The pioneers of pervasive computing aren't getting any younger.
As a student at Columbia in the turbulent late 1960s, Bill Reed played a role in in the legendary occupation of campus buildings. Weeks later, he dressed as a cavalry officer and staged what he calls a "takeover of the campus sundial" - a protest against the protests. The proud descendant of an English horse thief who came to America on the Mayflower, Reed was, to take liberties with Jack Kerouac's description of the first hippies, the rucksack revolutionary's rucksack revolutionary.
These days, the 53-year-old entrepreneur ranks among Portland, Oregon's business elite. He has a restaurant, Billy Reed's American Grill, that dispenses roadhouse fare along with free Net access; an upscale residence with remote-controlled utilities and security; and, a few miles south in the suburb of Milwaukie, a $16 million rest home, Oatfield Estates.
As befits an aging rebel, Reed remains doggedly committed to socially and environmentally responsible projects. The walls of his eatery are cooled by well water and the tables topped with tropical hardwood scavenged from local shipyards. His house has solar heating, the garden is organic. And at Oatfield he's rallying his peers once again, this time in defiance of their biological destiny.
Oatfield, which opened in September 2000, is the country's first wired rest home. Perched on a hilltop in the shadow of the spectacular Mt. Hood, the facility comprises three (eventually to become eight) Swiss chalet-style residences, each including a kitchen, common areas, and fifteen apartment suites. Living spaces are outfitted with touchscreen-equipped PCs for surfing the Web, monitoring vital signs, and recalling names (tap a photo and up pops a personal profile). Computers are connected via Ethernet, and everything from lighting dimmers to ceiling fans can be remote-controlled. Caregivers, their families, and residents all live together and make decisions democratically about food and activities. It's a high tech commune for oldsters.
This, according to Reed, is what his generation will expect. "The boomer elderly won't want to be hamstrung with rules," he says. "They'll want to continue leading unscripted lives. Academics talk about technology providing that. I'm doing it." Last June, Oatfield received a Computerworld award that has, in the past, gone to eBay and Amazon.com.
Forget science fiction depictions of a machine-driven future populated by young people. More likely, the elderly usher in the era of pervasive computing. Within a decade, the first of 76 million Americans born during the baby boom years (between 1946 and 1964) will turn 65. Three decades hence, when the last boomer reaches that milestone, 40 percent of US households will include a dependent adult. "America will look like Miami," says Alice Pentland, medical director of the University of Rochester Center for Future Health.
The generation that hoped to die before it got old will in fact live longer than any group in history - possibly a great deal longer if gene therapy and stem cell transplants fulfill their promise. By the same token, the baby boom cohort will spend more time in a debilitated state. The American Council of Life Insurers predicts that by 2030, annual US nursing home expenses could reach $330 billion - three times the size of today's industry. Gargantuan elder-care bills could break the nation's back unless technology can ease the burden. (At Oatfield, residents pay around $45,300 a year. That's less than the $50,000 national average for a full-fledged nursing home, and Reed expects the cost to fall as he expands the operation.)
The health care industry will adjust - but not necessarily on its own terms. Dylan Thomas instructed 20th-century youth to "rage against the dying of the light," and that's just what boomers are expected to do. They won't tolerate being dragged from bed to bingo by low-paid nurse's aides. They'll insist on an active, productive, technology-assisted old age.
And they'll be able to afford it. Already fabulously wealthy relative to previous generations, boomers are on track to prosper even more. They're projected to inherit $14 trillion in the next decade - the largest intergenerational transfer of wealth in history. What's more, they're consummate consumers, unhindered by memories of the Great Depression and trained by Madison Avenue to spend their way out of any problem.
"Gerontechnology will be huge," says Joe Coughlin, director of MIT's Age Lab. The $115 billion nursing home market already grows 10 percent annually. But those numbers are likely to be dwarfed by trade in tools that enable seniors to function independently.
Researchers at MIT, the Georgia Institute of Technology, and the University of Rochester are at work on applications that might eventually end up in geriatric products. MIT's gerontechnologists are designing a cell phone that they hope will keep the brains of Alzheimer's patients from hanging up. The caller would write "Call John" on any surface using the tip of the phone. As the phone dialed, those words would appear in the phone's display to refresh failing short-term memory - all in a fluorescent orange package, to appeal to the aging boomer's inner teen. For a car in development, the Age Lab is considering a part-infrared windshield to help joyriders with failing night vision avoid colliding with warm bodies. The vehicle would monitor vital signs, switching off distractions like the radio if the driver's blood pressure rises precipitously. The make of the car? A Volkswagen Beetle, naturally.
