At-home care

In this episode, we explore the latest thinking and newest innovations in at-home care for seniors. Guests include AgeWave founders,Doctors Ken and Maddy Dychtwald, our own Adam Pellegrini (SVP Enterprise Virtual Care & Consumer Health), and health care futurist Zayna Khayat (author of The Future of Aging).

What is Healthy Conversations?

Healthy Conversations brings together leaders and innovators in health care to talk about the biggest issues facing patients and providers today. Every month, we explore new topics to help uncover the clinical insights and emerging technologies transforming health care in real time.

Speaker 1:
Going to the experts for finding the gaps.

Dr. Daniel Kraft:
How do you end up connecting that data so it's useful?

Ken Dychtwald:
First of all, we're going to have to apply technology.

Maddy Dychtwald:
There's going to have to be a kind of reinvention.

Ken Dychtwald:
We have to have a new vision for this field.

Dr. Daniel Kraft:
Welcome to Healthy Conversations, the podcast, an open discussion with health care experts about what we're learning on the front lines of clinical transformation. I'm Dr. Daniel Kraft, and I'm really pleased to be joined by Ken Dychtwald and Maddy Dychtwald as we explore a little bit of the future of aging in the context of the future of home care and beyond. Welcome Ken and Maddy.

Maddy Dychtwald:
Thank you, Daniel. It's great to be here with you.

Ken Dychtwald:
It's good to see you, my friend.

Dr. Daniel Kraft:
Well, I've been really lucky to know you guys for a few years, and you do incredible work through your organization called Age Wave. You started this work 30 plus years ago. Maybe just share a little bit about how you got into it and maybe even your perspective of when you were 30, now to someone 70, about aging in general.

Maddy Dychtwald:
Wow, you can start that off because you were the one-

Ken Dychtwald:
It's a little more extreme even than that. I was 24 years old and was asked to head up the first preventative health research project with the elderly in the United States to be funded by NIMH. I became really captivated by older people, and partly the realization that you don't just wake up one day as an older person. It's the outcome of a variety of choices along the way. I've now spent 45 years working myself around within this whole space of aging. Of course, along the way, it's become increasing interest in the world and with regard to longevity, aging in my own generation, our generation, the boomers. We set up our company Age Wave 35 years ago. We've given talks, between the two of us, to about two and a half million people around the world, and between the two of us, we've written, I guess around 20 books.

Maddy Dychtwald:
He's written most of them.

Ken Dychtwald:
It's been an interesting journey. At the same time along the way, Maddy and I turned our 70th birthday during the time of COVID, so we're getting to be older people ourselves. Our own version, of course. What about you, Maddy?

Maddy Dychtwald:
Well, when I was 30, I wasn't really thinking about my own aging. I was thinking about aging as a trend. I saw large swaths of the population aging, and I was thinking to myself, let's talk about it. Let's see how their aging is impacting business and society and lifestyle, and how is it changing us as people? Now that I'm 70, I definitely personalize it, so I feel like my professional and my personal interests have really merged together in a way that makes me much more invested and passionate about what aging means for us as a country and as individuals.

Dr. Daniel Kraft:
Aging happens to all of us. We're increasingly recognizing that, and I think it's through your work at Age Wave, you have been redefining how people see aging, what you often call the silent generation and boomers. Can you help us define what these groups are, how they're different in terms of needs, attitudes, and even their expectations towards wellness and healthcare?

Maddy Dychtwald:
Seniors and boomers are very different from each other. Seniors are people over the age of 75 and they trust authority. They think the healthcare system is there to serve them in positive ways. For instance, they put their doctors on pedestals, their doctor tells them what to do, and they're more inclined to do it than let's say boomers are. Boomers on the other hand, don't trust authority. Especially, let's keep in mind that boomer women are making most of the healthcare decisions in their family for themselves, for their husbands, for their children, even for their parents and their siblings sometimes. They love to get second opinions.

