9 Hagen, S., "Rising demand for long-term services and supports for elderly people," Washington, DC: 

Congressional Budget Office, 2013. See: www.cbo.gov/sites/default/files/113th-congress-2013-

2014/reports/44363-LTC.pdf. 10 Kemper, P., Komisar, H.L., Alecxih, L., “Long-Term Care Over an Uncertain Future: What Can Current Retirees 

Expect?” Inquiry, 42: 335–350, 2005. 11Gaudette, E., Tysinger, B., Cassil, A., Goldman, D., "Health and Health Care of Medicare Beneficiaries in 

2030," Forum for Health Economics and Policy, 18(2): 75-96, 2015. 12 Hagen, S., "Rising demand for long-term services and supports for elderly people," Washington, DC: 

Congressional Budget Office, 2013. See: www.cbo.gov/sites/default/files/113th-congress-2013-

2014/reports/44363-LTC.pdf 13 Farber, N., Shinkle, D., Lynott, J., Fox-Grage, W., Harrell, R., “Aging in place: A state survey of livability policies 

and practices,” AARP, 190, 2011.
Independence, Technology, and Connection in Older Age

9

Figure 2. Potential future health challenges for older adults (projections from 2010 to 2030).14

To remain in the community, older adults may need specific supportive services and assistance. Some 

people may need support to manage chronic conditions and health ailments; others may need help with 

specific activities—such as managing money—even though they can manage all other aspects of their 

life. Some may need assistance with basic activities such as eating, bathing, and using the bathroom; 

others may only need help with instrumental activities such as managing medications, preparing meals, 

and shopping; and still others may just need support to be active broadly in social activities and 

hobbies.

15

When a large portion of the community is older, local services can be overwhelmed, especially when 

such services are limited; there are older houses that need extensive maintenance, and few younger 

adults are nearby that can provide additional support.16 In these situations, technology may provide the 

necessary services that allow individuals to stay in the community, and some technologies may perform 

tasks that previously required a health care professional.17 Technology can also be useful for many other 

situations facing older adults.

Study Overview

Given the potential of technology to change how people live, work, and interact, the President’s Council 

of Advisors on Science and Technology (PCAST) undertook a study of technologies that could support 

older adults. Through a working group composed of PCAST members and national experts in multiple 

fields, it gathered information on the range of technologies available now or with the potential for 

 14 Gaudette, E., Tysinger, B., Cassil, B., Goldman D., “Health and Healthcare of Medicare Beneficiaries in 2030,” 

Forum for Health Economics & Policy, 18(2): 75-96, 2015. 15 Lawton, M. P., and Brody, E. M., "Assessment of older people: Self-maintaining and instrumental activities of 

daily living," Gerontologist, 9: 179-186, 1969; also see: www.apa.org/science/about/psa/2004/02/rogers.aspx. 16 See: www.wsj.com/articles/communities-struggle-to-care-for-elderly-alone-at-home-1443193481. 17 Mynatt, E., Borrelli, A., Czaja, S., Iturriaga, E., Kaye, J., Nilsen, W., Siewiorek, D., Stankovic, J., “TransNIH/Interagency Workshop on the Use and Development of Assistive Technology for the Aging Population and 

People with Chronic Disabilities,” Computing Community Consortium, 1-15, 2015, See: cra.org/ccc/wpcontent/uploads/sites/2/2015/06/CCC-AiP-White-Paper.pdf. 17 “Report to Congress: Aging Services Technology Study,” 2012. See: aspe.hhs.gov/basic-report/report-congressaging-services-technology-study. 

0

13

25

38

50

Multiple Chronic Conditions Obesity Disabled

Percent of Older 

Population

2010 2030
Independence, Technology, and Connection in Older Age

10

future development. The study identified technologies that address multiple goals for older adults: 

supporting independence; providing new opportunities for socialization, engagement, and education; 

assisting in self-management of chronic diseases; improving quality of life; expanding access to health

care, preventive services, and wellness activities; ensuring safety and security, maintaining or reducing 

costs to individuals and society; and others. 

Promising technologies are not being used for many reasons, including a paucity of structured programs 

for seniors themselves to acquire technology skills, lack of awareness by consumers, usability problems, 

physical and cognitive challenges to use the technology, or limited training for healthcare 

professionals.18 The study examined the barriers and challenges preventing the spread of potentially 

useful technologies. PCAST is recommending strategies to spur faster development and adoption of 

effective technologies. 

The scope of the report is limited in two ways. First, the report considers common functional changes

that occur to older adults, but not specific diseases. The chapters in the report each address a major 

dimension of change for many older adults: social engagement and connectivity, cognitive decline, and

physical mobility. Second, the report does not make recommendations on every technology that could 

be useful for these problems—indeed, the study found hundreds of technologies that could be 

applicable. Rather, the recommendations are limited to those technologies with the greatest potential 

for short-term impact and where Federal action could have the greatest effect. By limiting its scope in 

this way, PCAST sought to make this report actionable in the short term.

Potential of Technology 

Technology can help older adults stay active and independent as they age; it can increase social 

engagement and activities that add to a person’s sense of purpose. Technologies also benefit caregivers 

who assist older adults with activities like taking care of routine health care needs and other daily living

tasks. Caregivers are critical in technology adoption and use. Technology can support older adults

wanting or needing to remain in the workforce, and many new technologies are emerging for a wide 

range of uses.

19,20 One Federal database, AbleData (sponsored by the National Institute on Disability, 

Independent Living, and Rehabilitation Research), has inventoried over 24,000 assistive technology 

products, including prosthetics, therapeutic aids, and other tools for assisting with activities of daily 

living.21 Another more focused database, Technology for Long-Term Care, has identified over 1,200 

technology products for people in long-term care settings.22

 18 Institute of Medicine and National Research Council, “Fostering independence, participation, and healthy aging 

through technology: Workshop summary,” The National Academies Press, 2013; See: aspe.hhs.gov/basicreport/report-congress-aging-services-technology-study; also see: www.pewInternet.org/2014/04/03/olderadults-and-technology-use. 19 “Report to Congress: Aging Services Technology Study, 2012; see: aspe.hhs.gov/basic-report/report-congressaging-services-technology-study. 20 See: www.leadingage.org/SubSection.aspx?id=525. 21 See: www.abledata.com. 22 See: www.techforltc.org.
Independence, Technology, and Connection in Older Age

11

A few examples illustrate technology’s usefulness. Smartphone apps can allow a person to monitor fine 

motor control, which might be helpful for a patient with Parkinson’s disease or multiple sclerosis.23

Remote monitoring, wearables, and sensors can help seniors age in place while ensuring their safety and 

maintaining their health.24 Basic home modifications can prolong independence and minimize the risk 

of falls. Predictive analytics and non-intrusive monitoring can protect older adults against financial 

scams or fraud. Technology, along with other changes, could also help slow (or prevent) the onset of 

disability.25 Online “time banks” can allow seniors to donate services now in order to access help from 

others when they need it.26 This is not to say that complex technology is always the solution—many 

times the answer may be relatively simple technology that can assist in common situations.27

Technological advances can also be helpful to older Americans who want, or need, to continue working. 

Many older adults desire to continue to work, mentor, or be entrepreneurial.28 The labor force 

participation for older adults has increased, rising from 13 to 17 percent during 2000-2010. This growth 

is expected to continue, with projections by the Bureau of Labor Statistics that the number of individuals 

in the workforce over the age of 65 will increase by over 80 percent between 2010 and 2020.29 Online 

tools can help older adults to participate in the sharing economy,30 and other technologies can help 

seniors work remotely. This would benefit society more broadly as those working people continue to 

expand the economy and pay taxes on their income. At the same time, older workers can have trouble 

finding any job, with some organizations unwilling to hire older workers,31 and other workers not finding 

the type of work that fits their capabilities, flexible work hours, or part-time work.32

Many seniors rely on caregivers to assist them with their routine health care needs and other activities 

of daily living. Caregivers are critical in ensuring that technology succeeds; they also need technology to 

 23 Daneault, J.F., Carignan, B., Codère, C.É., Sadikot, A.F., Duval, C., "Using a smart phone as a standalone platform 

for detection and monitoring of pathological tremors," Frontiers in Human Neuroscience, 6(357): 1-12, 2013.

See: www.ncbi.nlm.nih.gov/pmc/articles/PMC3548411. 24 See: www.huffingtonpost.com/paul-h-irving/aging-in-place_b_8056900.html. 25 Institute of Medicine and National Research Council, “Fostering independence, participation, and healthy aging 

through technology: Workshop summary,” The National Academies Press, 2013. 26 linkAges TimeBank, David Druker Center for Health Systems, Palo Alto Medical Foundation, See: 

timebank.linkages.org. 27 Institute of Medicine and National Research Council, “Fostering independence, participation, and healthy aging 

through technology: Workshop summary,” The National Academies Press, 2013.

28 Irving, P., and Chatterjee, A., “The Longevity Economy: From The Elderly, A New Source Of Economic 

Growth” Forbes, 2013, See: www.milkeninstitute.org/publications/view/687. 29 Toossi, M., "Labor force projections to 2020: a more slowly growing workforce," Monthly Labor Review, 135: 43-

64, 2012, See: www.bls.gov/opub/mlr/2012/01/art3full.pdf. 

30 See: www.nytimes.com/2015/09/26/your-money/the-sharing-economy-attracts-older-adults.html. 

31 Heidkamp, M., Mabe, W., DeGraaf, B., “The Public Workforce System: Serving Older Job Seekers and the 

Disability Implications of an Aging Workforce,” NTAR Leadership Center, 2012, See: 

www.dol.gov/odep/pdf/NTAR_Public_Workforce_System_Report_Final.pdf. 32 Irving, P., "Self-empowerment in Later Life as a Response to Ageism," Generations, 39(1): 72, 2015, See: 

www.milkeninstitute.org/publications/view/714.
Independence, Technology, and Connection in Older Age

12

help them meet their responsibilities. The needs of caregivers must also be taken into account in the 

design of technology systems.

Cross-Cutting Themes

As PCAST explored the different areas in this study, it uncovered several cross-cutting themes: 

heterogeneity of the older-adult population; the foundational role of Internet connectivity; monitoring 

within homes and communities; the need for more research; and technology standards. These are 

important considerations for implementing the specific recommendations found in later chapters.

The first important theme is that older adults in the United States are heterogeneous. The population of 

older Americans includes people in all economic circumstances and income levels; people who live in 

urban, rural, and suburban communities; people of all racial, ethnic, and language backgrounds; and 

people with different levels of physical and cognitive functioning. There are also significant differences 

in the uses of technology among seniors. Some older adults use technology extensively (especially 

younger, highly-educated, affluent seniors) and have smartphones, tablets, and online communication 

tools such as Skype or FaceTime to connect with family members, while others have limited engagement 

with technology or do not use information technology at all.

33 Multiple solutions will be needed to 

support older adults based on their capabilities and access to technology.

This diversity affects the recommendations throughout this report and suggests that one-size-fits-all 

solutions are unlikely to be effective; rather, different solutions and technologies may be needed based 

on the different needs of the particular individual and his specific capabilities. Versatile technologies 

that can be used by a wide range of older adults are likely to be the most effective. 

The lessons from user-centered design approaches and universal design are applicable. Significant 

knowledge, much of it held by industry, already exists on how to design technology and user interfaces 

to make them most useful for all people (regardless of their age). This work can be extended to older 

adults by paying particular attention to how vision, memory, and dexterity of different people affect 

ways in which they interact with technology.

Another important theme is the foundational role of Internet connectivity. The Internet can allow older 

adults to interact with others to reduce social isolation, can provide new connections to health 

professionals through telehealth services, and can offer opportunities for intellectual stimulation. 

Unfortunately, many older adults do not use the Internet, although that number is rising quickly—from 

14 percent in 2000, to 45 percent in 2010, to almost 60 percent in 2014.34,35 As noted in the next 

chapter, there are multiple reasons why older adults do not have access to broadband or any Internet 

connection—cost can be a barrier for those on fixed incomes, many rural areas still lack broadband 

connections, and there are few centers that teach older adults how to use and navigate online. 

 33Pew Research Center, “Older Adults and Technology Use,” 2014, www.pewInternet.org/2014/04/03/olderadults-and-technology-use. 34 U.S. Census Bureau, “65+ in the United States: 2010,” U.S. Government Printing Office, P23-212, 2014. 35 Smith, A., “Older Adults and Technology Use,” Pew Research Center, 1-26, 2014, See: 

www.pewinternet.org/files/2014/04/PIP_Seniors-and-Tech-Use_040314.pdf.
Independence, Technology, and Connection in Older Age

13

Related to this heterogeneity of older adults is the wide range of Federal agencies and programs that 

have grown to provide needed services. Each agency operates under a different mission relevant to 

successful aging. Health care services focus on medical needs while housing services emphasize 

independent living environments and veterans’ services strive for continued participation in the 

community. While these services meet important specific needs, opportunities are lost for cross-agency 

support for aging adults, especially when integrated models of support could achieve greater support at 

lower costs. The aging of the population, in the United States and in countries around the world, calls 

for a more specific and thorough-going focus of government on the specific challenges and 

opportunities presented by longer lives. This reality affects national policy not only in health care, but in 

housing, transportation, communications, energy, and education as well as environmental and public 

safety on both the national and local level. The Office of Science and Technology Policy could play an 

important role in setting common goals for the agencies, and an independent academic and privatesector advisory group would be useful for sharing knowledge and experience for all sectors.

A third cross-cutting theme is the growing role of monitoring within homes and communities, which has 

been facilitated by new devices and fast Internet connections. Without remote monitoring technology, 

people have to be in a specialized facility (like a nursing home) to have their health monitored 

continuously. The advantage of monitoring is that its information can alert a family member, caregiver, 

or health professional to take immediate action if there is a fall or other problem. Studies have shown 

that remote monitoring can improve quality of life and reduce health care usage, for example by 

preventing hospitalizations.36

These monitoring opportunities can be used to great benefit for reminders, predictions and possible 

prevention of events such as falls, threats to financial security, identification of problems with normal 

activities of daily living, or discovering vulnerable people in emergencies. Further innovation is needed 

to account for the diversity of situations where monitoring will be used (especially given the differences 

in each person’s home and differences in each person’s functioning), to improve ease of use for older 

adults, and to ease the burden of maintaining the technology.37

Monitoring technologies also come with concerns about privacy, which vary.38 Some people do not want 

any information shared about themselves, while others are willing to provide information about 

themselves via monitoring devices if it allows them to live with dignity and independence. As the 

 36 Goldwater, J. and Harris, Y., “Using technology to enhance the aging experience: a market analysis of existing 

technologies,” Ageing International, 36(1): 5-28, 2011. 37 Mynatt, E., Borrelli, A., Czaja, S., Iturriaga, E., Kaye, J., Nilsen, W., Siewiorek, D., Stankovic, J., “TransNIH/Interagency Workshop on the Use and Development of Assistive Technology for the Aging Population and 

People with Chronic Disabilities,” Computing Community Consortium, 1-15, 2015, See: cra.org/ccc/wpcontent/uploads/sites/2/2015/06/CCC-AiP-White-Paper.pdf.

38 “Report to Congress: Aging Services Technology Study, 2012. See: aspe.hhs.gov/basic-report/report-congressaging-services-technology-study; and Mynatt, E., Borrelli, A., Czaja, S., Iturriaga, E., Kaye, J., Nilsen, W., Siewiorek, 

D., Stankovic, J., “Trans-NIH/Interagency Workshop on the Use and Development of Assistive Technology for the 

Aging Population and People with Chronic Disabilities,” Computing Community Consortium, 1-15, 2015, See: 

cra.org/ccc/wp-content/uploads/sites/2/2015/06/CCC-AiP-White-Paper.pdf.
Independence, Technology, and Connection in Older Age

14

technology matures, policies will need to be in place that specify how information is shared and 

promote confidence that monitoring technology supports dignity and independence.

The fourth theme is the need for more interdisciplinary and translational research into technologies that 

can support an aging population. Such research areas include home robotics, advanced mobility 

technologies and next-generation technologies for wheelchairs, communications technology (especially 

during emergencies) cognitive training and coaching, and home monitoring technologies.

The final theme is the importance of standards, as effective use of many technologies is stymied by 

limited standards. For example, many hearing aids are unable to communicate with people’s cellular 

phones. Similarly, technologies need to be interoperable in order to exchange information, such as 

between remote devices and healthcare providers. There are further challenges in having information 

flow between long-term care facilities and other health care settings, such as hospitals or outpatient 

clinics.39

The three key areas of the study and the cross-cutting themes led us to the four recommendations that 

underlie the technologies discussed subsequently in the report.

 39 Institute of Medicine and National Research Council, “Fostering independence, participation, and healthy aging 

through technology: Workshop summary,” The National Academies Press, 2013.
Independence, Technology, and Connection in Older Age

15

Cross-Cutting Recommendations

Recommendation 1: Integrating Federal Action

Optimizing Federal support for independent aging requires coordinated action in health, housing, transportation, 

communications, energy, education, environment, and public safety.

1. The Office of Science and Technology Policy (OSTP) should create a one-year Task Force of the National 

Science and Technology Council that will identify technologies vital to an aging population, focused on 

enhancing work between agencies.

2. The Department of Health and Human Services (HHS) should support a standing private/public Council, 

with private-sector leaders from industry, academia, and advocacy organizations to advise on sectorwide ways to advance technology in the service of improving quality of life for older people.

Recommendation 2: Engagement and Social Connectivity

Access to Internet communications is essential to health, social engagement, and well-being.

1. The HHS Administration for Community Living (ACL) and the National Telecommunications & Information 

Administration (NTIA) at the Department of Commerce (DOC) should create a national plan to ensure all 

older people have broadband Internet access.

2. The Federal Communications Commission (FCC) should ensure that older adults are included, as are 

school children, in all negotiated agreements for Federal telecommunications approvals.

3. FCC and NTIA should create a plan, including a matching program with private support, to support 

training centers in accessible distance for all older people.

Recommendation 3: Monitoring Technology for Frail and Vulnerable Elders

Monitoring holds great promise for predicting problems and enhancing safety of people at risk, and the Federal 

Government could promote the needed frameworks and standards to encourage innovation and access to this 

service.

1. The National Institute of Standards and Technology (NIST), in collaboration with the private sector, 

should develop guidelines for marketing and instructional materials to ensure that consumers 

understand the operational requirements, benefits, and risks of various monitoring technologies.

2. NIST, in collaboration with the private sector, should develop guidance to identify privacy and security 

risks in a way that does not pose undue barriers to innovation and adoption.

