Honor Thy Mother and Father

The Japanese have the right idea. Their Prime Minister recently announced his government would invest in the development of “nursing care robots” that help older people with everyday tasks. With just over 20% of its people over age 65, Japan has the largest proportion of elders of any country in the world–the corresponding number for the US is 12%, but we can expect to reach the 20% level by 2030. The Japanese also live longer than other peoples: at birth, life expectancy is 84 years (compared to 79 in the US) and at age 60, life expectancy is 26 years (compared to 23 in the US). But in Japan, the “old age dependency ratio,” or the number of older people as a share of those of working age, is a stunning 39, compared to 21 in the US (for anyone wondering how these numbers could possibly be 39 and 21, the actual formula used is the number of people 65 and older divided by the number of people age 20-64, times 100).  That means there simply aren’t enough caregivers for the burgeoning elderly population—hence the interest in robots.

America is catching up quickly. If we don’t find creative ways to help older people who have problems with basic needs such as going to the bathroom and eating and dressing, we are headed for trouble. A report just released by the Congressional Budget Office (CBO) finds that already now, “informal caregivers,” a euphemism for unpaid friends and relatives, account for over half the total economic value of care provided to elders, or an impressive $234 billion per year. Caregivers for the oldest and frailest elders spend an average of nearly 10 hours a day providing personal help.

The CBO presents a stark statistical portrait of contemporary reality and it also projects our future needs. To reflect the uncertainty involved in these predictions, it gives high, medium, and low estimates of caregiving needs between now and 2050. If the rate of impairment in elders is the same in 2050 as it is today, then we will need to double the number of caregivers from 4% of all non-elderly adults to 10%. In the most optimistic projection, in which older people are less likely to need help with their daily activities than they are today, demand for caregivers will result in 7% of all non-elderly adults serving in this role by 2050 because of the growth of the elderly population. And in the event that the rate of impairment actually rises, an all too plausible scenario in light of the obesity epidemic, which predisposes to chronic diseases such as arthritis and diabetes, the need for caregivers will result in 11%of all non-elderly adults serving this function in 2050.

The CBO numbers tell us something we don’t want to hear or think is of little consequence—the report was not even picked up by the NY Times, the Washington Post, or the Wall Street Journal. But taking steps now can help the elderly and their caregivers today and can stave off disaster tomorrow. The Japanese model is a good place to begin: they have already invested in robots that track older people with dementia who tend to get lost, robots that aid mobility, and soft, furry, animal-like robots that are used to treat depression. Exciting research is also going on to a limited extent in the US at MIT’s AgeLab (which has developed a high tech wheelchair that navigates by voice commands), at the University of Southern California Center on Robotics (which has a robot that acts as a sort of physical therapy aide, supervising exercise programs), and at Carnegie Mellon’s Quality of Life Technology Center (which made HERB, the “Home Exploring Robotic Butler” to facilitate keeping the disabled and the elderly independent).

Technology will not solve all our caregiving needs. We will still need real people to provide companionship, to make complex medical decisions, and to plan for the future. But robots are valuable adjuncts that can do some of the mind-numbing as well as the back-breaking work that humans do today. It will take more young people studying robotics, more government investment in research, and more companies producing technological innovations to compensate for the problems older people face.

 Dr. Muriel Gillick is a geriatrician and palliative care physician, and a professor in the Department of Population  Medicine at Harvard Medical School. She has written four books for a general audience discussing ethical, medical, and other issues arising in old age, most recently “The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies” (Cambridge, MA: Harvard University Press, 2006). She blogs at Life in the End Zone, where this post was initially published.