Maddy Dychtwald:
They don't necessarily trust what a doctor says. They're far more demanding consumers, and I think the healthcare system is going to have to get ready for that. They want, by the way, a more holistic approach. Just as an example, with my doctor, I recently had a telemedicine appointment with my doctor and she's asking me all these very typical questions, and what I said to her is that, "I really want a more holistic approach to things. I want you to not just look at my lipid numbers, but I also want to know what is my vitamin D, and do I need more B complex, and what could I be taking to help me live longer, better, keep my health span long, rather than just kind of surviving?"

Ken Dychtwald:
Partly, to answer your question, aging happens. There's a certain sort of passive acceptance in those kinds of phrases, and I think more and more, now that we've watched our own moms and dads grow old, that the boomer generation is really the first generation to imagine the idea of an 80 or 90 or 100 plus year life. In fact, many of them think, that's probably going to happen to me. So then, the question becomes what version of aging am I hoping for and what kinds of things should I be looking up on the internet? Who should I be putting in my kind of, tribal council as I'm figuring out my path to lifelong health and wellness? What technology should I be using? The boomers are going to be a far more, as Maddy said, questioning authority, but also demanding as they grow older.

Dr. Daniel Kraft:
Also not just demanding, but wanting to maybe demand to be a bit more of a partner in their care. Used to be on the pedestal, Dr. Wellby tells you what to do, but the boomers grew up in the sixties, they question authority and hopefully, are more partnering in their care.

Ken Dychtwald:
By the way, I was always 25, that's just who I am. And then, somehow last year I became 70. It just sort of popped on me, but when I grew up, my doctor wrote his prescriptions in Latin. The idea was that the doctor was all knowing and you were just supposed to do what you were supposed to do. And then, the Boston Women's Health Collective broke loose of that and wrote that book, Our Bodies, Ourselves. And then, the boomers sort of embraced the idea of we want to be partners in our healthcare relationship, not just do what we're told, and I think that the healthcare system is going to have to make some adjustments because of the current generation of seniors, as Maddy said, were far more compliant, far more obesient as a generation, and there's a new batch coming.

Maddy Dychtwald:
I think that women are really going to be the ones who are leading the way into being more questioning, into being more looking for a partner with their healthcare system, and as Ken said, this all started with the Boston Women's Health Collective. We're just doing what comes naturally to women, because honestly, the healthcare system originally was designed primarily for men by men, and that's changing pretty radically now, and I think it's going to continue to change.

Dr. Daniel Kraft:
Medical information was siloed in strange languages or in the library. Now in our increasingly digital connected age, everyone goes to Dr. Google for their first searches and can be more empowered to be partners in their care, but can you mention, many folks want to live to a hundred or even more when you spoke at my Exponential Medicine Conference, you asked the question, who wants to live to a hundred? But then, no matter what? Can you maybe explain the difference about just lifespan versus healthspan?

Ken Dychtwald:
I think we're becoming increasingly aware as a nation that there's an average number of years to which people live. It doesn't mean that's the number of years you're going to live. For example, right now in the United States, it's around 79, life expectancy at birth, but that's at birth. If you're 65, the average life expectancy is about 85, so the longer you live, the longer you'll live. We're all becoming more aware of that as we have an aunt or an uncle or a mom or dad that's living into their 80s, 90s, or maybe even hits a hundred, but what people are starting to ask themselves is what kind of later years do I want? And what's just not acceptable? And then, we begin to realize that there's lifespan, and then there's healthspan. As a nation, we don't do so well. There's many countries around the world that have a much higher healthspan and life expectancy lifespan than we do.

Ken Dychtwald:
Who wants to spend the last 7, 8, 10, 15 years of their life in pain or not able to be independent or with loss of cognitive functions? Frankly, COVID has kind of broke this open. People are now talking about, how do I be the healthiest version of me for all the years that I live? Because as you pointed out, when I was at exponential medicine, I asked the audience, "How many of you would live to a hundred, like to live to a hundred?" Almost every hand in the room went up. But then when I said, "No matter what?" about half the hands in the room went down, because people are realizing, I don't think I want to live a very long life if I'm sick or suffering or frail or devastated with pain. The question then becomes, is that, how do we create a healthcare system that creates healthy aging?