Recommendation 4: Research is Needed to Spur Further Innovation

The National Institutes of Health (NIH), HHS Agency for Healthcare Research & Quality (AHRQ), the National 

Science Foundation (NSF), the Veterans Health Administration (VHA), the Department of Defense (DOD), and the 

Defense Advanced Research Projects Agency (DARPA) should support interdisciplinary and translational research 

including robotics, advanced mobility technologies, communications technology with special emphasis on 

emergency situations, cognitive training, and home monitoring.
Independence, Technology, and Connection in Older Age

16

2. Technologies for Social Connectivity and 

Emotional Health 

Evidence indicates that engagement in family, community, and organizations helps to promote health 

and reduce the risk of mortality in later life.40 Advances in several fields of technology in the 21st

century have significantly changed and expanded how people interact with information, each other, and 

the greater world around them; in some cases, new technologies have replaced traditional methods of 

engagement completely. 

Improving Engagement through Technology 

Technology can assist Americans in reaching the engagement goals for older adults identified by the 

World Health Organization: social participation, employment and volunteerism, and access to 

information and resources.41

Social Participation

Social participation is strongly linked to improved physical and mental health42 and delayed cognitive 

decline.43 Social participation often varies throughout life, with the most important changes occurring at 

common major events, such as retirement or losing a significant other or family member.44 Although 

social isolation and loneliness may be linked to factors relating to the individual, a number of 

environmental factors can contribute to isolation, such as the absence of formal and informal social 

support structures or whether buildings and streets allow older adults with physical limitations to 

navigate them. Social isolation may exacerbate depression among older adults. This is a challenge given 

the number of older adults struggling with depression. Older men are at special risk of suicide.45 

Technologies can help Americans live fully in their later years. In cases where adults have physical 

barriers to leaving their homes or traveling, social-networking technologies can facilitate and increase 

 40 Choi, N.G., Dinitto, D.M., “Internet use among older adults: association with health needs, psychological capital, 

and social capital,” Journal of Medical Internet Research, 15(5): 97, 2013. 41 World Health Organization, “Global Age-Friendly Cities: A Guide,” Geneva, 1-76, 2007; See: 

www.nyam.org/agefriendlynyc/docs/WHO_Global_Age_friendly_Cities_A_Guide.pdf. 42 Higgs, P., Nazroo, J., Hyde, M., “The relationship between health and social participation: Results from the 

English Longitudinal Study of Ageing (ELSA),” Gerontologist, 44: 288, 2004. 43 Lovden, M., Ghisletta, P., Lindenberger, U., “Social participation attenuates decline in perceptual speed in old 

and very old age,” Psychology and Aging, 20(3): 423-434, 2005. 44Alpass, F., Towers, A., Stephens, C., Fitzgerald, E., Stevenson, B., Davey, J., “Independence, well-being, and social 

participation in an aging population,” Annals of the New York Academy of Sciences, 1114: 241-250, 2007. 45 Centers for Disease Control and Prevention and National Association of Chronic Disease Directors., “The State of 

Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us?,” National Association of Chronic 

Disease Directors, 2008, See: www.cdc.gov/aging/pdf/mental_health.pdf.
Independence, Technology, and Connection in Older Age

17

access to social-support systems. Social networking use among Internet users ages 50 and older nearly 

doubled, from 22 percent to 42 percent between 2009 and 2010. In addition, 47 percent of Internet 

users ages 50–64 and 26 percent of users 65+ now use social networking sites.46 Technologies to 

facilitate social participation include:

• Social media (Facebook, Twitter, Pinterest, Instagram)

• Virtual communities (Selfhelp Community Services)

• Real-time video conferencing/calling (Skype, FaceTime, Google Voice)

• Interactive applications and games (collaboration tools, social gaming, religious services)

• In-person facilitation technologies (Stitch, companionship websites, dating sites, Meetup) 

• Social support applications (online spiritual care, Vincles, CareLinx, Honor)

• Blogging and Internet-forum platforms (Wordpress)

A number of technologies also being developed assist in creating a social support system for the smaller 

contingent of older adults who may be homebound or socially isolated. In Barcelona, Spain, the Vincles 

project uses an application to connect older adults, caregivers, health care providers, and social services 

through an online and mobile platform.47 The application helps to create “circles of trust” among all of 

the people in an older person’s life (e.g., neighbors, service providers, and family members nearby and 

far away) that the older person can call upon when necessary. The Vincles project has leveraged both 

public and private funding from the city of Barcelona and the Bloomberg Philanthropies.48 In the United 

States, applications like Honor are also attempting to change how older adults participate in their own 

care.49 Customers can request home health aides, transportation, and housekeeping services, as well as 

companionship and check-up services to increase social engagement and prevent loneliness. Both 

caregivers and the older adults themselves can rate the services provided to them and customize how 

future caregiving is provided.

Employment & Volunteerism

Employment and civic participation among older adults have been closely linked to improved quality of 

life, reduced cognitive decline, and reduced risk of mental health decline such as depression.50,51,52 The 

benefits of prolonged employment and participation are often associated with greater sense of self-

 46 Smith, A., “Older Adults and Technology Use,” Pew Research Center, 1-26, 2014, See: 

www.pewinternet.org/files/2014/04/PIP_Seniors-and-Tech-Use_040314.pdf. 47 Chesser, A., Burke, A., Reyes, J., Rohrberg, T., “Navigating the digital divide: a systematic review of eHealth 

literacy in underserved populations in the United States,” Informatics for Health and Social Care, 41(1): 1-19, 2015. 48 BCN Smart City, “Vincles BCN,” Accessed March 14, 2016, smartcity.bcn.cat/en/vincles-bcn.html. 49 Honor, “Home Care like You're There,” Accessed March 14, 2016, www.joinhonor.com. 50 Moen, P., Dempster-McClain, D., Williams, R.M., “Successful aging: A life-course perspective on womens 

multiple roles and health,” The American Journal of Sociology, 97(6): 1612-1638, 1992. 51 Hao, Y.N., “Productive activities and psychological well-being among older adults,” Journals of Gerontology, 

63(2): S64-S72, 2008. 52 Adelmann, P.K., “Multiple Roles and Psychological Well-Being in a National Sample of Older Adults,” Journals of 

Gerontology, 49(6): S277-S285, 1994.
Independence, Technology, and Connection in Older Age

18

identity and purpose, as well as larger and more diverse social networks.53,54 Prolonged employment can 

also improve financial security and delay reliance on social insurance programs.55 Phased retirement, job 

sharing, paid sick leave, flexible work schedules and locations, and other family- and life-course friendly 

workplace policies are needed to enable older people to remain in the workforce;56 however, 

technology can also facilitate or inhibit continued employment. 

The process of finding opportunities for work and volunteerism has radically shifted in the last decade, 

with recruitment, job listings and applications, and personal networking opportunities often only 

accessible online. In addition, technology has become essential to most industries and workplaces and 

continues to catalyze changes to business and workplace practices. Among older adult Internet users, 

21 percent used the job-search and networking site LinkedIn.57 This represents an eight percent increase

from 2013 and is one of the most significant increases in utilization among all age groups. As these 

technologies are further developed for use by job-seekers and job-recruiters alike, many older adults 

will need to learn how to use these technologies to advance their careers.

Technologies to access employment or volunteer opportunities and resources include:

• Accessing professional development and training opportunities (Lynda.com)

• Online job boards and volunteer boards (Monster, Craigslist, Idealist, NYC Service)

• Reviews of industry, salary potential, and employer qualities (GlassDoor)

• Professional networking sites (LinkedIn)

• Increased capacity for staying engaged with work remotely through a suite of productivity tools 

tailored for professionals working from home or local co-working spaces (Office 365, Google 

Apps, GoToMeeting)

New technologies can allow older adults to leverage their skills, either for paid work as service providers 

or as volunteers. For example, older adults could volunteer their expertise via online mentoring 

programs, older adults who enjoy crafting could sell their products via online shops, and retired 

individuals could generate income on an as-needed basis providing transportation or technical 

assistance using service-based smartphone applications such as Uber or TaskRabbit. In addition, older 

 53 Hao, Y.N., “Productive activities and psychological well-being among older adults,” Journals of Gerontology, 

63(2): S64-S72, 2008. 54 Calvo, E., “Does Working Longer Make People Healthier and Happier?” Munich Personal RePEc Archive 5606, 

University Library of Munich, 2006.

55 Johnson, R., “Should People Work Longer, and Will They? Fact Sheets on Population Aging,” The Retirement 

Policy Center, 1-7, 2007. 56 Finkelstein, R., Roher, S., Owusu, S., “Age-Smart Employer NYC: A Compendium of Strategies and Practices,” The 

New York Academy of Medicine, 2013, See: www.agesmartemployer.org/wpcontent/uploads/2015/01/ASE_Compendium.pdf. 57 Duggan, M., Elllison, N., Lampe, C., Lenhart, A., Madden, M., “Demographics of Key Social Networking 

Platforms,” Pew Research Center, 1-17, 2015, See: www.pewInternet.org/2015/01/09/demographics-of-key-socialnetworking-platforms-2.
Independence, Technology, and Connection in Older Age

19

adults can take advantage of crowd-funding sites to fund projects in their local communities or support 

local organizations. Technologies could promote opportunities in the following areas:

• Mentoring (ICouldBe.org)

• Volunteering (Volunteermatch.org, AARP’s CreateTheGood.org/Volunteer-Search)

• Access to and provision of goods/services through the sharing economy (Timebanks USA, Village 

to Village Network, Uber, TaskRabbit, LiftHero, Craigslist, AirBnB)

• Online storefronts (Etsy, Squarespace, Ebay)

• Fundraising and capital building (Kickstarter, GoFundMe, IndieGoGo)

Information & Resources

Older adults require access to information such as news, weather, traffic, home maintenance, personal 

finance, and recreation and culture to maintain their independence.

58,59 Older adults frequently 

consume traditional forms of mass media;60 however, much of the information they need has migrated 

online, including information about benefit and entitlement programs, banking and retirement savings 

records, affordable housing listings, patient portals, electronic health records, and access to health 

insurance. Web-based resources are taking a lead role for managing consumer health and well-being. 

As more resources become completely digitized, older adults who do not have an Internet connection 

must rely on formal and informal networks to access vital information. Even when they have access, 

older people with low digital literacy may have more difficulty understanding content presented 

online.61 Inaccurate comprehension of health- and emergency preparedness-related information can 

pose a significant threat to health and safety. 

If older people are connected and trained to use new technologies that generate more relevant, timely, 

personalized and location-based information, they will be able to meet their needs faster, more 

efficiently, and, in many instances, without leaving their homes. This is beneficial for those who are 

homebound due to physical or cognitive impairment or who are transportation disadvantaged. 

Technologies can facilities access to information in the following areas:

• Housing information (Craigslist, affordable housing listings/lotteries, NYC Housing Connect)

• Arts/culture and event information (discounts, schedules, NYC-Arts Cultural Guides for Seniors)

• Education and training opportunities (Massive Open Online Courses [MOOCs], EdX, 

agefriendlycollege.org, Lynda.com)

• Information about benefit and entitlement eligibility (accessnyc.gov)

 58 Walker, J., Herbitter, C., “Aging in the shadows: social isolation among seniors in New York City United 

Neighborhood Houses of New York,” UNH Special Report, 2005. See: 

www.unhny.org/LiteratureRetrieve.aspx?ID=95124. 59 Williamson, K., “Older Adults: Information, Communication and Telecommunications,” PhD thesis. Melbourne: 

RMIT, 1995. 60 Simmons Market Research Bureau, “The 1996 Study of Media and Markets,” Simmons Market Research Bureau, 

1997.

61 Farnsworth, M., “Differences in perceived difficulty in print and online patient education materials,” The 

Permanente Journal, 18(4): 45-50, 2014.
Independence, Technology, and Connection in Older Age

20

• Information about finances and regulations (online tax filing such as Tax E-File with H & R Block, 

access to stock and financial records from home such as E*Trade)

• Information about local businesses, services, and products, including reputability and safety 

(Yelp, Angie’s List, Amazon)

• Healthcare services and information (ZocDoc, WebMD, Telehealth Services)

• Online fitness and nutrition services (Daily Burn, WeightWatchers) 

Technology Utilization and Adoption

In 2013, 65 percent of older adults lived in homes with computers, and over half of all older adults 

reported using the Internet.62 Older adults are using the Internet for a variety of purposes, primarily 

email, information-seeking, or purchasing products.63 Older people most frequently looked for healthrelated information, news, and government websites, trends that are similar among younger Internet 

users. This is not surprising, given that the majority of older people live and manage their health care 

needs independently.

It is important to note that even with increasing utilization rates, a sizable contingent of those age 65 

and over either cannot access or do not wish to engage with some or any technological devices or 

services (Figure 3).

64 Across all generations, the major reasons for not adopting new technologies are 

lack of interest, perceived high costs, perceived level of difficulty, and inability to access those 

technologies. Fear or privacy and security concerns have been found to be most prevalent among older 

people.65 

Older populations are less likely to have broadband at home than younger populations, as illustrated by 

Figure 4. There is further disparity among older adults. Younger, higher-income, and more highlyeducated older adults are more likely to use the Internet and broadband.66 Of older adults with an 

annual household income of $75,000 or more, 90 percent reported going online and 82 percent 

reported having broadband at home. In addition, 87 percent of older adults with college degrees 

reported going online. Seventy-six percent of them adopted broadband at home. This sharply contrasts 

with the utilization rates of low-income older people and those who did not attend college. Of older 

adults earning less than $30,000 annually, only 39 percent reported going online and 25 percent 

reported having broadband at home.67 There are also differences by race in access. Black and Hispanic 

 62 File, T., Ryan, C., “Computer and Internet Use in the United States: 2013,” American Community Survey Reports, 

ACS-28, U.S. Census Bureau, 2014, See: www.census.gov/content/dam/Census/library/publications/2014/acs/acs28.pdf. 63 Zickuhr, K., “Generations 2010,” Pew Research Center, 2010. See: 

www.pewInternet.org/2010/12/16/generations-2010. 64 National Telecommunications & Information Administration, “Digital Nation Data Explorer,” 2015, See: 

www.ntia.doc.gov/other-publication/2015/digital-nation-data-explorer. 65 Mason, O.J., Stevenson, C., Freedman, F., “Ever-present threats from information technology: the CyberParanoia and Fear Scale,” Frontiers in Psychology, 5: 1298, 2014. 66 Smith, A., “Older Adults and Technology Use,” Pew Research Center, 1-26, 2014, See: 

www.pewinternet.org/files/2014/04/PIP_Seniors-and-Tech-Use_040314.pdf. 67 ibid
Independence, Technology, and Connection in Older Age

21

older adults have significantly less access to a high-speed Internet connection than their White or Asian 

counterparts.68

Figure 3. Percentage of adults not accessing the Internet.69

Broadband Internet availability varies substantially between urban and rural areas of the United States. 

Urban areas have much higher availability of broadband Internet services than rural areas (99.6 percent 

have availability in urban areas vs. 82 percent in rural areas).70 This divide in access is most prominent in 

Southwestern states (particularly Arizona), Northwestern states (such as Montana, Idaho, and 

Wyoming), and U.S. Territories and tribal lands.71 At the same time, over 95 percent of the rural 

population has mobile Internet technologies, such as smartphones, available to them.72 Many older 

adults in rural areas of the Southwest, Northwest, and U.S. Territories cannot access the Internet

because adoption of mobile technologies has been slower among older adults.

Figure 4. Percentage of adults with broadband access.72

 68 File, T., Ryan, C., “Computer and Internet Use in the United States: 2013,” American Community Survey Reports, 

ACS-28, U.S. Census Bureau, 2014, See: www.census.gov/content/dam/Census/library/publications/2014/acs/acs28.pdf. 69 Anderson, M., Perrin, A., “15% of Americans don’t use the internet. Who are they?” Pew Research Center, 2015, 

See: www.pewresearch.org/fact-tank/2015/07/28/15-of-americans-dont-use-the-Internet-who-are-they. 70 Kruger, L.G., Gilroy, A.A., “Broadband Internet Access and the Digital Divide: Federal Assistance Programs,” 

Congressional Research Service Report, RL30719, 2013 See: www.fas.org/sgp/crs/misc/RL30719.pdf. 71 National Telecommunications and Information Administration, and Federal Communications Commission, 

“Broadband Statistics Report: Broadband Availability in Urban vs. Rural Areas,” 1-12, 2015 

www.broadbandmap.gov/download/Broadband%20Availability%20in%20Rural%20vs%20Urban%20Areas.pdf.

72 Horrigan, J., DugganM., “Home broadband 2015,” Pew Research Center, 1-32, 2015, See: 

www.pewInternet.org/files/2015/12/Broadband-adoption-full.pdf. 

0

10

20

30

40

50

18-29 30-49 50-64 65+

Percentage of 

Age Group

Age Range

0

20

40

60

80

18-29 30-49 50-64 65+

Percentage of Age 

Group

Age Range
Independence, Technology, and Connection in Older Age

22

Federal Actions to Improve Connectivity

Improving affordability, accessibility, training, and usability of technology for older people is critical for 

increasing usage. The Federal Government can take several steps to improve these factors.

A major impediment to Internet access for seniors is cost, including the cost of data consumption and 

basic connectivity. Accessing broadband Internet through cellular data networks will be a new cost for 

many older adults. While low- and no-cost options for older adults currently exist to provide cellular 

calling services, there are no such programs for wireless Internet or broadband.73

In addition, access to Internet connectivity may be worse in rural areas where broadband installation is 

difficult and expensive. This can further decrease engagement among those older adults who are 

already physically isolated from others. While wireless and mobile Internet technologies are improving 

and can help ameliorate some of these issues, certain rural areas also have little or no cell-phone 

coverage.74,75 Low-income urban areas may also have low levels of connectivity or very slow 

connectivity, limiting access to free or affordable Internet.76

As Internet technologies including websites and apps become more sophisticated, they also require 

more data and faster connections to run content. For example, streaming online videos requires a much

faster connection and more data usage than accessing a text-based email. High-speed broadband is also 

required for many new health IT programs that can improve health and health care delivery.76

Free WiFi access in community-based organizations, religious institutions, senior centers, senior housing, 

and libraries has the potential to increase connectivity among older people. Outdoor, publicly available 

WiFi hotspots and kiosks, such as those currently being installed in place of payphones in New York City, 

can also help to get older people online, if they are user-friendly and responsive to a range in functional 

capacity; however, a precondition of outdoor WiFi access is the ability to successfully navigate the built 

environment, which requires safe streets, accessible pedestrian plazas, and adequate seating for older 

people. 