"The idea is baby boom forever young," Coughlin explains. "We want to extend the lifestyle of our youth into old age."
So far, Oatfield is the only rest home using high tech so intensively to mitigate the frailties of old age. Wireless has yet to become sufficiently cheap, effective, and standardized. The major obstacle, however, isn't technical, it's psychological. Monitoring plays a big role in numerous gerontechnologies. Many boomers may have grown up to become the Man, yet they still don't trust him, and they're not sure they want him watching.
But he already is. Web-enabled cameras are "the fastest-growing segment of the home-automation market," says David Hanchette, VP of marketing at OnQ Technologies, a home-networking company, and past president of the Home Automation and Networking Association. "Grandma is becoming a key focus of video monitoring." By 2003, Matsushita plans to offer toilet seats that detect and transmit vital signs.
The elderly will be monitored from the inside out. Conventional pacemakers make cyborgs of 170,000 heart patients a year in the US alone, while units like the one implanted in Vice President Dick Cheney's chest last June not only rein in hearts on the verge of ventricular tachycardia but monitor their performance. By waving a wand over the device, a patient can send doctors a beat-by-beat history of the heart from the day of installation.
It's inevitable: Old age will be mechanized and monitored. "The technology is here," Coughlin says. "Our biggest hurdle is cultural. We have to accept it, and we haven't quite."
At first glance, Oatfield appears no different than other upper-tier assisted-living complexes. At lunch in a pine-and-pastel dining area, the usual age-related disabilities are on display. Asked if she uses a computer often, Roseland, who once owned a construction company, replies, "Oh, I'm done with lunch, dear." Helen, a former nurse plumped comfortably in a wheelchair, is muttering something about Wisconsin, which is where she thinks she is. Sybil, a 75-year-old former editor with two master's degrees, can recite passages from her theses, but her short-term memory is as evanescent as disappearing ink. "Not today," she barks when offered computer instruction, only to ask minutes later, "When is my lesson?"
Yet the environment is unusual for an elder-care facility. Dogs, not allowed at most rest homes, pad up and down the stairs. The kitchen - typically a dangerous place for oldsters - is separated from the dining room by only a counter, over which attendants lean to offer "More?" The effect is that of an ordinary home stocked with 17 grandparents.
This normalcy is extraordinary. Two-thirds of US rest homes are understaffed, according to the federal Health Care Financing Administration. The General Accounting Office reports that one in four such facilities actually harm residents or place them at risk of death or serious injury. For insurance reasons, patients must often wait for aides to escort them from place to place. Or they're confined to lock-in units, as was the case with some Oatfield Alzheimer's patients at their previous homes.
At Oatfield, caregivers and residents alike retain their freedom by, in effect, surrendering it. All Oatfielders wear infrared/radio-frequency tracking badges that constantly transmit their locations to the local-area network - IR for precise, close-range tracking; RF for less-exacting surveillance, should the IR beam be blocked by, say, a patient's hand. A resident who falls can press a button on the badge, prompting computers in common areas to display the person's name and location - and to sound an alarm (a human voice continuously mutters, "Uh-oh"). If the alarm goes unanswered for five minutes, the system sends email to supervisors' cell phones. The system covers all of Oatfield, indoors and out, and tripped-beam sensors alert the staff if a patient leaves the grounds.
The tracking network allows residents liberties they wouldn't find at most rest homes. They can, for example, use the kitchen to cook, an activity fraught with hazards. If a patient who's a confirmed danger wanders into a food prep area alone, the system can issue an email alert. If a caregiver is present, the system keeps mum.
In the apartments themselves, wall-mounted IR motion detectors, offered as an option, keep track of occupants' comings and goings. Lights turn on (slowly, to protect aging eye muscles) when residents enter and off when they leave, so arthritic fingers need not fumble for a switch. Oatfield's residents move, Cleopatra-like, through a deferential environment.
Even the furniture is mindful. Beds equipped with load cells - electromechanical transducers used in industry to weigh flour bags and other unwieldy objects - alert caregivers to changes in weight (an early warning sign of some types of cancer). The same devices can lend a cognitive crutch to residents who request them. When a sleeper rises for the toilet, the bed can prompt the system to switch on the bathroom light, so occupants don't find themselves wondering why they got up. Those who forget to turn off their load cells pay a price - especially couples, whose nocturnal activities are duly recorded.