Maddy Dychtwald:
The last 10 years of our lives, many Americans, most Americans are living with some kind of chronic degenerative disease and maybe even some kind of physical ailment that's holding them back from just living a vital active life.

Dr. Daniel Kraft:
Maddy, one of the implications of longer healthspan for elders and providers is financial. Can you maybe touch on some of your work and thinking there?

Maddy Dychtwald:
The idea of having extended healthspan is kind of a miracle. It's like our dreams come true. It's something that we've been really focused on from the beginning of time. Think about it, the fountain of youth. If you have more healthy years of life, that's the fountain of youth. It changes the healthcare system pretty dramatically, I think. You just said, Daniel, that it's really a sick care system. Well, suddenly they're going to have to be all about sustaining health or improving health, and that's a game that the healthcare system is not necessarily geared up to do. The health care, I don't really see a lot of that. I see mostly the sick care. I think that there's going to have to be a kind of, reinvention with huge financial considerations there. By the way, for the average person, the idea that you can stay healthy longer is going to be a great financial boon because suddenly, you're not spending all that money to take care of your long-term care needs because you're healthy.

Dr. Daniel Kraft:
Can you help summarize kind of what's here and what's coming, because I don't think many of the folks listening, healthcare practitioners included, really realize what's ahead of us in the next couple decades?

Ken Dychtwald:
It's kind of an extraordinary story actually. Most people don't realize that throughout 99% of human history, the average life expectancy at birth was under 18. There have been 40 and 60 and 70 year olds, but not very many. Beginning in the 1800s, and then the 1900s, as we began to see public health, and then antibiotics, and then the arrival of a pharmacopia, and then surgical procedures made more possible by anesthesiology, and then people taking charge of nutrition and exercise and such. The breakthroughs in health, every one of them, caused somebody who might otherwise have died, to not. What began happening was that the average life expectancy started rising and rising and rising and rising. We're in the midst of a longevity revolution right now, and it's conceivable, I know this is the world that you're so familiar with, Daniel, that with further breakthroughs, whether it's in heart health or diabetes health or brain health or joint health, you're going to see the average life expectancy rising even further.

Ken Dychtwald:
That's theme one. Big deal. Layered on top of that is the fact that we had birth rates declining for about 150 years in America, but then World War II ended and the depression in the war was such a dark period, there was so much exuberance that followed it, and 92% of all women who could have kids did, and the average just under four kids each. That baby boom is now becoming an age wave. On top of this longevity revolution, most of the growth in American demography is not taking place in the younger generations, it's taking place in maturity. You're going to see everything from the way we design our automobiles to the size of the typeface in our printing materials to the skills needed to be a health care practitioner to the role models we're going to see in movies and TV shows are going to increasingly become older men and women, and that's never happened before.

Ken Dychtwald:
First of all, we're going to have to apply technology, so that people can stay in their homes, and not just stay in their homes, but so that people can have a preventative path to their own wellness. I personally think that we're going to need some kind of a health ways that'll be engined by AI, so that you and I, we both want to be optimally healthy when we're a hundred, but the path there will be different based on all sorts of variables. I think we need to apply technology beyond just the, I've fallen down and can't get up, and beyond telemedicine. That's a reasonable start, but it's kind of like pong when it emerged in the seventies. It's sort of the beginning. I think ultimately, having customized individualized paths to optimal health. Second, I think we need to make sure that our medical practitioners, whether they be physicians, nurses, physical therapists, pharmacists, are going to really need some extra training when it comes to geriatrics.