As described in a recent National Technology and Information Administration (NTIA) report, several 

existing Federal initiatives aim to improve Internet usage through, e.g., infrastructure, training, or public 

computer access.

77 For example, the United States Department of Agriculture (USDA) Rural Utility 

Service operates two loan programs and one grant program focused on broadband infrastructure, as 

well as another grant program for distance learning and telemedicine. All these programs are explicitly 

 73 Choi, N.G., Dinitto, D.M., “Internet use among older adults: association with health needs, psychological capital, 

and social capital,” Journal of Medical Internet Research, 15(5): e97, 2013. 74 Bajarin, B., “Living in the Last Mile: How to Improve Rural Internet Access” Time Magazine, 2013, See: 

techland.time.com/2013/10/14/living-in-the-last-mile-how-to-improve-rural-Internet-access/. 75 Dailey, D., Bryne, A., Powell, A., Karaganis, J., Chung, J., “Broadband Adoption in Low-Income Communities,” 

Social Science Research Council, 2010. See: webarchive.ssrc.org/broadband_adoption.pdf. 76 The Office of the National Coordinator for Health Information Technology, Office of the Secretary Department of 

Health and Human Services. “Federal Health IT Strategic Plan 2015 – 2020,” 2014, See: 

www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf. 77 National Telecommunications & Information Administration, “BroadbandUSA: Guide to Federal Funding of 

Broadband Projects,” Department of Commerce, 2015.
Independence, Technology, and Connection in Older Age

23

focused on improving broadband access in rural areas. The Federal Communications Commission (FCC) 

oversees the Lifeline program, which offers discounts for mobile and landline phone service. This 

program can provide Internet access to those receiving the mobile-phone discount. More could be done 

to coordinate these existing initiatives and meet the specific needs of older adults.

The Department of Housing and Urban Development (HUD) has started the ConnectHome program to 

improve broadband access for residents of HUD-assisted housing. The main focus of this program is 

children, so seniors who live with children (such as grandchildren) may benefit, but older adults are not 

the target of the program’s efforts. In addition, HUD recently required that all HUD-funded housing that 

is newly-constructed or is a substantial rehabilitation project of an existing building is required to have 

broadband connectivity. This requirement can have a large impact, since 1.4 million households aged 62 

and over benefited from rental assistance from HUD in 2011 (out of the 3.9 million households that 

were eligible). In 2013, roughly 263,000 older renters were provided Section 202 units and 483,000 

were given housing choice vouchers.

78 

Education & Training

While older adults often express the desire to use new technologies such as computers, tablets, ereaders, and smartphones, many have difficulties learning to use technology without assistance. To use 

social media, job-searching sites, and other online resources, seniors must know how to use the Internet 

and connected devices. Statistics demonstrate the extent of the need. In one survey, only 18 percent of 

older adults reported feeling comfortable learning to use new devices such as smartphones or tablets on 

their own, and three-quarters indicated that they would need someone to help walk them through the 

process.79 Among older adults currently online, over half said they would need assistance to use new 

social networking sites to connect with friends or family.79 Experience in the field has shown that many 

seniors are willing to learn and will adopt new technologies if provided structured and high-quality 

technology training in a supportive setting (Box 1). 

Training in technology is especially important for older adults seeking employment, since the number of 

jobs that require knowledge of technology is increasing. At the same time, many employers have 

neglected to train older employees on newer technologies,80 which creates a skills gap for many older 

workers. Even for older people who are technologically literate, training must be ongoing as systems 

and programs are frequently updated.81 Where training does exist, it is often delivered through a 

 78 Section 202 housing is supportive affordable housing specifically established for very low-income elderly that is 

built by nonprofit organizations using HUD capital funding; however, the Section 202 house program has received 

no new funding in a number of years resulting in no new housing. (See Crosscutting Recommendation 2 in the 

Introduction.)

79 Smith, A., “Older Adults and Technology Use,” Pew Research Center, 1-26, 2014, See: 

www.pewinternet.org/files/2014/04/PIP_Seniors-and-Tech-Use_040314.pdf. 80 Finkelstein, R., Roher, S., Owusu, S., “Age-Smart Employer NYC: A Compendium of Strategies and Practices,” The 

New York Academies of Medicine, 1-68, 2013, See: http://www.ilc-alliance.org/images/uploads/publicationpdfs/Age_Smart_Employer_-_Compendium_of_Policies_and_Practices_-

_The_New_York_Academy_of_Medicine.pdf. 81 Mermin, B.T., Johnson, R.W., Tower, E., “Will employers want aging boomers?” The Retirement Policy Program 

Discussion Paper 08-04, 1-57, 2008. www.urban.org/uploadedPDF/411705_aging_boomers.pdf.
Independence, Technology, and Connection in Older Age

24

webinar format that may not match the learning styles of many older adults, making job training less 

effective. 

In addition to its work on expanding access, HUD is seeking to improve training through the HUD Service 

Coordinator Program. This program, part of HUD’s Multifamily Housing (MFH) Portfolio, funds the hiring 

or contracting of service coordinators for assisted housing for the elderly and persons with disabilities. 

These service coordinators are trained based on the specific training guidelines, including a set of 

training principles to help older adults get online. 

The Federal Government can create more opportunities for older people to access education and 

training on the use of information and communications technologies through broadband adoption 

programs and other initiatives with education/training provisions, such as Section 415 of the Older 

Americans Act. Training should include access to essential online-only services and protection from 

scams and fraud and should be tailored to the learning styles of older people. The Corporation for 

National & Community Services (CNCS) should build on its existing employment and volunteer 

programs, such as Senior Corps, by recruiting older people who are technologically literate to serve 

older people in need of assistance.

Box 1. Older Adults Technology Services, Inc. (OATS)

Since 2004, the nonprofit organization OATS (www.oats.org) has partnered with elected officials, government 

agencies, corporations, educational institutions, and community organizations to establish “broadband adoption 

ecosystems” designed especially for older adults. OATS serves urban settings such as New York City and 

Washington, DC and rural areas such as South Dakota and New York State’s Adirondack region. OATS advocates 

that technology use is relevant and valuable in a senior’s life, and it has successfully helped tens of thousands of 

seniors get online already. 

OATS has developed a unique model that proactively targets and engages seniors; provides access, training, and 

support specifically tailored to the needs of seniors; and builds a membership community of active learners who 

are seeking to understand and use technology. It does so at no cost to the senior to ensure that finances are not 

a barrier. Once trained, the seniors involved with OATS use technology to expand their social connections, 

improve their health, enhance their economic prospects, and enrich their lives through creative and educational 

pursuits.

The nonprofit’s Senior Planet Exploration Centers are technology-themed community centers that offer free 

training courses, seminars, and more year-round. Smaller Senior Planet tech labs are established in neighboring 

communities or in the region. Intensive free training courses are delivered by professional multilingual 

instructors 

In addition, Senior Planet mobile labs also transport tablets and other portable devices to community events and 

to seniors living in underserved areas. It runs an award-winning website, SeniorPlanet.org, which celebrates 

technology, digital culture, and “Aging with Attitude.” Senior Planet U. offers a series of free online learning 

modules that allow seniors anywhere to learn how to use technology to improve their lives. OATS engineers also 

provide strategic consulting, program planning, and program implementation services to public and private 

institutions
Independence, Technology, and Connection in Older Age

25

Including Older Americans in Emergency Disaster Planning 

Older adults may be more vulnerable in disasters than younger people due to mobility and cognitive 

impairments, chronic health conditions, diminished sensory awareness, social isolation, or financial 

limitations.82,83,84 As a result, older people have been disproportionately affected by recent catastrophic 

events (Box 2). Technology has great potential to maintain the health and well-being of older people 

during disasters, maximize scarce resources, and reduce emergency department usage; however, some 

of the most promising new initiatives have not adequately addressed the needs and communication 

modalities of older people. There is also evidence that older adults may be more psychologically 

resilientin the face of disaster than younger people and should therefore be mobilized to assist in 

response and recovery efforts.82,85 

Older technologies are rapidly being replaced by newer ones that may not have all of the same features 

and capabilities required by an older population. In addition, older people may be unaware of how 

changes to technology may affect their health, safety, and communication capabilities during 

emergencies. For example, in the transition from landline to mobile phone technologies or Internetbased phone services, several emergency functions of traditional copper landlines are lost. Copper wire 

lines route calls to the correct 911 center automatically (based on location) and include the caller’s 

name, residence, and exact location. If the speaker is confused/unable to speak, the landline’s location 

appears on a map and help can be dispatched. In addition, copper wire landlines are powered by the 

central phone service, making them much more likely to work in bad-weather conditions. In contrast, 

satellite-based Internet services can have outages during storms, and cell towers are vulnerable to losing 

 82 Acierno, R., Ruggierio, K., Kilpatrick, D., Resnick, HS., Galea, S., “Risk and Protective Factors for Psychopathology 

Among Older versus Younger Adults After the 2004 Florida Hurricanes,” The American Journal of Geriatric 

Psychiatry, 14(12): 1051-1059, 2006. 83 Fernandez, L.S., Byard, D., Lin, C., Benson, S., Barbara, JA., “Frail elderly as disaster victims: emergency 

management strategies,” Prehospital and Disaster Medicine, 17(2):67-74, 2002. 84 Evans, J., “Mapping the vulnerability of older persons to disasters,” International Journal of Older People 

Nursing, 5(1): 63-70, 2010. 85 Thompson, M., Norris, F., Hanacek, B., “Age differences in the psychological consequences of Hurricane Hugo,” 

Psychology and Aging, 8(4): 606-616, 1993.

Recommendation 5: Education and Training in Online Technologies

The Administration should support ongoing reauthorization of the Older Americans Act and build on the 

provisions on Section 415 to ensure access to online services and protection from scams and fraud, tailored to 

the learning needs of older adults. Corporation for National & Community Services (CNCS) should expand Senior 

Corps to include older people with literacy and skills in technology use.
Independence, Technology, and Connection in Older Age

26

power in natural disasters.86 The phone transition is bringing clear benefits to many, but these are

challenges that need to be addressed to ensure older adults and all people remain safe. 

Redundant power sources are critical for older people who are dependent on durable medical 

equipment such as oxygen concentrators, motorized scooters, and dialysis units, as well those who take 

refrigerated medication and those who require an elevator to leave home. Because there are no 

dedicated funding streams for generators in low-income senior housing or public housing where many 

older people with chronic conditions reside, and because private homes rarely have generators, older 

people often visit the emergency room for access to charging stations for durable medical equipment. 

Newly available data from the Centers for Medicare and Medicaid Services (CMS) can help identify 

electricity- or oxygen-concentrator-dependent people at the zip code level along with the regions that 

most require high-tech, renewable power/battery charging stations.87 Senior housing, senior centers, 

community centers, nursing homes, and libraries are ideal venues to house this technology.

 86 Dharma, D., Amelia, B., Powell, A., Joe, K., Jaewon, "Broadband adoption in low-income communities," Social 

Science Research Center, 1-103, 2010, See: webarchive.ssrc.org/broadband_adoption.pdf. 87 Expert interview with Nicole Lurie, Assistant Secretary for Preparedness and Response, U.S. Public Health 

Service, 2015.

Box 2. Older Adults during Superstorm Sandy

During Superstorm Sandy, older people’s reliance on landlines and lack of redundant communications impeded 

their ability to maintain situational awareness, access information, and connect to formal and informal support 

systems.88 Older adults were more likely to use landlines (between 12-18 percentage points higher than their 

younger counterparts) and less likely to report an additional form of communication, such as cell phones, email, 

or social media.88 In many neighborhoods, however, cell phones were more likely to work than landlines.89 Older 

people who did have cell phones sometimes did not understand how to use them to access assistance or could 

not access redundant power sources to charge them.90 Because it is difficult to predict what forms of 

communication will work in an emergency, having more options creates better odds of connection.88

Red Hook, Brooklyn, which has a large concentration of older people residing in public housing in poverty, was 

one of the most significantly affected communities. This neighborhood is geographically isolated and digitally 

underserved. Prior to the storm, The Red Hook Initiative, a community-based youth-empowerment organization, 

partnered with the Open Technology Institute to create a community wireless network (Red Hook WiFi) to 

provide free Internet access, local applications and services, and digital literacy training. When the 

neighborhood lost power for over a month after Superstorm Sandy, Federal Emergency Management Agency set 

up a satellite link on the roof of the Red Hook Initiative and a commotion router on the roof of a local business to 

leverage this network and target connectivity where residents and responders were most in need. In their 2013 

report on the Red Hook WIFI initiative, the Open Technology Institute recommends pre-positioning wireless 

network equipment and increasing technological literacy in underserved communities prior to a disaster to 

expedite the deployment of connectivity, targeted outreach, and essential resources following a disaster.91
Independence, Technology, and Connection in Older Age

27

The Federal Emergency Management Agency (FEMA) has recognized the unique challenges for those 

with disabilities or functional limitations, regardless of age, during an emergency. Since 2010, it has 

operated the Office of Disability Integration and Coordination to consider how to improve emergency 

management for all people regardless of their functional capabilities. This office brought together 

previous activities at the Agency for Disability Inclusion, and it ensures that Disability Integration 

Advisors are included in the national command teams coordinating responses to major 

disasters.88,89,90,91

FEMA should advance national strategies to create interoperable and more effective emergency 

communications systems in which the needs and capabilities of older people are included in evidencebased standards for existing and future wireline and wireless voice, data, image, and video technologies.

The Assistant Secretary for Preparedness and Response, Office of the National Coordinator for Health IT, 

and CMS should promote more rapid access to relevant data and interoperability of electronic health 

records to make possible the identification of vulnerable people and relevant medical information and 

resources in emergency situations.92 The Food and Drug Administration has an important role to play in 

this as well. This recommendation builds on the 2011 PCAST report on health information technology 

and the 2014 PCAST report on systems engineering in health care.

 88 NORC Center for Public Affairs Research and the Associated Press, “Communication during disaster response and 

recovery,” 1-5, 2013. See: 

www.apnorc.org/PDFs/Resilience%20in%20Superstorm%20Sandy/Communications_Final.pdf. 89 New York City Housing Authority. Emergency Preparedness Resident Survey, Unpublished Data. 2013. 90 Goldman, L., Finkelstein, R., Schafer, P., Pugh, T., “Resilient Communities: Empowering Older Adults in Disasters 

and Daily Life,” The New York Academy of Medicine, 2014. www.nyam.org/publications/publication/resilientcommunities-empowering-older-adults-in. 91 Open Technology Institute and The New America Foundation. “Case Study: Red Hook Initiative WiFi & 

Tidepools,” 2013. commotionwireless.net/files/rhiwifi_tidepools_casestudy.pdf. 92 The President’s Council of Advisors of Science and Technology, Report to the President: Realizing the Full 

Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward, 2010, 

www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf; Report to the President: 

Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering, 2014, 

www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_systems_engineering_in_healthcare_-

_may_2014.pdf.
Independence, Technology, and Connection in Older Age

28

Recommendation 6: Emergency Response and Communications

Older people are especially vulnerable in disaster and emergency situations.

1. The Federal Emergency Management Agency (FEMA) at the Department of Homeland Security (DHS) 

should advance national strategies to create effective communications systems that reach isolated and 

vulnerable older people.

2. Within HHS, the Office of the Assistant Secretary for Preparedness and Response (ASPR), the Office of 

the National Coordinator for Health Information Technology (ONC), and the Centers for Medicare & 

Medicaid Services (CMS) should promote more rapid interoperability of medical information to ensure 

timely access whenever and wherever a patient may appear.

3. FEMA, ASPR, and CMS should advance policies that make medical device interfaces more consistent and 

interoperable to ensure timely access to people who depend on these devices.
Independence, Technology, and Connection in Older Age

29

3. Technologies to Address Changes 

in Cognitive Ability 

The opportunity for the Federal Government to facilitate the development and adoption of technology 

that supports the mental abilities and cognitive health of older Americans comes at an auspicious time. 

The 2015 White House Conference on Aging had a specific theme of improving older adults’ cognitive 

health; the Centers for Disease Control (CDC) continues its public health initiative to promote healthy 

brain aging;

93 and Medicare’s Annual Wellness Visit requires the detection of any cognitive 

impairment.94 In addition, there are specific national plans to understand, treat, and prevent diseases 

that impair older adults’ cognition, the most common being Alzheimer’s disease, and to better meet the 

needs of the millions of Americans currently living with these diseases.95

Each of these policy initiatives responds to the challenge of an aging population in which older 

Americans commonly report problems with cognitive function.96 The changes in cognition may be due to 

cognitive aging, a process inherent in humans as they age, or due to a specific disease like Alzheimer’s

disease or dementia, which are prevalent, costly, and cause notable suffering.,97,98,99,100 Regardless of 

 93 The Center for Disease Control and Prevention: “The CDC Healthy Brain Initiative: The Public Health Road Map 

for State and National Partnerships, 2013-2018,” pg. 51. www.cdc.gov/aging/pdf/2013-healthy-brain-initiative.pdf. 94 Centers for Medicare and Medicaid, The Medicare Learning Network. “The ABCs of Providing the Annual 

Wellness Visit.” 2012. www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf

95 Office of the Assistant Secretary for Planning and Evaluation, “National Plan to Address Alzheimer’s Disease: 

2015 Update,” United States Department of Health and Human Services; 2015. aspe.hhs.gov/national-planaddress-alzheimer%E2%80%99s-disease-2015-update. 96 Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey (BRFSS) of adults 60 

years, See: www.cdc.gov/brfss; “Self-reported increased confusion or memory loss and associated functional 

difficulties among adults aged ≥60 years — 21 States” Morbidity and Mortality Weekly Report, 62(18): 347-50, 

2013.

97 Plassman, B.L., Langa, K.M., Fisher, G.G., Heeringa, S.G.,Weir, D.R., Ofstedal, M.B., Burke, J.R., Hurd, M.D., Potter, 

G.G., Rodgers, W.L., Steffens, D.C., McArdle, J.J., Willis, R.J., Wallace, R.B., “Prevalence of Cognitive Impairment 

without Dementia in the United States,” Annals of Internal Medicine, 148(6): 427-434, 2008. 98 Hurd, M.D., Martorell, P., Delavande, A., Mullen, KJ., Langa, K.M., “Monetary costs of dementia in the United 

States.” New England Journal of Medicine, 368(14): 1326-1334, 2013. 99 Schulz, R., Mendelsohn, AB., Haley, WE., Mahoney, D., Allen, RS., Zhang, S., Thompson, L., Belle, SH., Resources 

for Enhancing Alzheimer's Caregiver Health Investigators, “End-of-Life Care and the Effects of Bereavement on 

Family Caregivers of Persons with Dementia,” New England Journal of Medicine, 349:1936-42, 2003 and Schulz, R., 

Visintainer, P., Williamson, GM., "Psychiatric and Physical Morbidity Effects on Caregiving," Journal of Gerontology: 

Social Sciences, 45(5): 181-191, 1990. 100 Pinquart M, Sörensen S., “Differences between caregivers and noncaregivers in psychological health and 

physical health: a meta-analysis,” Psychology and Aging, 18(2): 250–67, 2003.
Independence, Technology, and Connection in Older Age

30

the cause, declines in cognitive health threaten the well-being, quality of life, and economic security of 

older adults and their families.