Ultimately, that price may turn out to be steeper than momentary embarrassment. After lunch, Oatfield's technical boy wonder, the bespectacled 31-year-old Bill Pascoe, sets out to demystify the surveillance system. He chatters excitedly as he walks past remote-controlled waterfalls and wrought-iron lamps.
"We have a ton of plans," he says, stepping down into a basement room. Here, he opens what looks like a fuse box, revealing the invisible arteries and veins of the place, a tangle of thick wires and thin ribbon cables. This is Oatfield's programmable logic controller, a device usually found in automated manufacturing plants. It translates the analog language of lights, load cells, and thermostats into digital protocols the network can understand. Every six months, the system collects 180 Gbytes of data, which are then off-loaded to make room for more.
Pascoe peers at a video monitor, watching a series of obscure words and numbers scroll upward every few seconds. Each new line, he explains, is an IR/RF message that says, I'm here. He deciphers: Helen is entering a friend's room. Frank is headed outside. "Every move they make is in there," Pascoe says. "Every move the caregivers make, too. They go out for a cigarette - we know." The system doesn't track vital signs - yet - but the residents have already turned over to Oatfield the rhythm of their lives.
Pascoe heads upstairs to his office, near a bathroom where a sardonic sign reads, TOILET CAMERA FOR RESEARCH PURPOSES ONLY - SMILE! Sitting at his PC, he clicks casually. Up pops a digital solitaire game in progress. He watches as cards are revealed, hidden, replaced. Reed's house is wired into the system, Pascoe explains; the player is Reed's wife (and Oatfield's co-owner), Lydia Lundberg. "Yesterday," the tech director says, "I turned on her sprinklers for her from here." For a moment, Pascoe seems to inhabit a world overturned, where kids watch in idle fascination as their fragile, bumbling grandparents retreat into an electronic womb.
For Reed and many others, gerontechnology isn't just about watching as waning minds surrender their autonomy to a communal intelligence. It's about using that intelligence to mitigate and even reverse the deterioration. The concept of elderly development - a phrase that once would have sounded oxymoronic - is changing the way many experts think about old age.
Beyond Oatfield's koi pond, two vans - painted, in Reed's typically whimsical style, to look like cows - are waiting to take the gang to Portland's famous Rose Festival parade. The jaunt isn't a time killer. It's therapy.
In 1998, neurobiologist Fred Gage at the Salk Institute reported that, contrary to accepted wisdom, neurons don't stop growing in adulthood. In people as old as 72, new neurons appear at an estimated rate of 500 to 1,000 per day in one area of the brain. Since then, studies of rats have suggested that thinking, exercise, and play can spur neuron growth in adults.
The recognition of neurogenesis in the aged - along with the finding that depression may squelch neuron production, a critical discovery, since half of rest home patients show signs of clinical depression - has led researchers to believe that technology can boost neuron growth indirectly. Systems that free old people from dependence on caregivers, and liberate caregivers to focus on providing experiences that stimulate neuron generation, may act as mental defibrillators, kick-starting flagging brains.
Reed had in mind something like geriatric neurogenesis when he conceived Oatfield in the mid-1990s. Growing up in an extended family with his grandmother and great-grandmother, he saw how his elderly relatives continued to develop throughout their lives. After graduating from Columbia with a BA in economics, he launched several failed businesses before finding success turning abandoned buildings into environmentally sound living spaces and selling them to Portland's ecologically correct elite.
One day, planning for his parents' future care, he visited a nursing home. He was struck by the condition of the patients - drugged, lonely, and bedridden - and left determined to create a place where elderly people would be connected in every way possible. He wanted to build, he says, "a place I could live in." Once restless at work and at home (his first marriage ended in divorce), intellectually rangy and unabashedly vain ("I'll wear a hearing aid when I can't hear my kids"), the aging businessman was his own ideal customer.
Indeed, Oatfield is a grassroots effort - there are no PhDs, and only one staffer with a master's, in the place. But Reed's high tech, high-touch pitch struck a nerve among experts in the field. Top researchers of aging - nearly all boomers - joined his advisory board, including the president of the American Geriatrics Society, the editor of the new journal Gerontechnology, and experts from the Mayo Clinic, Harvard, and Intel.
Continual growth of the kind Oatfield is designed to foster may be "the prize of technology," says University of Rochester aging specialist Bill Hall, who also serves as president of the American College of Physicians. "Is elderly development, which until recently was considered an inappropriate goal, a fountain of youth?"