Ken Dychtwald:
Doesn't mean we need geriatric specialists, of which we only have about 6,000 in the country right now, but 95% of all the docs and nurses and pharmacists who graduated last year from school did not take one elective in geriatric medicine. That's a problem because older people are not a different species, but there's more likely to be polypharmacy, there's more likely to be comorbidities. It's a whole sort of, a different puzzle. Third, we need to do a far better job of encouraging people to take better care of themselves. We have repeatedly done studies at Age Wave that tell us that about 90% of older adults know what they could be doing to live very healthfully, but only 50% do it. That's a behavioral issue, so you can have all the answers, but if you don't take better care of yourself, if you don't encourage your partner to do the same, if we don't make that important, we're going to be missing out.

Ken Dychtwald:
Next, my biggest concern has to do with cognitive health and dementia because if we did away with cancer and heart disease and all sorts of other problems, we would just have longer living people with Alzheimer's disease. Right now, the dementia rate over the age of 85 is about one in three. We have not made the kind of progress I would've hoped we would've made by now to either preventing this disease or curing it or having a vaccine. We've been sort of letting that one lie on the sidelines, but it is rising up and it could possibly be the sinkhole of this new century.

Dr. Daniel Kraft:
Healthy aging, healthy brain health especially, is multifactorial, the idea of precision wellness and optimization and being proactive. This idea now that we have this multiomics, and we can put that in the context of our environment and our social network and our relationships, I think will help guide that. Speaking of technology, we often sometimes think about wearable devices, both Maddy and I are wearing smart watches where we can even track our own health and activity, and you're doing that with your son, you mentioned. How do you think these new technologies from telemedicine to wearables to insideables are being adapted by older folks and how would you say the range of comfort is shifting and how might we optimize these technologies, so they're not just for the, let's say, the millennials?

Ken Dychtwald:
I think we got ourselves in a little bit of a problem situation right now because the people who could most benefit from a health point of view, from the use of technology are the ones who've been sort of, left behind or left outside, that when our great tech firms were coming up with their next cool thing, they're mostly thinking about what will the early adopters, the 28-year-olds, the 32-year-olds like? What do the 41-year-olds want? I think there's no doubt that in the years to come, in a variety of areas, first of all, personal emergency response systems are going to have to become more sophisticated and more virtual, so that if I'm outside my house or I'm in a car and my heart starts to go into tachycardia, my doctor will be alerted.

Ken Dychtwald:
Second, I think the ability to anticipate. Can we track my biomarkers in a way so that a year or five or 25 years before a health event, we can see some patterns forming, so that I can take some actions, whether they be a medication or a meditation or exercise or whatever. When people need assistive care, people are really scared now about going into long-term care facilities and that might correct itself, but to whatever extent there can be a doctor, telemedicine, or a nurse, or monitoring in the home that's comfortable, that's wearable, that's communicative, and that is sensitive to that individual. There's no question that that's going to be emerging in the next several years.

Maddy Dychtwald:
There's just one word that comes to mind when it comes to wearables, and that is user-friendly. It has to be easy and fun and something that does create some kind of social interaction. That's why I love my little Apple Watch. It creates all kinds of opportunities for me to not just see how many steps I've walked, although I love that, and how many calories I've burned, but also to interact with my son who's not living close to me right now, and it's something that we share and I really love that.

Dr. Daniel Kraft:
Ken, you recently wrote an article about the five part solution to healthy aging, and the first on this list is using technology. What might be your favorite game changers about, maybe beyond the simple wearable, and what's your favorite example, and where might you see this heading in the next few years?

Ken Dychtwald:
I think that we're going to have Biolabs in our homes. They'll be built into our toilets and plumbing. They're already occurring in Japan. It hasn't caught on yet in the United States. For example, if I were to take vitamins in the morning, how do I know which ones are the right ones and my body needs today? If there was a Biolab that figured me out during the night and in the morning directed me towards Ken fuel so that I was eating or behaving or resting based on what was happening in my own system. That's different than going off to a laboratory somewhere and getting a few tests. Having a full spectrum lab built into your own home so that people can make directed precision choices in their own lives.

Maddy Dychtwald:
I think that we're going to see more and more emphasis on this whole idea of community and purpose even and how that helps keep people healthy longer.