There are multiple technologies to help older adults manage cognitive impairments or maintain their 

current cognitive health. Some promising technologies include ones that can monitor cognition and 

functional performance, detect the earliest signs of cognitive impairment, and maintain and improve 

cognition and functional capacity. Maintenance or improvements in cognitive health could minimize the 

physical and emotional co-morbidities associated with cognitive impairment, help older adults remain 

out of institutions, and reduce burdens (both time and economic) on family caregivers.101

PCAST identified at least three important opportunities to develop and use technology to maintain older 

American’s cognitive health. First, in-home sensing and wearable technologies can be employed to 

detect changes in an older adult’s activity patterns and their ability to perform day-to-day tasks, such as 

cooking or medication management. These changes may indicate not only declines in physical function 

but in cognitive function as well. Second, technology can help older adults with their finances, such as 

paying bills on time or preventing fraud or exploitation. The third promising but unfulfilled opportunity 

is technology that promotes cognitive health by maintaining or enhancing cognition or preventing 

cognitive decline.

How Technology Can Monitor Cognitive Function 

Technologies that monitor cognitive changes offer vast potential to foster older adults’ functional 

independence. Many types of monitoring systems exist, and their development is continuously 

evolving.

102 Some technologies can automatically detect events such as falling, which may be caused by 

problems with cognition or otherwise, while others use location devices designed to reduce potential 

injuries to adults with dementia who wander. There are many devices available for preventing or 

detecting wandering, such as Project Lifesaver,103 Alzheimer’s Association Comfort Zone,104 or GPS 

Smart Sole.105 Smart phone apps such as “FindMyFriend” can locate a wandering person.

Another type of monitoring system is unobtrusive home monitoring, such as home sensors that track 

activity patterns. These systems can be used to detect changes in activity or unusual patterns that might 

suggest functional or cognitive decline, for example, detecting that a normally active and sociallyinvolved older adult is spending more time being sedentary, napping, or is having fewer social 

interactions could signal a problem. Studies have found that an adult’s total active time, time out of the 

 101 A 2010 Investor Protection Trust survey found 40 percent children of parents 65 or older are “very” or 

“somewhat” worried that their parents “have already become or will become less able to handle their personal 

finances over time,” 36 percent are “not worried at all” about such a development. 

www.investorprotection.org/downloads/EIFFE_Survey_Report.pdf 102 Kang, H.G., Mahoney, D.F., Hoenig, H., Hirth, V.A., Bonato, P., Hajjar, I., Lipsitz, L.A.,“In Situ Monitoring of Health 

in Older Adults: Technology and Issues,” Journal of the American Geriatric Society, 58(8): 1579-1586, 2010. 103 "Project Lifesaver International | Bringing Loved Ones Home," Project Lifesaver International RSS2, 2015, 

Accessed March 14, 2016, www.projectlifesaver.org/. 104 See: www.alz.org/comfortzone/about_comfort_zone.asph. 105 "Hidden GPS Enabled Insoles Keep You Connected to Who Matters Most," GPS SmartSoles GPS Tracking Device, 

Accessed March 14, 2016, See: www.gpssmartsole.com/.
Independence, Technology, and Connection in Older Age

31

house, walking speed, or gait may predict cognitive decline.

106 Changes in computer keystrokes and 

linguistic features of emails as well as home computer usage could also be useful for tracking cognition 

changes.

107

It is also possible to use mobile technologies to measure a person’s cognitive abilities.108 The FDA 

recently approved the use of the Defense Automated Neurobehavioral Assessment (DANA), a mobile 

phone-based application that operates much like a video game, to help identify cognitive decline 

associated with traumatic brain injury.

109,110

Older adults are receptive to these types of technologies if they are perceived as useful and foster their 

ability to live independently.

111 For example, interviews with a sample of older adults who had a sensorbased monitoring system installed in their home found that the older adults valued the monitoring 

system, as they perceived that it helped them to remain independent and contributed to their sense of 

safety.

112 In short, the question is whether the perceived benefits outweigh privacy concerns.

Smart technologies show promise in detecting changes in cognition and functional performance that 

may be indicative of cognitive decline and impairment. Before the large-scale deployment of these 

systems can occur, however, several issues need to be addressed. There is limited evidence, especially 

 106 Kaye, J.A., Maxwell, S.A., Mattek, N., Hayes, T.L., Dodge, H., Pavel, M., Jimison, H.B., Wild, K., Boise, L., 

Zitzelberger, T.A., “Intelligent Systems For Assessing Aging Changes: home-based, unobtrusive, and continuous 

assessment of aging,” Journal of Gerontology, 66B(Suppl 1): i180-i190, 2011; Aki, A., Taati, B., Mihailidis, A., 

“Autonomous unobtrusive detection of mild cognitive impairment in older adults,” IEEE Transactions on 

Biomedical Engineering, 62(5): 1383-1394, 2015; Verghese, J., Wang, C., Lipton, R.B., Holtzer, R., Xue, X., 

“Quantitative gait dysfunction and risk of cognitive decline and dementia,” Journal of Neurology, Neurosurgery & 

Psychiatry, 78(9): 929-935, 2007; Buracchio, T., Dodge, H.H., Howieson, D., Wasserman, D., Kaye, J., “The 

trajectory of gait speed preceding mild cognitive impairment,” Archives of Neurology, 67(8): 980-986, 2010. 107 Kaye, J., Mattek, N., Dodge, H.H., Campbell, I., Hayes, T., Austin, D., Hatt, W., Wild, K., Jimison, H., Pavel, M.,

“Unobtrusive measurement of daily computer use to detect mild cognitive impairment,” Alzheimer's & Dementia,

10(1): 10-17, 2014. 108 Allard, M., Husky, M., Catheline, G., Pelletier, A., Diharreguy, B., Amieva, H., Peres, K., Foubert-Samier, A., 

Dartigues, J.F., Swendsen, J., “Mobile Technologies in the Early Detection of Cognitive Decline,” PLoS ONE, 9(12): 

e112197 , 2014. 109 Lathna, C., Spira, J.L., Bleiberg, J., Vice J., Tsao, J.W., “Defense Automated Neurobehavioral Assessment (DANA)-

psychometric properties of a new field-deployable neurocognitive assessment tool,” Military Medicine, 178(4): 

365-371, 2013. 110 Currently, the “app” has only been used for military applications. Clearly, this is an emerging area of 

development as these types of systems have the potential to be used with other populations to detect cognitive 

change associated with other conditions such as mild cognitive impairment or dementia. DANA provides an 

example of how mobile “apps” can be used to monitor cognitive decline.

111Melenhorst, AS., Bouwhuis, D., “When do older adults consider the internet?

An exploratory study of benefit perception,” Gerontechnology, 3(2): 89-101, 2004; Wild, K., Boise, L., Lundrell 

J.,Foucek, A., “Unobtrusive In-Home Monitoring of Cognitive and Physical Health: Reactions and Perceptions of 

Older Adults,” Journal of Applied Gerontology, 27(2): 181-200, 2008; Pol, M., van Nes, F., van Hartingsveldt, M., 

Buurman, B., de Rooij, S., Krose, B., “Older People's Perspectives Regarding the Use of Sensor Monitoring in Their 

Home,” Gerontologist, 00, 1-9, 2014. 112 Pol, M., van Nes, F., van Hartingsveldt, M., Buurman, B., de Rooij, S., Krose, B., “Older People's Perspectives 

Regarding the Use of Sensor Monitoring in Their Home,” Gerontologist, 00, 1-9, 2014.
Independence, Technology, and Connection in Older Age

32

from large-scale studies, on the feasibility, validity, reliability, and comparative effectiveness of these 

approaches. There is more to learn about implementation, such as the optimal monitoring schedule, 

usability, and cost. While many older adults are comfortable with the privacy implications of monitoring 

(as noted above), more work is needed on privacy and security.113 (See Crosscutting Recommendation 3 

in the Introduction.)

How Technology Can Protect Older Adults’ Economic Security 

Cognitive impairment can often reduce a person’s ability to manage finances (“financial capacity”). 

When Alzheimer’s, Parkinson’s, or similar diseases become symptomatic, declines in financial capacity 

are typically even greater.114 Compared to younger adults, older adults may be more likely to make poor 

financial decisions that depend on recent learning,115 although older adults are likely to exhibit less risk 

taking if a decision relies on well-learned behaviors. This may be why older adults were more likely to 

express intent to purchase products the Federal Trade Commission had cited as fraudulently 

marketed116 or to make suboptimal decisions across financial tasks such as fee payments or credit card 

balance transfers.117 Notably, these decisions often either involve interactions with technology or can be 

identified with technology. 

Changes in financial capacity—skills, knowledge, or judgment—are among the reasons that older adults 

are more likely to be victims of financial fraud and exploitation. The fraud can go unnoticed for some 

time as reduced financial capacity is often the first effect of cognitive impairment.118 The annual losses 

due to fraud and exploitation are estimated in the billions of dollars.119 A 2010 study gauged it as $3 

 113 The President’s Council of Advisors on Science and Technology, Big Data and Privacy: A Technological 

Perspective, 2014, See: 

www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_big_data_and_privacy_-_may_2014.pdf. 114 Marson, D.C., Sawrie, S.M., Snyder, S., McInturff, B., Stalvey, T., Boothe, A., Aldridge, T., Chatterjee, A., Harrell, 

L.E., “Assessing financial capacity in patients with Alzheimer’s disease: a conceptual model and prototype 

instrument,” Archives of Neurology, 57: 877-84, 2000; Martin, R.C., Triebel, K.L., Kennedy, R.E., Nicholas, A.P., 

Watts, R.L., Stover, N.P., Brandon, M., Marson, D.C., “Impaired financial abilities in Parkinson's disease patients 

with mild cognitive impairment and dementia,” Parkinsonism & Related Disorders, 19: 986-90, 2013. 115 Mata, R., Josef, A.K., Gregory R., Samanez-Larkin, G., Hertwig, R., “Age difference in risky choice: a metaanalysis.” Annals of the New York Academy of Sciences, 1235: 18-29, 2011. 116 Denburg, N.L., Cole, C.A., Hernandez, M., Yamada, T.H., Tranel, D., Bechara, A., Wallace, R.B., “The orbitofrontal 

cortex, real-world decision making, and normal aging.” Annals of the New York Academy of Sciences, 1121: 480-

498, 2007.

117 Agarwal, S., Driscoll, J,. Gabaix, X., D. Laibson, D., “The age of reason: Financial decisions over the life cycle and 

implications for regulations.” Brookings Institution, 973790: 2009. See: 

www.brookings.edu/~/media/Projects/BPEA/Fall%202009/2009b_bpea_agarwal.PDF

118 Triebel, KL., Martin, R., Griffith, HR., Marceaux, J., Okonkwo, OC., Harrell, L., Clark, D., Brockington, J., Bartolucci,

A., Marson, DC., “Declining financial capacity in mild cognitive impairment: A 1-year longitudinal study. 

Neurology,” Neurology, 73: 928-34, 2009. 119 MetLife Mature Market Institute “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, 

and Predation Against America’s Elders” www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elderfinancial-abuse.pdf, 2011 and The 2015 TruLink study used measurement that accounted for the different kinds of 

elder abuse and estimated the total costs of all causes of abuse to be $36.48 billion. 
Independence, Technology, and Connection in Older Age

33

billion a year, and a 2015 study suggested annual losses to be as high as $36 billion.120 When these 

losses occur, family or public sources of funds often have to support day-to-day expenses and medical 

care.121 Since older adults generally are not working, they cannot rebuild their lifetime savings after 

making an unsuitable financial decision or being a victim of fraud or exploitation.122

Exploitation and fraud manifest themselves in numerous ways.123,124 In the grandparent scam, for 

example, an older adult receives a phone call from a person who pretends to be the older adult’s 

grandchild, claims trouble that requires urgent financial help, and begs the grandparent not to tell the 

child’s parents. The help is a cash transfer to pay a bill, fine, or bail. 

Although the kinds of fraud and exploitation and their perpetrators vary, many involve an older adult 

transferring or withdrawing cash, which is why banks and other financial institutions should be able to 

identify routinely not only declines in financial capacity but also fraud and exploitation. Bank personnel 

could take immediate action in a face-to-face encounter, but technology for online banking could also 

identify unusual activity compared to the client’s past behaviors and patterns. This would be the case, 

for example, when a client who has never used a bank card transfers money to overseas accounts or 

withdraws cash at an ATM. There are also technologies that could prevent or limit fraud, such as 

providing read-only views of accounts to caregivers or algorithms that flag potential declines in financial 

capacity (Box 3). While these technologies and analytics exist, the banking and financial services 

industries have not widely adopted them. 

Multiple Federal agencies are engaged in activities to stop or prevent financial exploitation of older 

adults, including the Administration for Community Living, Consumer Financial Protection Bureau’s 

(CFPB) Office for Older Americans, Federal Trade Commission (FTC), Securities and Exchange 

Commission (SEC), and Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN), 

 120 MetLife Mature Market Institute study, and True Link studies.

121 A Utah Division of Aging and Adult Services study used a review of 80 financial exploitation cases from 2010 to 

estimate that Utah seniors and businesses lost $4,766,196 and the state’s Medicaid program would have to pay 

about $900,000 for the care of adults who suffered exploitation. Gunther, Jilenne, “The 2010 Utah Cost of Financial 

Exploitation,” Utah Division of Aging and Adult Services, 2012. See: victimsofcrime.org/docs/defaultsource/financial-fraud/2011-economic-cost-of-financial-exploitation.pdf?sfvrsn=2.

122 An example of the impact of losses in financial capacity on a patient and family is captured in “Money woes can 

be early clue to Alzheimer’s disease,” The New York Times, 30 October 2010, which recounts the story of Arthur 

Packel, whose earliest symptoms of Alzheimer’s disease were troubles making financial decisions resulting in a loss 

of his business and much of his family’s wealth in order to pay creditors. See: 

www.nytimes.com/2010/10/31/health/healthspecial/31finances.html?_r=0.

123 The National Council on Aging categorizes fraud and exploitation into ten groups: Medicare and health 

insurance fraud, counterfeit prescription drugs, funeral and cemetery scams, fraudulent anti-aging products, 

telemarketing, Internet fraud, investment schemes, homeowner/reverse mortgage scams, sweepstakes and lottery 

scams, and the grandparent scam. www.ncoa.org/economic-security/money-management/scams-security/top-10-

scams-targeting-seniors . 124 United States Government Accountability Office. Report to Congressional Requesters. “Elder Justice: National 

Strategy Needed to Effectively Combat Elder Financial Exploitation,” GAO-13-110, 2012.
Independence, Technology, and Connection in Older Age

34

and Department of Justice. Their activities include raising awareness of the problem, educating 

consumers and the industry, and intervening to address fraud and exploitation and impairments in 

financial capacity.125 The 2009 Elder Justice Act created the Elder Justice Coordinating Council and an 

Advisory Board on Elder Abuse, Neglect, and Exploitation to develop priorities for the elder justice field, 

coordinate Federal activities, and provide recommendations to Congress.

Other groups, such as private organizations and industry groups, are focused on reducing financial fraud 

and exploitation.

126 A 2012 Government Accountability Office report on financial exploitation found that 

much of the investigation of fraud and exploitation is handled by State social services, criminal justice 

 125 United States Government Accountability Office, “National Strategy Needed to Effectively Combat Elder 

Financial Exploitation,” GAO-13-110, 2012, and White House Conference on Aging, Elder Justice: See: 

www.whitehouseconferenceonaging.gov/blog/policy/file.axd?file=/Elder%20Justice%20Policy%20Brief/Elder%20J

ustice%20Policy%20Brief%205_08_15_FINAL.pdf. 126 As examples, see: "Protect Your Money," Protect Your Money, Accessed March 14, 2016, 

www.aba.com/Consumers/Pages/Consumer_PYM.aspx; and "Senior Investor Protection Resource Center," Sifma, 

Accessed March 14, 2016, www.sifma.org/issues/savings-and-retirement/senior-investor-protection/overview/.

Box 3. A case study in how a bank uses technology to enhance older adults’ financial security

Bank of American Fork is a leader in using online, view-only accounts to promote age-friendly banking practices. 

They came to use this technology as part of a culture change that includes employee awareness and training and 

laws that mandate reporting cases of suspected fraud or abuse. 

Five years ago two events occurred: the bank was approached by a customer writing a book about individuals 

over the age of 55 navigating their rights, and the Utah Division of Aging and Adult Services issued a study that 

demonstrated the cost of elder financial exploitation. The timing of these two events coincided with the 

company’s recognition that Utah mandated that financial services report suspected elder abuse, but the bank 

managers had been reluctant to get involved in cases because of concern that this would reflect poorly on the 

bank, and even if they did, they were poorly equipped to address customers experiencing financial exploitation 

or impaired capacity. 

Their response was multi-pronged. They developed a toolbox of banking services for elderly clients, built around 

products called AccountSmart Tools for Seniors. They also engaged in public seminars for seniors and caregivers 

to raise awareness. Employee training includes how to recognize the signs of elder financial abuse and report it 

and how to help families structure banking needs to protect both the senior and the caregiver, such as 

recommending limited power of attorney to assist seniors and their caregivers in managing finances. 

Technology is essential as well. The bank offers senior-friendly iPad applications that use intuitive design, 

automatic transfers and bill payments, and the innovative view-only access to accounts. "View-only" access 

allows a third party, such as a friend or adult child, to see a senior’s account transactions but does not allow the 

viewer to make transactions. This account allows the third party to identify concerning transactions or changes 

in patterns that might signal a decline in financial capacity or abuse. The inability for the third party to make 

transactions protects the senior from fraud and protects the third party from unwarranted suspicion that they 

might commit fraud.
Independence, Technology, and Connection in Older Age

35

and consumer protections systems, and particularly the county-by-county system of Adult Protective 

Service (APS) agencies that are charged with investigating and substantiating cases of suspected elder 

fraud, abuse, or neglect.127 The broad range of organizations highlights the need to integrate and 

coordinate activities.

