Let’s Talk about Loneliness

My mother is 67 years old and lives alone, 3000 miles away from me, her only child. She retired two years ago after three decades spent working as an elementary school teacher. When she retired, I was the one preoccupied with how busy she would or would not be. She was unconcerned. She wanted to play tennis a lot. She joined a group of ladies who meets up every Monday night to play. And when she got a “Golden Sneakers” coupon in the mail from her health insurance company, she gladly redeemed it at the local 24 Hour Fitness and has become a Zumba addict.

Perhaps my mother is thriving. She’s a “yes” person — she accepts whatever adventure comes her way and her life is full because of it. But still I worry. Are the activities and cats and phone calls with me and her sisters enough? Or is she starting to feel really lonely?

A few months back, I read that the UK had appointed a Minister of Loneliness. Why did the UK take the drastic step of focusing public resources on this problem? Because loneliness affects our health — and our health expenditures. Research shows that loneliness is as much a risk factor for early death as smoking 15 cigarettes a day. It is worse for us than obesity and physical inactivity. Loneliness increases our risk of death by 26%.

It turns out that loneliness is not a problem unique to people who live alone, or to those who live across the country from their children, or even just to seniors. But those groups do experience loneliness particularly acutely. In the UK, over half of people over age 75 live alone and 40% report that the television is their main companion. 17% of older people are in contact with family, friends or neighbors once weekly, and 11% less than once monthly. 63% of older adults who have been widowed, and 51% of the same group who are separated or divorced report feeling lonely often. These statistics are true in the UK, and I presume that the facts are equally grim in the US, if not more so.

As someone who invests in emerging technologies for a living, I can’t help but wonder: What role can technology play in mitigating loneliness among the elderly? Can digitally native technologies (e.g., video, voice, AR/VR) reduce it, or will they, as social media, tend to exacerbate the problem? Should the role of technology be to facilitate more human contact in real life?

There is a lot of exciting startup activity in this space. On the spectrum from “in real life” to “digitally native,” I see four main clusters of activity.

Companies such as Honor, Hometeam, and Care.com create a marketplace between professional caregivers and families who need specialized help to look after elderly loved ones. New startups such as Mon Ami, The Helper Bees, BuddyHub and Umbrella are taking a different approach, concerned more with companionship than professional help. Mon Ami connects seniors with student companions; Umbrella connects seniors with neighbors who can help them around the house.

Advice for founders: The best marketplaces add value in three ways. First, they enable an experience that is clearly better than the status quo. Second, they enable a superior economic experience on both sides. Lastly, they’re able to use technology to enhance the service. In this particular category, the challenge is to provide a superior experience at a price point lower than what families of the elderly would pay for professional help today. No marketplace in this space has been truly price disruptive yet.

Perhaps in fifty years we will look back aghast that we ever sent our elderly to nursing homes. Social isolation is particularly rampant there. In Singapore, the government has introduced a new program whereby nursing facilities are co-located with preschools, the elderly providing the little ones with cross-generational playmates. In the US, the number of facilities that have adopted a cross-generational model remains fleetingly small. Providence Mount St. Vincent, better known as “The Mount,” is the paradigmatic example — five days a week, elder residents share the 300,000 square-foot facility with up to 125 children, ages zero to five. There are a number of startup companies that are thinking about co-living: Common, HubHaus, Roam — though to date these have focused more on the urban millennial than on a cross-generational mix. There are also a number of startups thinking about daycare — Wonderschool, WeeCare, CottageClass — but none yet have blended early-childhood with end-of-life care.

Startup Idea: “SoHo House for the Elderly” Today, many people my mother’s age voluntarily move to assisted living or retirement communities — in part, preparation for years to come, and in part for companionship. Meanwhile, my generation is busy building new forms of companionship, my favorite being co-working spaces like Spacious, The Wing, The Riveter, and The Assembly. Who’s going to build a similar community focused on our parents’ generation?

Traditional medicines take a ton of time and money to develop. According to the Tufts Center for the Study of Drug Development, the cost of bringing a medicine from invention to pharmacy shelves is $2.7B. And even once a drug has been brought to market, it’s of no use unless a patient remembers to take that drug as prescribed. Studies have consistently shown that 20 to 30 percent of medication prescriptions are never filled, and that about 50 percent of medications for chronic disease are not taken as prescribed. Adherence is particularly low when the disease itself (e.g., dementia) impacts a patient’s ability to remember to take a medication. In total, medication non-adherence costs our healthcare system between $100 billion and $250 billion a year.

What if software could be just as effective at treating certain conditions as a physical pill? So-called “digital therapeutics” take a lot less time to develop — weekly sprints, rather than decades-long R&D. They also stand to benefit from the same engaging properties that have us all glued to our smart phones. Someday a doctor might prescribe an elderly patient a software program rather than a pill to treat loneliness, depression, anxiety, or cognitive decline.

Though the field of digital therapeutics remains nascent, there are startups working to bring therapeutic software to market. In September 2017, the FDA cleared a mobile app called Reset, made by a company called Pear Therapeutics, as the first mobile medical app to help treat addiction. Other digital therapeutics in the process of seeking FDA approval are Alkili Interactive, which makes a video game-like device to treat children with ADHD, and Dthera Science’s ReminX device to treat those with Alzheimer’s.

What if seniors could be transported to their childhood home, or to a concert at The Met, or to an Oahu beach, all from the comfort of their own bed? An MIT startup called Rendever has developed virtual reality products for the elderly, and boasts that their nursing home customers have seen a 40% increase in resident happiness. Another company called One Caring Team has developed a similar product called Aloha VR. The pervasiveness of the problem definitely justifies the need for these interventions, though it remains to be seen just how effective they will be in fighting loneliness — can virtual companionship ever be a true substitute for the real thing?

Bibliography

News Articles

• U.K. Appoints a Minister for Loneliness, The New York Times
• The Preschool Inside a Nursing Home, The Atlantic
• Take This App and Call Me in the Morning, The New York Times
• For Senior Citizens, the Future of VR Lies in the Past, Wired

Scientific Studies

• Loneliness and Social Isolation as Risk Factors for Mortality: a Meta-Analytic Review
• Also see: Loneliness Research compiled by the Campaign to End Loneliness