Ken Dychtwald:
But I think that a lot of older people realize that just as important as being youthful is the importance of being useful. Last year, before COVID, the average retiree in America watched 48 hours of television a week. Now, that's enough to numb your brain and make you into a lesser version of whoever you might have otherwise been. I think we need to create some new expectations and hopes for what a 68-year-old could be and learn and do, and what the role might be of 75-year-olds in families and communities. I think we've given a lot of older people a suggestion of moving off the playing field, and a lot of them have done just that, and I don't know that that's good for anybody in terms of mental or psychosocial wellbeing. I'll also tell you that I think society could use a little more grown up contribution, that there are so many young people that have gotten the wind knocked out of them during COVID.

Ken Dychtwald:
Where's my job? My kids are at home and they're banging off the walls because they miss their friends, and what happens if I don't have medical insurance? To have a little bit more input from older men and women who have been to lots of rodeos and have been through maybe some tough times and seen the loss of loved ones and they have a little more resilience, I think could benefit them and society, and in working in this gerontology field, people will often comment that, "Oh, older people get sent off to the sidelines." I've seen that a lot of people as they age, they send themselves off to the sidelines. They make themselves irrelevant. There's a responsibility I think, as we live longer lives, to stay current, to stay modern, to tune into new technologies, to understand the young generations, and to be relevant to the modern age.

Ken Dychtwald:
That's going to require work on everyone's part. I think that people are going to create a flex version of work and leisure and learning, so that instead of you work like a crazy person for 40 years and then you kind of lounge around for the next 25, I think people are going to glide in and out of work and leisure and go back to school, so that they can stay fresh and alert and reinvent themselves. Last, I think that what do retirees want? They really want to be healthy. Man oh man, you could have a whole big house, big car, big title. You're hurting or you're losing your brain functioning, not anybody's hope for their retirement years. Secondly, I think people want to have some sense of purpose. Who am I now? Who can I be in this new stage in my life that maybe is even a grander, better version of who I've ever been?

Maddy Dychtwald:
People are going to have to be able to reconcile the fact that they have to plan for their present and for their future self at the same time. It's not an easy task, but I think that if you instill the message early enough that young people will catch on and start taking action.

Ken Dychtwald:
It's not just you wake up and then something good happens or something bad happens, or you keep your fingers crossed. In a way, we're charting our course. I was fascinated. I did some homework on the Apollo 11 mission because that was the most heavily planned trip in history, and yet 90% of the time, that rocket was off course, and so the journey was really one of continual course correcting. I think that's what we all need to learn how to do with regard to our mental health, our physical health, and our financial health, and we're not really given those chops. We're not given those skills when we're young, and we're not even given those skills when we're middle age.

Maddy Dychtwald:
Or even old, to be honest with you.

Ken Dychtwald:
It ought to be a part of our continual life learning, how do you continually course correct to get yourself to the optimal version of you?

Maddy Dychtwald:
It's time that health care providers start to change their mindset about that, that rather than being reactive, that they help their patients be proactive to take control of their health, and in fact, focus on health and wellbeing. Sustaining that and improving that health and wellbeing, rather than just reacting to an illness or disease that happens.

Ken Dychtwald:
There is an age wave coming. It's not going away, and let's smarten ourselves up about how to deal with aging bodies, and let's also really begin to focus in our country and around the world on how do we match healthspan to lifespan, and even brainspan to lifespan, that we have to have a new vision, a new vector for this field, that the one that worked fine for the 20th century is proven to be faulty with regard to where we're heading as a long-lived people.

Maddy Dychtwald:
Outdated.

Dr. Daniel Kraft:
Thanks for updating us. Thanks for this healthy conversation and everything you've both been doing now to really improve the present and the future of healthy aging for all of us. Thanks, Ken and Maddy.

Ken Dychtwald:
Thank you, Daniel.

Maddy Dychtwald:
Thank you, Daniel.

Dr. Daniel Kraft:
Thanks for listening to Healthy Conversations, the podcast. It's our mission to reveal the front lines of the health care profession and to educate everyone about the challenges and opportunities in this new landscape of health care.