PCAST believes that one way the Federal Government can achieve a more integrated and coordinated 

network is to more accurately measure the size of the problem and issue an annual report of the kinds 

of abuse and exploitation and their costs to the nation. The Currency and Foreign Transactions 

Reporting Act, commonly called the Bank Secrecy Act, provides a regulatory framework for reporting 

cases of fraud and exploitation into a central database. The Act requires financial institutions to report 

suspicious transactions, called Suspicious Activity Reports (SARs), to FinCEN at the Department of 

Treasury. Since 2011, institutions can mark SARs reports as incidents of elder financial exploitation, 

which gives the Federal Government additional data on the size, scope, and trends in elder exploitation, 

data that are essential for evidence-based policymaking.128

Beyond measurement, two technological approaches are particularly promising. Financial institutions 

could use algorithms to passively identify transactions that may signal impairments in financial capacity 

as well as fraud or exploitation. Algorithms could identify instances such as missed payments, repeated 

withdrawals, or transfers to atypical destinations that are indicative of a problem. These algorithms 

would be similar to existing ones used by large credit card issuers to detect whether a card has been lost 

or stolen, such as FICO’s Falcon Fraud Manager Machine learning system.129

In addition, technologies could allow trusted parties, such as a family member or caregiver, to monitor 

financial accounts for impaired financial capacity or exploitation. View-only online accounts, such as 

 127 United States Government Accountability Office, “National Strategy Needed to Effectively Combat Elder 

Financial Exploitation,” GAO-13-110, 2012. 128 Department of the Treasury, Financial Crimes Enforcement Network. “Advisory to Financial Institutions on Filing 

Suspicious Activity Reports Regarding Elder Financial Exploitation.” FIN-2011-A003, 2011. 129 Urban, M., Public Comment, 2011, See: www.federalreserve.gov/SECRS/2011/March/20110303/R-1404/R1404_022211_67635_571427685645_1.pdf.

Box 4. EverSafe’s use of algorithms to unobtrusively monitor activity across multiple accounts

An example of technology that unobtrusively and remotely monitors multiple financial accounts across 

institutions has been developed by EverSafe, a company founded in 2012 after the Founder and CEO’s mother 

was a victim of multiple credit card scams. EverSafe’s rules-based learning system developed in consultation 

with industry experts analyzes its members’ bank, investment and credit card accounts, and credit reports on a 

daily basis to identify suspicious activity. Once suspicious activity is identified, an alert is sent to the member 

along with designated trusted advocates, such as family members, professionals, powers of attorney and 

guardians. These advocates have read-only access to financial information and serve as an extra set of eyes in 

monitoring accounts, credit reports and alerts. Read-only access means money cannot be moved, and no 

financial transactions can be effected through the use of EverSafe. This is a safer alternative to creating a joint 

account which can be subject to exploitation or the joint owner’s creditors. Once alerted, EverSafe assists in 

remediation and tracks issues through to resolution.
Independence, Technology, and Connection in Older Age

36

described in the case studies of Bank of American Fork and EverSafe (Box 4), allow a trusted person to 

monitor in real time the activity of another person’s account without the ability to trade or manipulate 

assets or without revealing the balance. General purpose bank-account monitoring software has been 

around for some time, but technologies specific to elder abuse—for example, specialized algorithms a 

customer can add to an existing account, aggregation tools to bring transactions from multiple accounts 

into a single viewable portal, and real-time detection systems to prevent fraudulent or exploitative 

transactions before they occur—have only recently been introduced into the market. 

There are several barriers to industry-wide adoption of new algorithms or third-party monitoring. No 

business model exists to foster the creation or implementation of algorithms by the banking industry 

itself. In addition, after a bank identifies a transaction as suspect and therefore needs to issue a SAR, 

financial institutions can be concerned that reporting the SAR to Adult Protective Services could violate 

privacy laws at both the State and Federal level. States have laws on reporting suspected cases of elder 

abuse, but they vary in who can report, whether reporting is encouraged or mandatory, and whether 

there are protections from liability for reporting and delaying a trade.130 All the relevant Federal 

agencies have issued joint guidance indicating that they do not anticipate initiating enforcement action 

for financial institutions reporting elder abuse pursuant to State mandates,131 but financial institutions 

remain concerned that taking steps to intervene on behalf of a client can violate rules on executing 

trades in a timely manner. 

Financial institutions also noted a challenge of how to address transactions that raise a concern of 

impaired capacity, but not fraud or exploitation that would necessitate a SAR. As illustrated in the Bank 

of American Fork case study, institutions expressed a concern that bringing the transaction to the 

attention of the customer or even a third party the customer designated, such as an adult child or 

friend, or reporting to local law enforcement, could cause customer dissatisfaction and ultimately the 

loss of that customer. 

The challenges to adopting online view-only accounts are how to make them part of routine banking 

practice. At the time a young or middle-aged customer is opening a bank or credit card account, he or 

she often does not select an institution based on the age-friendly features the customer may eventually 

need; in turn, banks are hesitant to raise the issue. By the time the need arises, the customer may not 

wish to switch accounts or may not be able to execute good judgment in the decision of how much extra 

financial authority should be delegated and to whom. Additionally, customers often have multiple 

accounts across several institutions, creating the challenge of aggregating information from multiple 

accounts into one secure portal. 

With the entire industry facing the same problem, no one institution has the incentive to be the first to 

make passive monitoring and reporting and online view-only accounts part of routine practice. A 

 130 PCAST identified three states—Delaware, Missouri, and Washington—that permit a financial institution to put a 

hold on a suspicious transaction while it is being investigated for fraud or exploitation.

131 Board of Governors of the Federal Reserve System, “Interagency Guidance on Privacy Laws and Reporting 

Financial Abuse of Older Adults,” 1-5, 2013, See: www.fdic.gov/news/news/press/2013/Interagency-Guidance-onPrivacy-Laws-and-Reporting-Financial-Abuse-of-Older-Adults.pdf?source=govdelivery.
Independence, Technology, and Connection in Older Age

37

regulatory nudge could, we believe, overcome this barrier and make these technologies and the 

practices that surround them part of routine banking and financial management. Customers would 

expect to have these conversations as part of opening an account at an institution or in communication 

with an online bank to meet their needs over the long term.

To protect the finances of older adults experiencing cognitive decline, the Federal Government should 

encourage the banking and financial services industries to build the capability to identify declines in 

financial capacity, promote older adults’ economic security, and protect their assets from fraud or 

exploitation and make the resultant information available to seniors. At minimum, the signatories to 

the 2013 Interagency Guidance on Privacy Laws and Reporting Financial Abuse of Older Adults [i.e., 

Board of Governors of the Federal Reserve System, Commodity Futures Trading Commission, CFPB,

Federal Deposit Insurance Corporation (FDIC), FTC, National Credit Union Administration, Office of the 

Comptroller of the Currency, and SEC] should assure financial institutions that complying with State 

mandatory reporting requirements, and reporting suspected elder abuse and fraud in states that do not 

have mandatory reporting requirements, does not violate the customer’s privacy rights under GrammLeach-Bliley Act.

In addition, the Executive Office of the President should convene State governors to identify the 

challenges and share successful strategies that ensure that SAR with information about suspected elder 

abuse or fraud are transferred to local adult protective services and law-enforcement authorities to 

protect seniors.

Other ways the Federal Government can protect older Americans is by facilitating and promoting the 

creation of industry standards for the collection and aggregation of data; requiring financial institutions 

to adopt commercially reasonable best practices for the use of technologies that detect potential fraud, 

abuse, or changes in financial capacity; and making rules that will cause financial institutions that offer 

online banking to create a means for seniors to give monitoring power to a trusted party without 

enabling that party to initiate transactions, change the senior's profile information, or otherwise engage 

in fraud or abuse. The SEC should assure financial institutions that holding a transaction due to 

suspected elder abuse or fraud or impaired capacity does not violate regulations for efficient and timely 

execution of a transaction, and the FDIC should require financial institutions to routinely offer safeharbor forms to customers that authorize the institution to share information with a designated family 

member or other trusted actor if an event of fraud or financial abuse is suspected or discovered.

Recommendation 7: Financial Services

The Federal Government should encourage the banking and financial services sector to offer monitoring services 

to protect assets from fraud and exploitation.

1. Signatories to the 2013 Interagency Guidance on Privacy Laws and Reporting Financial Abuse of Older 

Adults should accelerate expectations of banks to offer a range of available protective services.

2. The Executive Office of the President should convene State governors to ensure that reports of 

suspicious activity are reported to relevant adult protective services agencies.
Independence, Technology, and Connection in Older Age

38

The Promise of Technology to Maintain or Enhance Cognitive Health 

Cognition changes across the lifespan of an adult, but people differ substantially from each other in how 

they perform as they get older.

132 Although many older adults show poorer performance than younger 

adults on a variety of cognitive tasks and skills, the trajectories of individuals’ attention, reasoning, 

memory, and other cognitive processes vary greatly over time. Importantly, factors including genetics,

health, sensory function including vision and hearing, mood, personality, and lifestyle factors such as 

physical activity, diet, cognitive engagement, and social interaction seem to influence these individual 

differences.

133,134 For example, several animal and human studies now suggest that physical activity and 

exercise can enhance cognitive performance and brain health in older animals and humans.

135

This study looked at two related areas where research studies and commercial entities have tried to use 

technology to understand, modify, or compensate for adults’ cognitive abilities. The first is cognitiveenhancement technologies or “brain games” that intend to improve an adult’s cognitive performance. 

The second is cognitive assistive systems that coach an older adult on activities in the home. These are 

described in more detail below.

Cognitive Enhancement 

Researchers believe that technologies intended to enhance cognition are promising, but there is little 

evidence that technologies affect real-world abilities.

136 Computer-based cognitive training can improve 

older adults’ performance on a variety of trained tasks, albeit often at a slower rate than younger 

adults.

137 Training can improve memory,138 sustained attention,139 and dual-task performance.140

 132 Hertzog, C., Kramer, A.F., Wilson, R.S., Lindenberger, U., “Enrichment Effects on Adult Cognitive Development: 

Can the Functional Capacity of Older Adults Be Preserved and Enhanced?” Psychological Science in the Public 

Interest, 9(1): 1-65, 2008. 133 Ibid. 134 Salthouse, T.A., “Why are there different age relations in cross-sectional and longitudinal comparisons of 

cognitive functioning?” Current Directions in Psychological Science, 23(4): 252-256, 2014. 135 Voss, M.W., Vivar, C., Kramer, A.F., van Praag, H., "Bridging animal and human models of exercise-induced brain 

plasticity,” Trends in Cognitive Sciences, 17(10): 525-544, 2013. 136 "Authoritative, Comprehensive and Systematic," Elsevier Current Opinion, Accessed March 14, 2016, 

www.current-opinion.com/journals/current-opinion-in-behavioral-sciences. 137 Li, T., Yao, Y., Cheng, Y., Xu, B., Cao, X7., Waxman, D., Feng, W., Shen, Y., Li, Q., Wang, J., Wu, W., Li, C., Feng, J.,

“Cognitive Training Can Reduce the Rate of Cognitive Aging: A Neuroimaging Cohort Study,” BMC Geriatrics, 16(1) 

1-12, 2008; Strobach, T., Frensch, P., Müller, H.J., Schubert, T., “Testing the Limits of Optimizing Dual-Task 

Performance in Younger and Older Adults,” Frontiers in Human Neuroscience, 6(39), 2012. 138 Richmond, L.L., Morrison, AB., Chein, JM., Olson, IR., “Working Memory Training and Transfer in Older Adults,” 

Psychology of Aging, 26(4): 813, 2011. 139 Fortenbaugh, F.C., DeGutis, J., Germine, L., Wilmer, JB., Grosso, M., Russo, K., Esterman, M., “Sustained 

Attention Across the Life Span in a Sample of 10,000: Dissociating Ability and Strategy,” 26(9): 1497-1510, 2015. 140 Kramer, A.F., Hahn, S., Gopher, D., “Task Coordination and Aging: Explorations of Executive Control Processes in 

the Task Switching Paradigm,” Acta Psychologica, 101(2): 339-378, 1999.
Independence, Technology, and Connection in Older Age

39

It can improve reasoning, processing speed,

141 and other cognitive abilities as well. 

Studies have investigated whether trained skills are retained over time and if the trained skills can be 

applied or transferred to other tasks. Similar to younger adults, older adults can maintain trained skills 

for months to years.

142 The evidence is less definitive whether training helps with dissimilar tasks. For 

example, there is little research that computer-based cognitive training can improve normal activities, 

such as driving, professional work, or leisure activities.

143 That is, computer-based training has only 

infrequently been shown to improve other real-world skills and tasks.

The same concerns also apply to the commercial “brain training industry,” which offers multiple 

products to consumers.

144 Unfortunately, product development has often gotten ahead of the 

demonstration that these products enhance cognitive processes and skills that are directly relevant to 

older adults’ lives.

The FTC should determine the appropriate regulatory review and guidelines for commercial cognitive 

training and coaching technologies and applications. These policies and guidelines are particularly 

warranted for those commercial products that make claims about general cognitive enhancement; 

maintenance and improvement of everyday skills and functional abilities such as driving, living 

independently, or functioning such as in employment and leisure activities; and improvements in 

 141 Ball, K., Berch, D.B., Helmers, K.F., Jobe, J.B., Leveck, M.D., Marsiske, M., Morris, J.N., Rebok, G.W., Smith, D.M., 

Tennstedt, S.L., Unverzagt, F.W., Willis, S.L., “Effects of cognitive training interventions with older adults: a 

randomized controlled trial,” JAMA, 288(18): 2271-2281, 2002. 142 Ball, K., Berch, D.B., Helmers, K.F., Jobe, J.B., Leveck, M.D., Marsiske, M., Morris, J.N., Rebok, G.W., Smith, D.M., 

Tennstedt, S.L., Unverzagt, F.W., Willis, S.L., “Effects of cognitive training interventions with older adults: a 

randomized controlled trial,” JAMA, 288(18): 2271-2281, 2002; Kramer, A.F., Hahn, S., Gopher, D., “Task 

Coordination and Aging: Explorations of Executive Control Processes in the Task Switching Paradigm,” Acta 

Psychologica, 101(2): 339-378, 1999; Rebok, G.W., Ball, K., Guey, L.T., Jones, R.N., Kim, H.Y., King, J.W., Marsiske, 

M., Morris, J.N., Tennstedt, S.L., Unverzagt, F.W., Willis, S.L., “Ten-year effects of the advanced cognitive training 

for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults,”

Journal of the American Geriatrics Society, 62(1): 16-24, 2014. 143 Kelly, M.E., Loughrey, D., Lawlor, B.A., Robertson, I.H., Walsh, C., Brennan, S., “The impact of cognitive training 

and mental stimulation on cognitive and everyday functioning of healthy older adults: a systematic review and 

meta-analysis,” Ageing Research Reviews, 15: 28-43, 2014; Willis. S.L., Tennstedt, S.L., Marsiske, M., Ball, K., Elias, 

J., Koepke, K.M., Morris, J.N., Rebok, G.W., Unverzagt, F.W., Stoddard, A.M., Wright, E., “Long-term effects of 

cognitive training on everyday functional outcomes in older adults,” 296(23): 2805-2814. JAMA, 2006. 144 "Cognitive Training Data," Cognitive Training Data., Accessed March 14, 2016, www.cognitivetrainingdata.org;

and “A Consensus on the Brain Training Industry from the Scientific Community,” Max Planck Institute for Human 

Development and Stanford Center on Longevity, Accessed March 14, 2016, 

longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientificcommunity/

Recommendation 8: Cognitive Training 

The Federal Trade Commission (FTC) should continue to enforce regulatory review and guidelines for commercial 

cognitive training products.
Independence, Technology, and Connection in Older Age

40

cognitive function for older individuals with and without age-associated neurodegenerative disorders 

such as Alzheimer’s and Parkinson’s diseases.

Cognitive Assistive Systems

In recent years, there has been an increasing interest in the use of artificial intelligence and cognitive 

science to develop technologies that can support older adults’ independence. These technologies are 

new and have been studied in research settings. They are referred to as cognitive assistive technologies 

and cognitive coaching and prompting systems. Some technologies are referred to as assurance systems

and usually include a wide range of sensors and software to monitor whether older adults are displaying 

changes of behavior that can signal cognitive or physical distress.

145 For example, one set of 

researchers developed a system using image-based sensors and computer-vision algorithms to detect 

falls in the home.

146 Initial tests indicated that the system detected falls on 77 percent of occasions.147 

Other systems have been developed using ingestible sensors to detect that elderly patients are taking 

their medication as prescribed.

148 

Compensation systems are another class of cognitive-assistive technologies. These systems go beyond 

detecting that something is amiss and also provide prompts or instructions to guide the user to ensure 

safe and effective behavior. For example, the COACH prompting system has been designed to assist 

older adults with dementia in effective hand washing.

149 This system uses computational vision and 

artificial intelligence algorithms to detect hand-washing behaviors and provide audio-visual prompts if 

individuals lose their place in the process. A study with six patients found that, in general, the COACH 

system did as well or better than human caregivers in engendering effective hand washing behavior. As 

an added benefit, it also reduced the time required for human caregiving.

150 Other systems have been 

developed to help maintain and enhance socialization, and in turn cognition, of older adults through the 

use of integrated technology including web cameras, Skype software, email, and phone systems.

In general, cognitive assistive technologies, in particular cognitive coaching and prompting systems, 

show promise in maintaining and enhancing the cognitive abilities of adults with and without 

neurodegenerative diseases. Given that these technologies are rather new, there are many important 

issues to be addressed in both research and product development. One way to support both the 

research and development of these potentially important products is through the funding of Small 

 145 Pollack, M. E., "Intelligent technology for an aging population: The use of AI to assist elders with cognitive 

impairment", AI Magazine 26(2): 9-24, 2005. 146 Lee, T., and Mihailidis, A., “An Intelligent Emergency Response System: Preliminary Development and Testing of 

Automated Fall Detection,” Journal of Telemedicine and Telecare, 11(4): 194-198, 2005. 147 Yu, X., "Approaches and principles of fall detection for elderly and patient," e-health Networking, Applications 

and Services, 10: 42-47, 2008. 148 Au-Yeung, K., Moon, G., Robertson, T., DiCarlo, L., Epstein, M., Weis, S.E., Reves, R.R., Engel, G., “Early clinical 

experience with networked system for promoting patient self-management,” American Journal of Managed Care

17: e277–87, 2011; Belknap, R., Weis, S., Brookens, A., Au-Yeung, K. Y., Moon, G., DiCarlo, L., and Reves, R. 