If so, it's another reason why boomers will ask more of gerontechnology than what a nursing home can provide, no matter how technologically advanced it might be. They'll want to live on their own. They'll have a fighting chance, too, in independent living situations where everything, from floor to ceiling, is alert to their needs.
In the northwest corner of the Georgia Institute of Technology's Atlanta campus sits the Aware Home, a laboratory for technology-mediated living. From the outside, it looks like any well-tended suburban home. Inside, it looks like the aftermath of an engineers' all-nighter: Coke cans, computers, papers, and toy robots everywhere. Here, researchers are seeking solutions to problems of artificial perception and cognition that, they hope, will lead to backup systems for crash-prone synapses.
The Aware Home builds on related Georgia Tech research. A smart undershirt, created in the mid-'90s by professor Sundaresan Jayaraman at the School of Textile and Fiber Engineering and scheduled for a market debut next year, permits people whose health requires constant monitoring to wander as they please. According to a 1998 AARP poll, a full 80 percent of boomers expect to keep working beyond age 65. The Smart Shirt will help them do that. (And save money: Among cardiac patients who used another - less sophisticated - networked device, Health Buddy, to send vital stats to their nurses, hospital visits dropped 73 percent, saving $9,151 per patient per year, according to research conducted by the Mercy Heart Institute.)
The T-shirt functions as a medical-grade EEG, and it monitors temperature, respiration, blood pressure, heart rate, and blood oxygen. Sensors attached to T-connectors woven into the cotton fabric feed a belt-mounted transceiver, which sends the info to caregivers and sets off alarms when signals indicate the wearer is in trouble. Indoors, vital signs can be sent using a wireless protocol like 802.11b. For roving use, the information can be stored in the belt pack.
So there you'll be, out and about in clothing that's fluent in both the body's electrochemical language and the electromagnetic dialect of wireless data transmission. Still, your memory is bound to fail. Time to check into Oatfield?
Not so fast, says Georgia Tech assistant professor Thad Starner. He enters the Aware Home carrying a backpack and gripping what looks like a TV remote. A key figure in the world of wearable computing - a field that market analysts at IDC expect to be worth $600 million by 2003 - he's dressed like a typical college student except for a pencil sharpener-sized object perched on his glasses.
"Alzheimer's costs us $100 billion a year," he says. "Wait, that's low." He stares into space, his fingers dancing across the remote's keys. "In 10 years, Alzheimer's will cost $1 trillion a year." He looks up, smiling. "Here's the elderly's memory aid."
In Starner's backpack is a lightweight PC, developed while he was at MIT and commercially available as the CharmIT. It holds a wealth of personal information that he has entered over the past six years. In his hand is an off-the-shelf keypad known as the Twiddler2. The thing on his glasses is a personal high-res LCD screen. The heads-up display, made by MicroOptical of Westwood, Massachusetts, is already used in precision work, from surgery to jet engine repair. It's compatible with almost any computer and OS, and delivers a readable full-screen image.
Starner's current system is decidedly for the young. The CharmIT is bulky and the Twiddler2 requires youthful finger dexterity. But more elder-friendly alternatives already exist. Xybernaut's fifth-generation wearable, for example, pairs a similar eyeglass display with a computer the size of a Walkman that can run full-featured Windows or Unix. Equipped with voice-recognition software and a small arm-mounted QWERTY keyboard, it hints at the future of memory enhancement. Facilities like Oatfield might even preload such systems with data that reflects the user's interests.
Eventually, wearables might incorporate face recognition, says MIT Media Lab's Alex Pentland, whose preliminary research in that field was declared the most influential of the 1990s by the journal Machine Vision and Applications. Some experts believe that Pentland's pixel-based approach, combined with other technologies (perhaps including one that measures distances between facial features), will enable computers to recognize faces reliably within the next several years. "Memory glasses offer a hypertext annotation to real life," he says. "They're exactly what the elderly need."
Flash-forward to 2021. You've just turned 75, among the first boomers to do so, and you still report to the office daily. At 60, you had a heart attack that would have killed your father. Now you wear a smart T-shirt, which once sent police to your side after a fall, thanks to the built-in accelerometer and GPS receiver. Whispering questions at your PDA and scanning your glasses for answers give you the illusion, at least, of having a fail-safe memory. And with a linear actuator-powered ankle brace (developed at MIT) that gently pushes your weaker leg into the proper gait, you've retained a youthful spring in your step despite advancing osteoporosis.
