Caregiving for elders is an ancient practice, echoing back to the dawn of human history. Although the need for care may be immutable, the fundamental math involved is changing.
Longevity gains — the triumph of more than a century’s worth of public health and nutritional victories — have resulted in a growing population of older adults in the United States and many other countries. Meanwhile, the aging of the sizable baby boomer generation and declining fertility rates mean that the elder population is growing not only in absolute terms but also relative to the young. In 2020, there were about 56.1 million people aged 65 or older in the United States — 17 percent of the population. In 2034, there will be more Americans aged 65 and older than children. These shifting demographics will lead to a drop in what’s known as the caregiver support ratio: the number of adults ages 45 to 64 who are available to provide care to those 80 and older. Between 1990 and 2010, the caregiver support ratio hovered at around 7 caregivers per care recipient, but by 2030 the ratio is estimated to decline to 4 to 1, hitting 3 to 1 by 2050.
One major caregiving question faced by aging countries is whether technological innovation can help make up for the demographic shortfall. It’s a concern not only for professional caregivers, but also for the 42-million-and-rising Americans who provide informal care to family members and loved ones.
Technology has been touted as one potential, albeit partial, solution to the caregiving crunch, but what hasn’t been clear is which areas of life for caregivers and care recipients stand to be most affected. Experts from academia and industry expect technological advancements in caregiving in the next 10 years to be concentrated around extended applications of existing technologies, such as smart home and wearable technologies. They project that the greatest impacts of tech innovation will be on relatively “low touch” activities, such as social engagement, medication management, and transportation. They expect technology to have little impact on more complex, “high touch” activities, such as feeding, dressing, and bathing.
It appears that caregiving faces an innovation gap. Although there is plenty of inventive energy pouring into some caregiving needs, the core tasks of caregiving — the ones requiring the most intensive, even laborious attention — appear to be last in line for a technological helping hand.
Part of the reason tech has been applied so unevenly to caregiving is that easier technological challenges tend to get solved first. It’s well beyond the current state of the technological art, for instance, for a robot to safely help a care recipient with the toilet or with getting dressed. But a subtler cause may be that the needs of caregivers are poorly understood. The vast majority of caregiving goes on in private homes, is experienced only on an individual basis, and is also in a state of constant flux, as needs evolve and the job of caregiving changes in response. As a result, despite the fact that caregiving is an extremely common activity, it’s also remarkably opaque.
Perhaps the most straightforward way to shed light on such private-yet-nearly-universal experiences is simply to ask people about them. For example, the MIT AgeLab CareHive draws on a multigenerational caregiver panel comprising more than 1,400 current and former caregivers who can speak to a variety of under-reported concerns and demands. Caregivers reported concerns about the reliability of certain technologies, such as various engagement or communications tools, for instance, which aren’t designed with care recipients in mind, or lack the flexibility to accommodate varied care situations. Caregivers “are shunning technology because it doesn’t seem to work,” one caregiver commented. Tech providers often seem to “have a solution, but just to things that aren’t the problem.”
The innovation gap facing tomorrow’s caregiving-intensive society has its roots in a different sort of lacuna: an information gap. Providing care is not only necessary for a decent quality of life and a functioning society; it also is, and always has been, a cornerstone of the human experience. We’ll do ourselves no favors by ignoring or turning a blind eye to caregivers. Far from it: To reimagine an innovative future of care, developers, policymakers, and researchers must first understand the requirements of those who provide and receive it. It’s an essential question. After all, many of us will find ourselves occupying one or both of those categories in the years ahead.
Lisa D’Ambrosio is a research scientist at the MIT AgeLab.