“Feasibility of an ingestible sensor-based system for monitoring adherence to tuberculosis therapy”, PLoS ONE, 

8(1): e53373, 2013. 149 Mihailidis, A., Boger, J.N., Craig, T., Hoey, J., “The COACH Prompting System to Assist Older Adults with 

Dementia Through Handwashing: An efficiency Study,” BMC Geriatric, 8(1): 2008. 150 Zhou, J., Salvendy, G., eds. “Human Aspects of IT for the Aged Population. Design for Aging: First International 

Conference,” Springer, 2015.
Independence, Technology, and Connection in Older Age

41

Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) from Federal 

agencies and from targeted funding programs from private organizations.
Independence, Technology, and Connection in Older Age

42

4. Technologies to Address Changes in Physical 

Ability

Mobility and successful aging are inextricably intertwined. Sustained mobility is a key ingredient for 

independence, quality of life, community participation, and—as needed or desired—employment for 

older adults. Successful aging in place heavily depends on an individual’s ability to remain mobile in and 

around his or her home, to maintain normal daily activities, and to access appropriate nutrition. 

Mobility loss is frequently a precursor to declining health and increased costs of care. Falls are a 

common problem. Over one-third of older adults reported a fall within a recent two year period.151

Injuries due to falls are a frequent cause for emergency room visits by older adults,152 and unintentional 

falls are the leading cause of death by injury for adults over 65 years old.153

There are multiple technologies that could improve mobility. Power wheelchairs, manual wheelchairs, 

walkers, and scooters are in common use now, and there are growing capabilities in prosthetic devices 

and robotic assistants. Several United States-based programs, such as those offered by the Department 

of Veterans Affairs, show potential approaches to meeting a spectrum of mobility needs.

There are multiple barriers to mobility for older adults. Architectural barriers in homes, buildings, and 

the environment may limit an individual’s mobility, and it may further limit mobility aids like scooters or 

walkers. Commercially available technologies such as hands-free faucets and door openers are rarely 

available in private homes. Post-construction architectural modifications to increase the accessibility of 

a home often are difficult or have high cost. Inaccessible or hard-to-use fixtures, cabinets, and furniture 

can make normal daily activities a challenge; difficulty reaching items or difficulty transferring on and off 

the toilet or in and out of a tub, chair, or bed create significant barriers to daily living. Kitchen 

appliances with challenging interfaces or food sealed in difficult-to-open packaging may make accessing 

proper nutrition a problem.

There are multiple ways to define mobility, which has implications for judging the success of a particular 

technology or treatment. There are clinical assessments that measure a person’s ability to walk a series 

of steps, to rise from a chair, or to exhibit fine-motor skills. Beyond that, others look at independence, 

such as whether an individual is mobile enough to conduct basic activities of daily living or take part in 

the community. A recurring theme is the tension between providing targeted medical treatment, in 

some cases very expensive medical treatment, without sufficient consideration for comprehensive 

 151 Cigolle, C. T., Ha, J., Min, L. C., Lee, P. G., Gure, T. R., Alexander, N. B., Blaum, C.S., “The Epidemiologic Data on 

Falls, 1998-2010: More Older Americans Report Falling,” JAMA Internal Medicine, 175(3): 443-445, 2015, See: 

archinte.jamanetwork.com/article.aspx?articleid=2091398. 152 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based 

Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Data, 2015. 153 ibid.
Independence, Technology, and Connection in Older Age

43

approaches that can sustain a range of activities, continued employment, and meaningful community 

participation. Enabling these comprehensive approaches requires new policy approaches and multiagency cooperation in addition to technical advances. 

This chapter discusses mobility capabilities at multiple levels. One is improving access to health care 

regardless of an individual’s physical mobility, using telehealth tools. Another is to promote universal 

design that helps ensure people can navigate a home or building independently. Third, the chapter will 

look at challenges in manipulating objects by hand—fine-grained mobility—which is critical to using 

tools and handling modern packaging. Finally, it will examine technologies to compensate for mobility 

loss, both within and outside the home.

Telehealth

Telehealth includes a wide range of technology and approaches that can allow adults to access health

care regardless of their physical mobility or location. By taking advantage of advances in 

communications and monitoring technologies, together with the capabilities of modern smartphones, 

telehealth can allow older adults to remain independent at home, prevent or delay institutionalization, 

effectively monitor chronic diseases and movement, and coordinate care between multiple providers 

that are not in the same location.

Promise of Telehealth 

One of the clearest benefits of telehealth is the ability to expand access. This capability can be 

particularly useful for older adults who live far away from medical centers or clinics, such as those who 

live in rural areas (Box 5). Furthermore, many older adults have difficulty getting to a health care 

appointment because they cannot drive, there are few public transit options, or they have limited 

personal mobility. Telehealth can provide additional options for those adults by allowing them to 

communicate with their healthcare provider from home. This can be useful for both primary care and 

specialty care, in areas ranging from minor injury to hepatology to cancer to mental health.154

New forms of technology also can strengthen the expertise of the local healthcare workforce. As 

described in Box 5, distance technology can expand the skills of local primary care providers with 

education and consultation, which will allow those providers to directly care for patients with specific 

complex conditions.

Another form of telehealth can help provide specialty consultation on medical images or scans (storeand-forward services). Those services are flexible in that they can be provided asynchronously, so that 

the patient and clinician do not need to be available at the same time. With this technology, a remote 

radiologist can examine a patient’s x-ray or MRI, or an ophthalmologist can review a picture of a 

patient’s eye to look for early signs of vision loss from diabetes. 

 154 eHealth Initiative, “A Study and Report on the Use of eHealth Tools for Chronic Disease Care Among Socially 

Disadvantaged Populations,” 2012.
Independence, Technology, and Connection in Older Age

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Other technologies allow for greater remote monitoring of patients (as noted earlier in Chapter 3). This

can assist older adults remain stable when coming home from the hospital, as many are readmitted to

the hospital in a short time after being discharged. Telehealth could monitor their vital signs to spot

Box 5. Expanding access to specialty care

Throughout the country, access to specialty care for complex health conditions remains limited, particularly in 

rural and underserved communities. Telemedicine has been proposed as a solution to bring specialty care to 

rural areas. Although telemedicine reduces travel time for patients, it does not build overall system capacity for 

specialized care. For every patient seen via telemedicine in a rural area, one less underserved patient is seen in 

the urban setting. Project ECHO (Extension for Community Healthcare Outcomes) addresses both the individual 

needs of patients and the collective needs of communities by providing medical education and care management 

that empowers clinicians everywhere to provide better care to more people, right where they live. In the ECHO 

model, primary care clinicians, nurses, and community health workers from multiple sites hold virtual clinics with 

expert specialist teams weekly to present patient cases, discuss new developments relating to their patients, and 

determine treatment. Specialists serve as mentors and colleagues, sharing their medical knowledge and 

expertise. At the same time, primary care providers learn from one another and, through mentoring and 

education, enhance their own knowledge and skills so that they can continue caring for their patients who might 

otherwise have to wait many months or travel many miles to receive care. 

Headquartered in Albuquerque, Project ECHO began with Sanjeev Arora, MD, a hepatologist (liver disease 

specialist) who was one of only a few experts providing care for Hepatitis C in the rural state of New Mexico. 

Many sick, weak, and older patients could not travel hundreds of miles to see him, and those who could might 

have to wait 8 months or more for an appointment. Recognizing that he could never meet the tremendous need 

for care, Dr. Arora developed this technology mediated consultation/mentoring model that allowed him to 

extend his expertise to many more patients while at the same time exponentially increasing the expertise among 

the rural primary care providers. Always knowing they could come back to Dr. Arora and his team with 

questions, a virtual multi-specialty team was created, and the non-specialists helped extend effective treatment 

to thousands of patients.

ECHO has now extended this model to HIV/AIDS, diabetes, behavioral health and substance abuse, chronic pain, 

dementia, and other complex chronic illnesses. The ECHO model is also being applied to correctional (prison) 

care, which includes treating tuberculosis and preventing drug resistance. The ECHO team also trains community 

health workers in remote locations to help communities with obesity prevention, health literacy, and cultural 

competency. Recently they began training programs in systems engineering approaches to quality improvement.

ECHO programs now exist in more than 20 states and a dozen countries throughout the world. Initially funded 

through foundation and grant support, policymakers are increasingly recognizing the potential of ECHO to 

exponentially expand workforce capacity to treat more patients sooner, using existing resources. Many State 

and national governments have found the ECHO approach to be cost-effective and deserving of direct 

government funding.
Independence, Technology, and Connection in Older Age

45

potential critical issues (such as changes in weight or blood pressure) before they require going back to

the hospital. Similarly, many healthy older adults end up in nursing homes simply because they need

more monitoring to ensure their safety. These technologies could offer a way to keep them in their

home and community (Box 6).

155

Other countries have increased their use of telehealth. For example, Australia has used such 

technologies to deliver cancer services to their large rural populations, including disadvantaged 

indigenous patients. Without telehealth, fewer diagnostic and treatment services would be available 

and there would be shortages , which would lead to later diagnoses and poorer health outcomes.156,157

Studies found that technology has made it feasible to deliver cancer services by telehealth,158 patients 

and health care workers were satisfied with teleoncology services,159 and that the services could be 

delivered safely.160

 155 Skubic, M., Rantz, N., Miller, S., Guevara, Koopman, R., Alexander, G., Phillips, L., “Evaluation of Health Alerts 

from an Early Illness Warning System in Independent Living,” Computers, Informatics, Nursing, 31(6): 274-280,

2013.

156 George, M., Ngo, P., Prawira, A., "Rural oncology: overcoming the tyranny of distance for improved cancer 

care," Journal of Oncology Practice 10(3), e146-e149, 2014. 157 Sabesan, S., Brennan, S., “Telemedicine Techniques and Applications,” Tele Oncology for Cancer Care in Rural 

Australia, ISBN: 978-953-307-354-5, 2011, See: www.intechopen.com/books/telemedicine-techniques-andapplications/tele-oncology-for-cancer-care-in-rural-australia. 158 Sabesan, S., Larkins, S., Evans, R., Varma, S., Andrews, A., Beuttner, P., Brennan, S., Young, M., “Telemedicine 

for Rural Cancer Care in North Queensland: Bringing Cancer Care Home,” Australian Journal of Rural Health, 20(5): 

259-264, 2012. 159 Mooi, J.K, Whop, L.J, Valery, P.C, Sabesan, S.S., “Technology for Indigenous patients: the responses of patients 

and health workers,” Australian Journal of Rural Health, 20(5): 265-269,2012. 160 Sabesan, S., Brennan, S., “Telemedicine Techniques and Applications,” Tele Oncology for Cancer Care in Rural 

Australia, ISBN: 978-953-307-354-5, 2011, See: www.intechopen.com/books/telemedicine-techniques-andapplications/tele-oncology-for-cancer-care-in-rural-australia.

Box 6. Case study of unobtrusive monitoring

TigerPlace is an example of how technology can foster older adults’ independence and allow them to age in 

place. It is also an example of an academic/private business partnership, as it involves the University of Missouri 

Sinclair School of Nursing and the long-term care corporation Americare, thereby showing how researchers and 

private industry can collaborate to help meet the challenges of an aging society. 

TigerPlace is a licensed aging-in-place building that allows seniors to live independently in an infrastructure that 

supports age-related research. By incorporating research in this way, the intent is to have residents be part of 

the research process and have a voice in it. One notable research initiative is to develop an integrated sensor 

network that maps patterns of motion. It is intended to identify the earliest signs of health or functional decline, 

and initial results suggest the system can provide clinically relevant alerts to caregivers to identify an older adult 

at risk.
Independence, Technology, and Connection in Older Age

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In general, the use of telehealth has grown in recent years—in 2012, over 40 percent of hospitals had 

telehealth capabilities.161 The potential for telehealth is expanding, as noted in the cases above, and 

there are other new horizons in telehealth, like expanding the ability to deliver medical advice via 

mobile devices. 

Federal Government Initiatives in Telehealth

Several Federal agencies use telehealth technologies to directly provide health care. The Veterans 

Health Administration (VHA) directly provides patient care using telehealth, fielding one of the largest 

integrated telehealth services across the United States. The services include mental health, pulmonary 

monitoring, ICU monitoring, and teleaudiology. The Department of Defense’s (DOD) Defense Health 

Agency similarly uses telehealth for direct patient care, and the TRICARE insurance program reimburses 

for telehealth services, including for mental health. The Indian Health Service (IHS) uses telehealth to 

provide services to Native American, Alaska Native, and Pacific-Islander populations, and it collaborates 

with the VHA in providing telehealth to veterans in those populations. The IHS uses telehealth for 

healthcare services such as eye screening for diabetic patients, cardiology consultations, and primary 

care.

The Centers for Medicare and Medicaid Services (CMS) support telehealth in the Medicare and Medicaid 

programs. Many State Medicaid programs cover some telehealth services, without being exclusive to 

just rural areas. Traditional Medicare, however, is limited by law in reimbursing telehealth.162 It can only 

pay for telehealth services where the patient lives in a rural area and receives the telehealth services in 

a healthcare setting, like a physician’s office or hospital, rather than in a patient’s home. The telehealth 

services must further be real-time communications, not asynchronous. There are further limitations on 

the types of clinicians who may provide the remote services and the types of services that can be 

provided. Other parts of Medicare provide additional telehealth services. Medicare Part D plans must 

cover a comprehensive medication review, which may be done in person or by telehealth. Medicare 

Advantage plans must offer at least the same telehealth benefits as traditional Medicare, but have the 

option to offer more. The recent Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) 

legislation required the Government Accountability Office to develop two reports examining telehealth: 

one on the Medicare telehealth program and another on remote patient monitoring technology and 

services. These reports will identify opportunities to improve telehealth for Federal programs.

In addition, there are a variety of Federal initiatives focused on research into improving telehealth. The 

Department of Defense (DOD) operates the Telemedicine & Advanced Technology Research Center that 

researches, prototypes, and evaluates telemedicine technologies. The DOD also runs the National 

Center for Telehealth & Technology that seeks to advance technologies in mobile health and telehealth 

for psychological health and traumatic brain injury care, which is a common injury for service members. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides grants for telemental health, and the Agency for Healthcare Research and Quality (AHRQ) supports research on 

 161 Adler-Milstein, J., Kvedar, J., Bates, D.W., “Telehealth among US hospitals: several factors, including state 

reimbursement and licensure policies, influence adoption,” Health Affairs, 33(2): 207-215, 2014, See: 

content.healthaffairs.org/content/33/2/207. 162 42 USC 1395l: Payment of benefits, From Title 42-The public health and welfare, See: 

uscode.house.gov/view.xhtml?req=(title:42%20section:1395l%20edition:prelim.
Independence, Technology, and Connection in Older Age

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telehealth. Recent AHRQ-supported projects focus on monitoring a patient after surgery to prevent 

surgical site infections, thereby reducing unnecessary hospitalizations, and supporting patients in 

performing physical therapy at home to help them heal more quickly. Those capabilities are particularly 

important for older patients for whom travel is difficult. The Office of the National Coordinator for 

Health IT (ONC) has included telehealth in its Federal health IT strategic plan for 2015–2020,163 and 

provided guidance on advancing telehealth and remote visits for consumers.164

Telehealth depends on an advanced broadband infrastructure. The United States Department of 

Agriculture (USDA) gives grants for broadband and advanced telecom systems, including the Distance 

Learning and Telemedicine program for rural communities. On National Rural Health Day (November 

19, 2015), the Secretary of Agriculture announced almost $10 million in grants for expanding telehealth 

capabilities in rural areas under the Distance Learning and Telemedicine program, including creating a 

tele-psychiatry network in Alaska and installing a telemedicine system that will coordinate care for highrisk patients in Georgia.165 Furthermore, the Federal Communications Commission (FCC) provides grants 

for broadband and advanced telecommunication systems, including grants to health care providers for 

broadband connectivity.

Beyond traditional telehealth models, there are ways for data and information technology to support 

novel programs that encourage aging in place. The Vermont pilot program Support And Services at 

Home (SASH) was funded by the Department of Housing and Urban Development (HUD) and the 

Department of Health and Human Services (HHS) as a Medicare/Medicaid demonstration measuring 

what happens when health and supportive services are coordinated with affordable housing for older 

adults. SASH is part of the HHS Multi-payer Advanced Primary Care Practice (MAPCP) demonstration, 

and the model is part of Vermont’s statewide health care reform program, with access to the state-wide 

data and analytics platform. Cathedral Square, a non-profit organization focused on developing and 

operating communities for seniors and individuals with special needs, manages the regional 

implementation of SASH throughout Vermont alongside other State and local organizations. An 

evaluation found that the model had to potential to reduce growth of Medicare expenditures.166

The cross-agency Federal Telemedicine Working Group, led by the Health Resources and Services 

Administration (HRSA), coordinates Federal telemedicine grants and funding opportunities. HRSA also 

 163 Office of the National Coordinator for Health Information Technology, “Federal Health IT Strategic Plan 2015-

2020,” United States Department of Health & Human Services, 2015, see: www.healthit.gov/sites/default/files/9-5-

federalhealthitstratplanfinal_0.pdf. 164 Bobinet, K., Petito, J., “Designing The Consumer-Centered Telehealth & eVisit Experience,” United States 

Department of Health & Human Services, 2015, See: 

www.healthit.gov/sites/default/files/DesigningConsumerCenteredTelehealtheVisit-ONC-WHITEPAPER2015V2edits.pdf. 165 United States Department of Agriculture, “FY 2015 Distance Learning & Telemedicine Grants,” 2015, See: 

www.rd.usda.gov/files/RD_DLTAwardsNovember2015.pdf. 166 U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of 

Disability, Aging and Long-Term Care Policy,”Support and Services at Home (SASH) Evaluation: First Annual 

Report,” 1-25, 2015, See: aspe.hhs.gov/report/support-and-services-home-sash-evaluation-first-annual-report. 
Independence, Technology, and Connection in Older Age

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provides grants for regional telehealth networks, funds research on license portability, and operates the 

Office for the Advancement of Telehealth (OAT).

Challenges for Telehealth Implementation 

Telehealth technology continues to evolve, and there are several challenges in implementing it 

successfully. Technology is only part of the solution; implementation requires addressing a number of 

human and social factors. Moreover, there are multiple types of technologies and approaches, and each 

has different advantages and disadvantages.