But you're pooped. Your shirt has been beeping, getting you thrown out of theaters. It may just be time to head home - but not to a nursing facility. Researchers are working on advancements that will keep old boomers living independently for years, well after, frankly, there's no one home.
Last fall, Rochester's Center for Future Health began showing off its nascent object-recognition technology, which currently identifies selected items, under controlled conditions, with 97 percent accuracy. The computer takes a picture of an object, then looks for a match among dozens of items whose images have been stored in its database. Ask, "Where's my cell phone?" and it might reply, "On the counter."
The process, which works by noting distinctive features of an object's profile and variations in light and dark, isn't easy on a CPU. "It takes about 10 billion calculations to recognize a coffee cup," says computer scientist Randal Nelson, who invented the system. Soft objects confound its algorithms, since their boundaries aren't fixed. And covering every nook and cranny of a house would take "lots of computers to keep up with multiple cameras," he says. Now that the technique is proven, however, he's confident that further progress will come in due course. Since up to half of all people over 85 have Alzheimer's, there's ample incentive to perfect the technology.
Also at Rochester, an orthopedic gesture-recognition program stops oldsters who are exercising improperly. Two cameras perched on a PC enable the computer to follow movement by tracking skin tone, which it perceives as blobs of like-colored pixels. The system watches you move, compares your motions to the ideal routine, and suggests changes. Stroke is the primary cause of adult disability, running up $30 billion in medical expenses each year. Exercise is the cornerstone therapy. The Rochester system aims to make it more effective.
Then there's the university's talking intention-recognition program, which interprets vague spoken questions and knows enough about some problems of old age to answer intelligently. Explains computer scientist James Allen, "If you ask, 'Can I take aspirin?' it knows you mean 'given my other medications' and answers appropriately." Drug-interaction databases have helped hospitals reduce medication errors by as much as 80 percent. Allen's project, a product of 10 years of military-funded research, may help seniors - 50 percent of whom don't take their meds properly - gain a similar benefit.
One goal is to combine approaches for the highly impaired - after all, sooner or later you'll forget to put on your wearable to begin with. Thus, although Georgia Tech has developed a motion-tracking program that uses RF tags, researchers there are also working on a blob-based tracking system and have played with a load cell-equipped floor that monitors foot traffic with 93 percent accuracy.
The technology is in its infancy, and years will pass before it's ready for the mass market. Meanwhile, though, Georgia Tech's smart floor could pick up gait abnormalities that signal the early onset of muscular dystrophy, leading to early treatment. A camera/IR system could detect pre-Parkinson's tremors. Researchers are hoping to have smart houses ready in two decades, by time the first boomers turn 75.
Elderly people may be hitting the Net in record numbers, but Oatfield's current crop knew nothing about computers when they arrived. Nonetheless, these latecomers seem to find the benefits of Oatfield's high tech safety net worth the intrusions it entails. Helen doesn't want anyone to know her weight, but she has activated her bed's load cells to trigger the bathroom light. Sybil, whose cat keeps running away, snaps at the suggestion she equip the animal with an RF tag: "The world is too mechanized." But she requests more Web lessons than anyone.
Lillian, a serene 81-year-old, holds a tiny finger suspended over her touchscreen. She has forgotten how to surf the Web. But she tries to keep up with the steady stream of email from her daughter-in-law - not to mention from pornographers who have discovered her Hotmail account. Using her touchscreen, she often taps on the faces of caregivers to recall their names - and on the faces of her co-residents, trolling for gossip. "I can find out all kinds of stuff about them," she giggles.
Then there's Frank. As night moves in, he's watching Who Wants to Be a Millionaire on a 62-inch HDTV. "It wasn't good," he says of his previous rest home residence, his voice paper-thin. "Everyone was afraid. We didn't know where we would go next." His eyes glaze. His awareness has shifted in midsentence, and now he's talking about the 1940s, when he was held in a camp for Americans of Japanese descent.
Memory loss, Reed says, can be a natural defense against the disenfranchisement and depression many feel in traditional nursing homes. Frank may have returned to a monitored environment, but at Oatfield the wires are designed not to fence him in, but to connect him to the surrounding world.
Will they serve their purpose? Will they increase his autonomy or defeat it? It's up to the pioneers at Oatfield Estates, and the boomer cohort that follows them, to embrace tools that augment more than they constrain. We may yet age gracefully.