The evidence behind telehealth reflects its evolution and the challenges in its implementation. One 

study found that telehealth reduced mortality risks for patients with three chronic diseases (congestive 

heart failure, diabetes (mellitus), and chronic obstructive pulmonary disease) and also reduced 

healthcare costs by 8–13 percent.167 A systematic review of chronic disease management programs 

provided via telehealth showed reductions in hospitalizations, shorter hospitals stays, and fewer 

emergency-room visits.168 At the same time, some studies have shown some forms of telehealth have 

not necessarily improved care. For example, a study looking at older adults with multiple health 

conditions found that remote monitoring did not reduce hospitalizations or emergency department 

visits, and it found that mortality slightly increased for those adults receiving monitoring than for those 

under usual care.169 The mixed evidence highlights the need for rigorous studies to identify which forms 

of telehealth are the most effective for different situations.170

There are multiple policy barriers that limit telehealth. One major one is professional licensure. 

Licensure is historically a State responsibility, so physicians, nurses, pharmacists, and other health care 

professionals are generally only able to legally practice in the one State where they have a license. As a 

result, telehealth is generally only able to connect patients and providers in the same State, and not take 

advantage of clinicians from other States unless those clinicians obtain multiple licenses for each State 

where they would deliver telehealth services. 

There has been movement to allow professionals to practice across State lines. The Nurse Licensure 

Compact, developed about 15 years ago, provides nurses the opportunity to obtain a multistate license 

that is valid in the states that have ratified the compact. As of 2015, 25 states have joined the 

 167 Baker, L. C., Johnson, S. J., Macaulay, D., Birnbaum, H., “Integrated telehealth and care management program 

for Medicare beneficiaries with chronic disease linked to savings,” Health Affairs, 30(9): 1689-1697, 2011, See: 

www.ncbi.nlm.nih.gov/pubmed/21900660. 168 Bashshur, R.L., Shannon, G.W., Smith, B.R., Alverson, D.C., Antoniotti, N., Barsan, W.G., Bashshur, N., Brown, 

E.M., Coye, M.J., Doarn, C.R., Ferguson, S., “The empirical foundations of telemedicine interventions for chronic 

disease management,” Telemedicine and e-Health, 20(9): 769-800, 2014, See: 

online.liebertpub.com/doi/abs/10.1089/tmj.2014.9981?src=recsys&journalCode=tmj&. 169 Takahashi, P.Y., Pecina, J.L., Upatising, B., Chaudhry, R., Shah, N.D., Van Houten, H., Cha, S., Croghan, I., 

Naessens, J.M., Hanson, G.J., “A randomized controlled trial of telemonitoring in older adults with multiple health 

issues to prevent hospitalizations and emergency department visits,” Archives of Internal Medicine, 172(10): 773-

779, 2012, See: www.ncbi.nlm.nih.gov/pmc/articles/PMC3914200. 170 Kahn, J.M., “Virtual visits—Confronting the challenges of telemedicine,” New England Journal of 

Medicine, 372(18): 1684-85, 2015.
Independence, Technology, and Connection in Older Age

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compact.171 More recently, the Federation of State Medical Boards has spearheaded the Interstate 

Medical Licensure Compact to allow physicians the opportunity to practice across State lines in 

participating states. In its first year, 11 States have enacted the Compact, and an Interstate Medical 

Licensure Compact Commission has been formed with representatives from each of the States 

participating.172

Another barrier is reimbursement, especially whether telehealth services are covered at all or what 

forms of the technology are reimbursed. There has been movement in this regard, although there are 

gaps in many plans and for many innovative services. Many private payers are now covering some form 

of telehealth services, and many states have passed laws requiring coverage of some types of telehealth 

services. Public payers have also expanded their telehealth coverage, and, as of July 2015, 47 Medicaid 

programs cover some form of telehealth services.173 As noted earlier, traditional Medicare is limited by 

law in reimbursing telehealth, especially by requiring that telehealth services can only be receiving in a 

clinic or healthcare setting (not a patient’s home).174 There are additional restrictions in the type of 

telehealth technologies covered by Medicare, the types of clinicians who may participate, and the types 

of services that can be provided by these technologies. It is important to note that these restrictions do 

not apply to Medicare Advantage plans or care models designed by the CMS Innovation Center.

Improving Telehealth

The early results for telehealth demonstrated that it can improve access, especially in underserved areas 

and for adults who have mobility impairments. Furthermore, telehealth has been applied to expand the 

skill set of primary care clinicians, such as to manage complex conditions that often require specialty 

care and to remotely monitor people who may be dealing with cognitive or physical impairments. 

Reciprocal state licensure policies would improve the access to care. New technologies, such as greater 

use of smartphones, sensor technology, and faster Internet, will expand the range of telehealth services 

and how they may be incorporated into routine healthcare. 

As noted in Chapter 2 on social connectivity, broadband is a prerequisite for many technological 

advances. This holds true for telehealth as well, as it cannot be delivered without a robust Internet 

connection. Lack of broadband may be especially acute in rural areas, which are the same areas that 

may need telehealth most to augment health care workforce shortages.

While there are legislative restrictions on how Medicare can cover telehealth, CMS can act by 

increasingly incorporating telehealth in Alternative Payment Models, demonstration projects, and 

Innovation Center models. The CMS Innovation Center has already included expanded access to 

telehealth in the Next Generation ACO model program and in the Bundled Payment for Care 

 171 “25 Nurse Licensure Compact (NLC) States,” National Council of State Boards of Nursing, 2015, See: 

www.ncsbn.org/NLC_Implementation_2015.pdf. 172 See: www.fsmb.org/Media/Default/PDF/Publications/compact_commission_meeting_oct2015.pdf and 

licenseportability.org. 173 "National Statistics," Centers for Disease Control and Prevention, 2015, Accessed March 14, 2016. See: 

www.cdc.gov/arthritis/data_statistics/national-statistics.html. 174 42 USC 1395l: Payment of benefits, From Title 42-The public health and welfare, See: 

uscode.house.gov/view.xhtml?req=(title:42%20section:1395l%20edition:prelim
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Improvement Initiative, and further action would be welcome. In addition to Medicare, CMS can 

increase the number of state Medicaid waivers that allow for more use of telehealth in Medicaid 

programs. Actions by these two large payers would have ripple effects and remove significant barriers.

Designing Buildings to Ensure Independence in the Home

Maintaining independence in the home is paramount for many older adults as they age. The ability to 

navigate one’s home is important for completing regular activities of daily living. If the home is designed 

to help people maintain their mobility as they age, these capabilities could delay or avoid the need for 

moving to a nursing home or institution. Well-designed lighting; an absence of slippery surfaces, sharp 

corners, or narrow corridors and doorways; and easily reached heights can all contribute to successful 

navigation. A well-designed environment can even reduce the need for using mobility aids and limit the 

risks of falls and injury. For example, although an individual in a wheelchair needs a chair lift or an 

elevator to move between floors in many houses, a home with ramps or that is a single story eliminates 

the need for the lift or elevator. The goal of all of this is to help people meet their needs across their 

lifespan.

Role of Home Design and Modifications

Through thoughtful design, the home can compensate for limitations in functional abilities to enable 

individuals to carry out basic activities associated with daily living safely and independently, participate 

in social roles, and receive personal assistance from caregivers as needed. The environment can also 

facilitate health maintenance and management by supporting health-promoting behaviors and provision 

of health care services.175

Conversely, a poorly designed home environment can exacerbate functional declines and raise the risk 

of injury. Physical environmental barriers such as stairs, the lack of tub and toilet grab bars or lowthreshold showers, poor visual contrast, lack of space and floor hazards such as rugs, are unfortunately 

 175 Harvard Joint Center for Housing Studies (with support of the AARP Foundation), “Housing America’s Older 

Adults: Meeting the Needs of an Aging Population,” 2014.

Recommendation 9: Improve Regulation and Payment to Reflect Innovation in Telehealth

HHS should convene the Federation of State Medical Boards and the National Governors Association to 

accelerate reciprocal State licensure policies. CMS should use the full capacity of the Innovation Center to 

advance payment policies that support innovation in telehealth.
Independence, Technology, and Connection in Older Age

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common. One study found homes average 13 problems that posed barriers to safe and independent 

living.

176

Home modifications (including assistive and communication technologies) have been found to prevent 

functional decline and disability, promote independence and safety, enhance health outcomes, increase 

caregivers’ effectiveness and well-being, and decrease caregiver stress.177

Despite numerous successful examples of new home designs and retrofitted modifications, without 

broader knowledge and expertise regarding these approaches, the majority of Americans will not 

experience these benefits. Training and guidance needs to be provided to create standards for the 

assessment of risks from residential environments and best practices about the effectiveness of 

different interventions. 

The separation of housing and health care in different governmental agencies has created various 

systems of public subsidies that make it difficult for individuals to find or receive adequate funding. As a 

result, funding to support mobility during aging can come from a number of sources that are hard to 

categorize and locate. Even within the seven departments that have programs in which funds can be 

used for home modifications, including Agriculture, Energy, Education, Health and Human Services, 

Housing and Urban Development (HUD), Treasury, and Veterans Affairs, there is a lack of coordination 

and the overall amounts may be inadequate. 

As aging at home, instead of in an institution, has been shown to improve health and happiness and 

reduce cost, the Federal Government should take action to support successful aging at home, including 

home modifications and mobility technologies. One way would be for HHS to convene a public-private 

task force to examine regulations and payment policies associated with CMS, ADA, and HUD that govern 

home accessibility and home modifications for aging and the disabled. Recommendations from the task 

force would strive to harmonize those policies with the goal of long-term, home-based aging-in-place. 

The agencies together should find ways to encourage private and government-funded retirement 

communities to adopt home design principles that can support successful aging, allow the growth of 

monitoring and oversight capabilities for predictive risk management, and deal with emergency 

situations.

 176 Gitlin, L.N., Corcoran, M., Winter, L., Boyce, A., Hauck, W.W., “A randomized, controlled trial of a home 

environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with 

dementia,” Gerontologist, 41(1): 4-14, 2001. 177 Sanford, J.A., National Research Council Committee on the Role of Human Factors in Home Healthcare, “The 

Physical Environment and Home Healthcare Role of Human Factors in Home Healthcare,” National Academies 

Press, 2010.

Recommendation 10: Home Design to Sustain Independence

HHS should work with the Department of Housing and Urban Development (HUD) to streamline and 

strengthen regulations and payment policies that govern home accessibility standards in order to promote 

uniform standards allowing efficient use and changes in technological support systems. This is especially 

important for retirement communities.
Independence, Technology, and Connection in Older Age

52

Role of Product Design

Sustaining mobility as a person ages also requires compensating for losses in fine motor capabilities. 

Over half of older Americans have been diagnosed with arthritis by a doctor, and half of those have 

some limitation in their daily activities due to arthritis.178 By 2030, it is expected that arthritis will affect 

an estimated 67 million American adults.179 Arthritis in the wrist, hand, and fingers can impair many 

daily activities including food preparation and consumption. Individuals with arthritis may experience 

painful inflammation of the joints causing a reduction in tactile sensation, range of movement, and a 

loss of dexterity and mobility. 

Many individuals with arthritis experience significant difficulty and pain when attempting to perform a 

variety of routine, everyday tasks. Studies have shown that arthritis can reduce hand strength by 70 

percent and also reduce hand functionality by almost half.

180,181 Technologies developed for other 

purposes, such as hands-free faucets and doors, and voice-controlled devices, can mitigate the 

challenges of arthritis, but are not readily available for that purpose.

Exacerbating these challenges is the increasing use of inaccessible packaging. Child-proof 

pharmaceutical packing can be a burden to older adults. Driven by efficiencies in transportation, 

increasing shelf life and deterring theft, food stuffs and many other household objects are commonly 

encased in difficult-to-open, often hard-shell plastics. Problems that ensue include:

• Malnutrition. A study in Australian hospitals found several food and beverage packages were 

difficult to open by at least 40 percent of patients. These included milk and juices, cereal, and 

water bottles. Patients level of malnutrition increased, correlated with longer hospital stays.

182

• Injury. Faced with difficult-to-open packages, many people will resort to unsafe tools such as 

kitchen knives and screwdrivers to pry open packages.

183,184

 178 Centers for Disease Control and Prevention, “Prevalence of Doctor-Diagnosed Arthritis and ArthritisAttributable Activity Limitation,” Morbidity and Mortality Weekly Report, 59(30): 1261-1265, 2010, 

www.cdc.gov/mmwr/pdf/wk/mm5939.pdf. 179 "National Statistics." Centers for Disease Control and Prevention. Accessed March 14, 2016, 2016, 

www.cdc.gov/arthritis/data_statistics/national-statistics.html 180 Bagis, S., Sahin, G., Yapici, Y., Bolgen Cimen, O., & Erdogan, C. “The effect of hand osteoarthritis on grip and 

pinch strength and hand function in postmenopausal women,” Clinical Rheumatology, 22: 420-424, 2003. 181 Centers for Disease Control and Prevention, “Prevalence of Doctor-Diagnosed Arthritis and ArthritisAttributable Activity Limitation,” Morbidity and Mortality Weekly Report, 59(30): 1261-1265, 2010. 182 Garling, Peter, “Final Report of the Special Commission of Inquiry into Acute Care Services in NSW Public 

Hospitals,” 2008. 183 Spitler, V., Mills, A., Marcey, N., O’Brien, C., “Packaging and Containers for Household Products.” Hazard 

Screening Report, Consumer Product Safety Commission, 1-19, 2005. 184DTI, “Domestic Accidents Related to Packaging: Analysis and Tabulation of Data,” Vol. II., Consumer Safety 

Research, 1-28, 1997; also: DTI, “Domestic Accidents Related to Packaging,” Vol. I., Consumer Safety Research, 1-

28, 1997.
Independence, Technology, and Connection in Older Age

53

• Inadequate aid. Over 2 million MREs (Meals Ready to Eat) were distributed in the aftermath of 

Superstorm Sandy. Unfortunately the packaging of the MREs (in addition to the hard-to-read 

fine print) left these MREs inaccessible to many senior adults.185

Older adults may transition from kitchen prepared meals to the regular consumption of pre-packaged 

meals when manual food preparation becomes too difficult, costly, or tedious. Packaging solutions for 

pre-packaged meals are often not accessible to older adults or require the use of tools such as knives to 

open the packaging, increasing chances of packaging-related injuries. When pre-packaged foods 

become too difficult for the person to open, she may transition to easy-to-open snack foods. This 

downward spiral in nutrition contributes to obesity and accelerates aging-related disabilities. Packaging 

designers are often able to develop solutions that meet the needs of older adults if they have access to 

research documenting the abilities and functional limitations associated with aging that are specific to 

their industry. Food-packaging guidelines exist but these guidelines are not well known and have not 

been widely adopted.186 The Federal Government should encourage product packaging that is useful to 

senior adults regardless of functional challenges, such as decreased vision, fine motor control, strength, 

and dexterity. The Consumer Product Safety Commission (CPSC) should work with AARP, the Arthritis 

Foundation and other relevant groups including Institute of Packaging Professionals and Association for 

Packaging and Processing Technologies to solicit design guidelines for senior-friendly product packaging. 

Federal purchasing guidelines by the Department of Defense (DOD) and the Federal Emergency 

Management Agency (FEMA) for supplies repurposed for civilian use, such as emergency and hospital 

food supplies, should drive the adoption of accessible food packaging.

Compensating for Mobility Loss

In addition to the universal design approaches discussed previously, technology can also play an 

important role in compensating for mobility loss through the design of prosthetic devices and other 

technologies that enable access to private and public services that meet transportations needs outside 

the home.

Power wheelchairs and scooters are now more commonly used in community settings than their older 

mechanical versions, and recent advances in motorized wheelchairs bear an increasing resemblance to 

home robots, electronic vehicles, and autonomous vehicles. Innovations spurred by the DoD and the 

 185 "LES Ready: Caring For Seniors in Hurricane Sandy & Beyond," The LoDown News from the Lower East Side, 

2013, Accessed March 14, 2016, See: www.thelodownny.com/leslog/2013/10/les-ready-caring-for-seniors-inhurricane-sandy-beyond.html#. 186 New South Wales Government HealthShare, “Food Packaging Design Accessibility Guidelines,” George Tech 

Research Institute and Arthritis Australia, 2012; see: 

www.packagingcovenant.org.au/data/Resources/NSW_Health_-_Food_Packaing_Accessibility_Guidelines.pdf.

Recommendation 11: Improving Product Design for Older Adults’ Needs

The Consumer Product Safety Commission (CPSC) should work with AARP and other relevant groups to 

accelerate better design guidelines for senior-friendly packaging, especially of technology and essential products 

like food and medical supplies.
Independence, Technology, and Connection in Older Age

54

U.S. Department of Veterans Affairs (VA) have made substantial strides in creating robust power 

wheelchairs that can navigate difficult settings, are easy to drive and manipulate, have usable controls, 

provide long-lasting power, and minimize further injury from pressure sores and muscle strain. 

Moreover, these innovations include advances in prosthetics augmentations to the human body and to 

the wheelchair. For example, prosthetic arms can increase the ability to conduct many daily activities. 

Finally, these arms can be separated from the body/chair and operate as an independent home robot 

attached to a kitchen counter or worktable. In a related way, caregiver robots are starting to appear, 

which could provide additional support in the home or institutional settings.

A glimpse into the future of powered mobility aids is a combination of extending the body, supporting 

the body, moving the body, and manipulating the physical world. A system currently under design 

includes a home-assistance robot designed to be safe and gentle enough to brush crumbs from its 

owner’s face following lunch, coupled with a robotic bed that can move its owner’s body to avoid 

pressure sores and to better position him to work with the assistance robot, coupled with hi-tech and 

low-tech prosthetic devices that help its owner use augmented communication tools.187 These assistive 

technologies, wheelchair, bed, prosthetic arm and more, are no longer stand-alone technologies but can 

work in concert together, across a variety of tasks.

Other advances in mobility aids include:

• Advanced battery technologies to accommodate long days traveling outside the home

• Laser navigation to simplify basic mobility tasks

• Additive printing for customized seats and prosthetic controls

• Sliding automation for semi-autonomous wheelchair operation 

• Human-robot interaction to simplify controls and enable a wider range of activities

There are policy challenges in ensuring these technological advances are accessible for all older adults, 

not just those that can afford them. One challenge is that the Medicare statute focuses on devices that 

can help people move around their homes. This limited statutory mandate generally prevents CMS from 

paying for advanced rehabilitative equipment or power wheelchairs capable of moving from home to 

car, since basic manual wheelchairs or power-operated scooters provide in-home mobility. Advanced 

technologies usually are designed to help people to move more easily around their community. In 

contrast, the VA’s statutory authority is different than Medicare’s, and the agency focuses on mobility 

both inside and outside the home, which can enable continued employment and community 

participation. This approach allows for integrating technologies and manufacturing on-demand, 

personalized solutions and integrating holistic support that also includes environmental modifications to 

the home and car, as well as training.

Health care reimbursement policies can inhibit or encourage innovation and use of advanced mobility 

technologies, and broader coordination is needed to improve mobility technologies. A multi-agency and 

industry task force including VA, DOD, DARPA, and HHS, should recommend a roadmap for wheelchair 

 187 Georgia Institute of Technology,"Hi, How Can I Help You?” 2014, Accessed March 14, 2016. See: 

www.rh.gatech.edu/features/hi-how-can-i-help-you.
Independence, Technology, and Connection in Older Age

55

functional capabilities for the next decade. This roadmap should, at a minimum, address advances in 

batteries, displays, sensors, wireless communication, security, navigation automation, and responsive 

materials. This task force should anticipate that wheelchairs become cloud devices that communicate 

and coordinate with home-based and public infrastructure as well as personalized robotic and prosthetic 

technologies.

Recommendation 12: Future Role of Assistive and Robotic Technologies

Advances have been made in wheelchairs and other mobility-necessary technologies, but Medicare payment 

policies inhibit access and market innovation.

1. CMS should examine current payment policies and implement changes that allow people to buy higher 

functioning products with some government support.

2. A multiagency and industry task force led by VHA, DOD, DARPA, and HHS should recommend a ten-year 

roadmap for improving wheelchair functional capabilities.
Independence, Technology, and Connection in Older Age

56

Appendix. Additional Experts Providing Input

Patricia Adair

Director

Engineering Sciences

Consumer Product Safety Commission 

Angela Baker

Senior Manager

Wireless Reach 

QualComm

Keith Adams

Assistant Administrator

Rural Utilities Services 

United States Department of Agriculture

Edo Banach

Acting Deputy Director 

Centers for Medicare and Medicaid Services 

Department of Health and Human Services 

Gretchen Alkema

Vice President

Policy and Communications

SCAN Foundation

Robbie Barbero

Assistant Director, Biological Innovation 

Office of Science and Technology Policy 

Jonathan Allen

Emeritus Astrophysicist 

Astrochemistry Laboratory

NASA

Brenda Battat

Executive Director

Hearing Loss Association of America

Majd Alwan

Senior Vice President of Technology and 

Executive Director of the LeadingAge Center 

for Aging Services Technologies

LeadingAge

Stephen Bauer

National Institute on Disability, Independent 

Living, and Rehabilitation Research

Administration for Community Living

Department of Health and Human Services 

Alicia Anderson

Branch Chief

Grants and New Funding Office

Housing and Urban Development

Lucille Beck

Deputy Chief Patient Care Services Officer 

Veterans Administration

Susie Armstrong

Senior Vice President

Engineering 

Qualcomm

Bill Belt

Senior Director

Technology & Standards

Consumer Electronics Association

Hakan Aykan

Project Officer 

Office of the Assistant Secretary for Planning 

and Evaluation 

Department of Health and Human Services

Marie Bernard

Deputy Director

National Institute on Aging 

National Institutes of Health 

Department of Health and Human Services
Independence, Technology, and Connection in Older Age

57

Kurt Beschorner

Research Assistant Professor

Department of Bioengineering

University of Pittsburgh

Stacy Canan

Deputy Assistant Director

Office for Older Americans

Consumer Financial Production Bureau

Nathaniel Beuse

Associate Administrator

Enforcement

National Highway Traffic Safety Administration

Department of Transportation 

Corey Carlisle

Senior Vice President 

Bank Community Engagement

American Bankers Association

Gerald Blazey

Director

Northern Illinois Center for 

Accelerator and Detector Development

Northern Illinois University 

James Carlisle

Senior Vice President

Federal Government Relations

Bank of America 

Thomas Blomberg

Dean and Sheldon L. Messinger Professor of 

Criminology 

Executive Director, Center for Criminology and 

Public Policy Research

Florida State University 

Laura Carstensen

Fairleigh S. Dickinson Jr. Professor in Public 

Policy

Professor of Psychology

Founding Director

Stanford Center on Longevity 

William Blumenthal 

Former General Council

Federal Trade Commission

Neil Charness

The William G. Chase Professor of Psychology

Florida State University 

Walter Boot

Cognitive Psychology Area Director

Florida State University 

Humayun Chaudhry

President and Chief Executive Office

Federation of State Medical Boards

Andy Bopp

Executive Director

Hearing Industries Association 

Jennie Chin Hansen 

Former Chief Executive Officer

American Geriatrics Society 

Alice Borrelli

Director 

Global Health and Workforce Policy

Intel Corporation

Lindsay Chura

Chief Scientific Officer

Global Council on Brain Health

AARP Services Inc.

Terry Bradshaw

AARP Services Inc. 

Julie Clark

Policy Advisor

Office of Disability Employment Policy 

Department of labor
Independence, Technology, and Connection in Older Age

58

Robert Clark

Counselor for Public Health and Science

Department of Health and Human Services

Ken Covinsky

Professor

School of Medicine 

University of California, San Francisco 

William Clark

Director

Program in Audiology and Communication 

Sciences

Washington University in St. Louis

Molly Coye

Former Chief Innovation Officer and Clinical 

Professor of Family Medicine

Health's Institute for Innovation

University of California, Los Angeles

Richard Cleland

Assistant Director

Advertising Practices, Bureau of Consumer 

Protection

Federal Trade Commission 

Poppy Crum

Senior Principal Scientist 

Head Scientist

Dolby Laboratories

Elizabeth Cocke

Director

Affordable Housing Research and Technology

Housing and Urban Development 

Stephanie Czuhajewski

Executive Director

Academy of Doctors of Audiology 

Patrick Conway 

Deputy Administrator for Innovation and 

Quality

Chief Medical Officer 

Centers for Medicare and Medicaid Services

Scott Davis

Chief Executive Officer

Sivantos

Rory Cooper

Director

Human Engineering Research Laboratories

University of Pittsburgh

Karen DeSalvo

Acting Assistant Secretary for Health

National Coordinator for Health Information 

Technology

Department of Health and Human Services 

Scott Cory

Chief Information Officer and Director

Center for Management and Budget 

Administration for Community Living 

Department of Health and Human Services

Eric Dishman 

Intel Fellow and General Manager

Health and Life Sciences 

Intel Corporation 

Joseph Coughlin

Director

MIT Age Lab

Sarah Domnitz

Program Officer

National Academy of Medicine
Independence, Technology, and Connection in Older Age

59

Amy Donahue

Deputy Director, Division of Scientific 

Programs

National Institute on Deafness and Other 

Communication Disorders

National Institutes of Health 

Department of Health and Human Services

Atul Gawande

Professor, Harvard Medical School

Gastrointestinal and General Surgery

Endocrine Surgery

Brigham and Women’s Hospital 

William Dow

Henry J. Kaiser Professor of Health Economics

School of Public Health 

University of California Berkeley 

Anna Gilmore Hall 

Former Executive Director

Hearing Loss Association of America 

Nora Dowd Eisenhower 

Assistant Director

Office of Older Americans

Consumer Financial Protection Bureau

Jacqueline Girard

State Director, Montana

Corporation for National and Community 

Services 

David Edelman 

Special Assistant to the President for Economic 

and Technology Policy 

National Economic Council

Lindsay Goldman

Deputy Director

Healthy Aging, Center for Health Policy and 

Programs 

The New York Academy of Medicine 

Richard Einhorn

Founder

Einhorn Consulting, LLC

Richard Goode

Professor of Otolaryngology, Emeritus

Stanford School of Medicine 

David Erickson

Director

Center for Community Development 

Investment 

Federal Reserve Bank of San Francisco

Peter Gore

Professor of Practice

Newcastle University 

Co-Founder 

ADL Smartcare

Ellen Flannery 

Partner

Covington 

Jason Gorevic

Chief Executive Officer 

Teladoc

Zachary Gaumer

Senior Analysts

The Medicare Payment Advisory Commission

George Graziani

Senior Vice President and Head

Longevity North America 

Swiss Re Group
Independence, Technology, and Connection in Older Age

60

Robbie Greenblum 

Senior Policy Advisor to the Secretary 

Department of Housing and Urban 

Development 

Sally Howard

Former Senior Advisor to the Commissioner

Food and Drug Administration

Head of Regulatory Affairs and Policy

Human Longevity, Inc.

Kathy Greenlee

Administrator

Administration for Community Living

Department of Health and Human Services

Ryan Howe

Director

Division of Practitioner Services, Centers for 

Medicare and Medicaid Services

Centers for Medicare & Medicaid Services

Marcus Grindstaff

Vice President 

Sales and Marketing Development 

Care Innovations

Wes Huang

Principal Robotics Engineer 

iRobot Corporation 

Gail Gudmundsen

Managing Director

Audiology Division

Etymotic Research 

Lisa Iezzoni

Professor of Medicine

Harvard Medical School

Jonathan Haaga

Acting Director

Division of Behavioral and Social Research

National Institute on Aging 

National Institutes of Health 

Paul Irving

Chairman

Center for the Future of Aging

Milken Institute 

Lise Hamlin

Director of Public Policy and State 

Development 

Hearing Loss Association of America

Erin Iturriaga

Clinical Trails Specialist

Program Officer, National Heart, Lung, and 

Blood Institute

National Institutes of Health 

Department of Health and Human Services 

Sarah Herrlinger

Senior Product Manager for Accessibility

Apple, Inc

Anne Jacoby 

Interim Vice President 

AARP TEK

Barbara Hill 

Consultant

Robert Jarrin 

Senior Director

Government Affairs 

QualComm

Michael Hogan 

Standards Liaison

Information Technology Laboratory

National Institute of Standards and Technology

Standards

Alan Jette

Professor

Health Law, Policy and Management 

Boston University 
Independence, Technology, and Connection in Older Age

61

Antwane Johnson 

Director

Integrated Public Alert and warning System

Federal Emergency Management Agency

Department of Homeland Security 

Elizabeth Kelly 

Special Assistant to the President for Economic 

Policy 

National Economic Council

Carole Johnson 

Senior Policy Advisor 

Domestic Policy Council

Mead Killion 

President and Chief Technology Officer

Etymotic

Mary Johnson 

Senior Staff Attorney

Federal Trade Commission 

Sue Kunz

Managing Partner and Founder

Thrive On Group

Joel Kaiser 

Director

Division of Durable Medical Equipment, 

Prosthetics, Orthotics, and Supplies Policy 

Center for Medicare and Medicaid Services 

Scott Laidlaw 

National Director

Payer and Provider Markets

Care Innovations

Karen Kali

Program Manager

National Community Reinvestment Coalition

Tracey Larson 

Vice President and Special Projects Manager

Peoples Utah Bancorp

Dean Kamen 

Founder

DEKA Research

Naomi Lefkovitz

Senior Privacy Policy Advisor 

National Institute of Standards and Technology

Naomi Karp 

Senior Policy Advisor

Consumer Financial Protection Bureau 

Todd Lemley

Founder

Thrive On Collaboratory

Jeff Kaye

Professor, Professor of Neurology and 

Biomedical Engineering

Director, Oregon Center for Aging and 

Technology 

Oregon Health and Science University 

Michael Liimatta

Manager

ConnectHome Initiative

Department of Housing and Urban 

Development 

Julie Kearney 

Vice President

Regulatory Affairs 

Consumer Electronics Association

Frank Lin 

Associate Professor of Geriatric Medicine

Associate Professor of Otolaryngology - Head 

and Neck Surgery

Johns Hopkins Medicine
Independence, Technology, and Connection in Older Age

62

Cathy Liverman 

Study Director 

Institute of Medicine

National Academy of Medicine 

Mahlet Mesfin

Senior Policy Advisor, International Science 

and Technology 

Office of Science and Technology Policy 

Elizabeth Loewy

General Counsel and Senior Vice President

Industry Relations 

Eversafe

John Morris

Associate Administrator and Director of 

Internet Policy

Office of Policy Analysis and Development 

National Telecommunications and Information 

Administration 

Ronald Long

Director

Regulatory Affairs and Elder Client Initiatives

Wells Fargo Advisors 

Jayne Morrow 

Former Executive Director

National Science and Technology Council

Office of Science and Technology Policy 

Michael Loughry 

Vice President 

Finance and Operations

iHear Medical 

Naganand Murty 

Innovator in Residence

Department of Health and Human Services 

Nicole Lurie

Assistant Secretary for Preparedness and 

Response

Department of Health and Human Services 

Thomas Nesbitt

Associate Vice Chancellor 

Strategic Technologies and Alliances

University of California Davis School of 

Medicine

Eric Mann

Clinical Deputy Director 

Division of Ophthalmic and Ear, Nose and 

Throat Devices

Office of Device Evaluation 

Center for Devices and Radiological Health 

Food and Drug Administration 

Elaine Newton 

Deputy Standards Liaison

Information Technology Laboratory

National Institute of Standards and Technology 

Mirella Marlow

Program Director 

Centre for Health Technology Evaluation

National Institute of Health and Care 

Excellence 

Wendy Nilsen 

Health Scientists Administrator 

Officer of the Director 

National Institute on Health 

Department of Health and Human Services 

Dana Martens 

Policy Associate 

New York Academy of Medicine 

Rei Onishi 

White House Fellow

Housing and Urban Development 
Independence, Technology, and Connection in Older Age

63

Allison Orris

Associate Administrator 

Office of Information and Regulatory Affairs 

Office of Management and Budget

Karissa Price-Rico

Chief Marketing Officer 

Care Innovations 

Tyler Overstreet

Branch Chief

Health and Human Services Branch

Health Division

Office of Management and Budget 

Michael Reardon 

Supervisory Policy Advisor

Office of Disability Employment Policy 

Department of Labor 

Ian Pearson 

General Attorney

Food and Drug Administration 

Nick Reed

Research Audiologist

Johns Hopkins University 

Rodney Perkins

Founder and Chairman of the Board

Soundhawk

Erin Richardson 

Senior Policy Advisor

Domestic Policy Council 

Hoangmai Pham

Director 

Seamless Care Models Group

Center for Medicare and Medicaid Innovation

Center for Medicare and Medicaid Services 

Department of Health and Human Services 

Carole Rogin 

President 

Hearing Industries Association 

Elizabeth Phillips 

Vice President 

Cause Development

Arthritis Foundation 

Philip Rubin 

Former Assistant Director 

Social, Behavioral, and Economic Sciences

Office of Science and Technology Policy 

Sarah Plante

Project Management Specialist 

Office of the National Coordinator for Health IT

Department of Health and Human Services

Elizabeth Rudd

Social Science Analyst

Housing and Urban Development 

Thomas Powers

Vice President 

Government Accounts 

Sivantos

Hearing Industries Association 

Michelle Rusk 

Senior Staff Attorney

Federal Trade Commission

Lewis Sandy

Senior Vice President 

Clinical Advancement 

UnitedHealth Group

Jocelyn Samuels 

Director

Office for Civil Rights

Department of Health and Human Services 
Independence, Technology, and Connection in Older Age

64

Judy Schafer

Audiologist

VA Medical Center

Department of Veterans Affairs

Dustin Sounders 

Graduate Research Assistant 

Florida State University 

Roxane Schneider

Director

Fraud Risk 

Financial Services Roundtable

Alicia Spoor 

Treasurer

Academy of Doctors of Audiology 

Lawrence Scott

Department Chair

National Technical Institute for the Deaf

Rochester Institute of Technology

Seth Sternberg 

Co-Founder and Chief Executive Officer 

Honor 

Martin Sepulveda

Vice President

Global Well-Being Services and Health Benefits

IBM Corporation

Robyn Stone 

Senior Vice President of Research

Executive Director, LeadingAge Center for 

Applied Research

LeadingAge

Jerry Sheehan 

Assistant Director

Scientific Data and Information

Office of Science and Technology Policy 

Takanori Shibata 

Designer

Paro Robot 

Dan Siewiorek 

Buhl University Professor

Electrical and Computer Engineering 

Quality of Life Technology Center

Carnegie Mellon University 

Nora Super

Executive Director

White House Conference on Aging

Nina Silverberg

Program Director

Alzheimer’s Disease Centers Program

National Institute on Aging

National Institute of Health 

Department of Health and Human Services 

Erwin Tan 

Director, Senior Corps

Corporation for National and Community 

Services

Bryan Sivak 

Former Chief Technology Officer

Immediate Office of the Secretary 

Department of Health and Human Services 

Paul Tang 

Vice President 

Chief Innovation and Technology Officer

Palo Alto Medical Center

Ken Smith 

Senior Research Scholar and Director

Mobility Division

Stanford Center for Longevity

Yolanda Taylor

Strategic Communications Director

AARP Services Inc.
Independence, Technology, and Connection in Older Age

65

Nate Tibbits 

Senior Vice President 

Government Affairs 

QualComm

Oliver Wells 

Commercial Director 

Devices for Dignity 

Mary Elizabeth Tinetti 

Gladys Phillips Crofoot Professor of Medicine 

and Professor in the Institute for Social and 

Policy Studies

Yale University

Simon Wilde 

Associate Director

External Communications

National Institute of Health and Care 

Excellence 

Howard Tischler 

Founder and Chief Executive Officer 

Eversafe 

Claudia Williams

Senior Health and Health IT Advisor 

Office of Science and Technology Policy 

John Tschida 

Director

National Institute on Disability, Independent 

Living, and Rehabilitation Research 

Administration for Community Living 

Department of Health and Human Services

Heidi Williams 

Assistant Professor 

Economics 

MIT

Lisa Tseng 

Chief Executive Officer 

HiHealth Innovations 

Sharon Williams

Research Staff Member 

Science and Technology Policy Institute

David Vladeck 

Professor of Law

Georgetown Law School 

Derek Yach 

Chief Health Officer

Vitality Institute 

Edwin Walker 

Deputy Assistant Secretary for Aging

Administration for Community Living 

Department of Health and Human Services

Corinna Zarek 

Senior Advisor to the Chief Technology Officer 

for Open Government

Office of Science and Technology Policy 

Nancy Weiss 

Senior Advisor to the Chief Technology Officer 

for Innovation and Intellectual Property

Office of Science and Technology Policy 

Robert Zdenek 

Director

National Neighbors Silver 

The National Community Reinvestment 

Coalition 
Independence, Technology, and Connection in Older Age

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Additional Acknowledgments 

Viktoria Gisladottir

PCAST 2015 Spring Intern 

Zeyi Lin

PCAST 2015 Fall Intern 

Erika Kohler

PCAST 2016 Spring Intern 

Carlton Reeves 

PCAST 2015 Summer Intern 

 

President’s Council of Advisors on Science and 

Technology (PCAST) 

www.whitehouse.gov/ostp/pcast