the need for innovation in ELDERLY CARE

marta g. zanchi

Published in

nina capital

9 min readJun 23, 2023

especially for polypharmacy & multimorbidity seniors

JUNE 2023

by Adrien Ezerzer & Marc Subirats

Not just retirement norms are being tested nowadays — while European societies from the Nordics to Southern European are debating how to adapt to retirement ages, medical needs are significantly increasing, and the way to provide them is evolving. There is a current shift in dynamics where seniors expect to live longer and spend more time at home, leading to an imperious need to design new models to provide geriatric care. Addressing the need for innovative at-home solutions to current challenges is critical for our healthcare industry and societies.

*we’d love for every senior, everywhere, to have access to high-quality health care without worrying about money, family availability, or provider shortage*

We want to share with you our trends and insights. Considering this unique European aging momentum, investing in this trend is a high priority.

trend #1 — a demographic shift

One of the worldwide demographic trends of the twenty-first century is an aging population fueled by a lower fertility rate, rising lifespan, and the transition of large cohorts into old age.

In 2020, 20.6% of the EU population was aged 65+ years.

By 2050 :

The number of people in the EU-27 aged 75–84 years is projected to expand by 56.1%
The number of people aged 65–74 years is projected to increase by 16.6%.
The number of elderly persons (65+ years) in the EU-27 will rise significantly to attain 129.8 million.

trends #2 — a high prevalence of multimorbidity

The healthcare needs of older adults are complex and multidimensional. Aging contributes to various age-related diseases, including neurodegenerative disorders, cardiovascular diseases, cancer, immune system disorders, musculoskeletal disorders, and sensory impairments. The likelihood of multimorbidity increases substantially with age. Between 2015 and 2035, we will witness an unprecedented rise in the prevalence of multimorbidity, with a nearly twofold increase in the proportion of individuals experiencing four or more diseases. Approximately two-thirds of those with four or more diseases also have mental health conditions such as dementia, depression, cognitive impairment, or related disorders. The flip side of multimorbidity is polypharmacy.

Prevalence of polypharmacy in elderly (65 years or older) among 17 European countries and Israel.

Recently, the medical community has acknowledged the significant allocation of resources within the medical system towards patients with multiple comorbidities, as evidenced by published studies showing varying results but consistent evidence of increased utilization of healthcare services by these patients. In their research “Healthcare use in patients with multimorbidity,” published in the European Journal of public health, researchers found and highlighted that patients in Portugal with multimorbidity are responsible for up to 75% of primary care appointments. Additionally, multimorbidities are significantly associated with a higher probability of unplanned care utilization, increased hospitalizations, and longer stays. A significant number of hospitalizations among elderly individuals are considered avoidable. These avoidable hospitalizations refer to cases where hospital care could have been prevented or managed effectively through alternative healthcare settings or support systems.

trend #3 — legislations are slow, but are adapting

Innovators should also keep in mind that while the demographic shift is impacting the whole of Europe, there are some specific variations, especially in how each country is taking care of its seniors. Some European countries devote less public money to elderly care, increasing the reliance on unpaid informal elderly caretakers. In the next few years, we expect to see new initiatives or regulations from governments with incentives to fuel innovation in the space and help entrepreneurs build, create and deploy innovative solutions.

data is king, and our thesis

A common theme orthogonal to these trends is the centrality of leveraging data. Data is critical to understanding this societal shift leading to unmet medical needs, designing new solutions, and convincing various stakeholders to adopt them — for which ROI and “immediacy of ROI” are paramount. Often, innovators present solutions that improve some (or one) of the following KPIs :

Reduce hospitalization stays
Reduce hospitalization days
Reduce emergency visits
Increase the number of patients served per healthcare professional
Increase the satisfaction of patients and their informal caregivers
Delay nursing home admission

Based on these trends and key insights, we identified four models of companies that could fit our investment thesis :

thesis #1 — improve the accuracy of providers’ and nursing homes’ operations

We cannot improve what we do not measure! Monitoring is not a panacea, but a need-driven approach has led some exciting companies to zero in on monitoring as the best way to achieve meaningful progress in how caregivers care for the elderly.

Teia Care — Italy — a portfolio company

TeiaCare’s Ancelia is a technology for contactless and continuous monitoring of vital signs and activity parameters, including heart, breathing and movements. The software platform using smart optical sensors are helping caregivers in care facilities with insight and smart alarms. By facilitating faster and more focused assistance, and diminishing the rates of falls, injuries and bedsores, TeiaCare improves the safety of residents and helps healthcare providers to optimize the management of their resources with a data-driven approach .

Presage — France

Presage value proposition is to allow physicians, care structures and family members to interact and act at the right time. By providing observations about the person under their care through an app, caregivers and family members share valuable data such as mobility, appetite, rest, and isolation. This regular monitoring enhanced by AI may allow physicians to detect risks of hospitalization earlier and make timely and efficient follow-ups.

thesis #2 — alternative care and navigation

We believe these solutions are set to become a crucial element in the shift from fragmented and reactive care for poly-pathological elderly patients to an integrated, preventive, and patient-centered approach. Additionally, as more data is gathered and analyzed, solutions will evolve, allowing platforms to segment patients into different subtypes of complex patterns leading to personalized approaches.

Lena — US — a portfolio company

Lena Health is simplifying healthcare navigation for seniors through a conversational health assistant for care navigation. Through a Biodesign innovation methodology approach, Alex Harb, CEO of Lena Health, identified an unmet medical need. He realized that even among the complex elderly population, navigating the healthcare system and social resources remains a significant portion of patient needs.

Epoca — France

Epoca is building a telehealth solution to help at-risk multimorbidity seniors, emphasizing anticipation and coordination. Through an intelligent telemonitoring platform and connected devices, patient data such as heart rate, blood pressure, and oxygen saturation is collected and analyzed in real time. By aggregating these data points using AI, Epoca’s team provides personalized insights into the patient’s overall health status. Care managers and the Epoca physician work closely with the patient’s regular healthcare team, ensuring continuous monitoring and timely/early intervention when necessary.

thesis #3 — home medical care, assistance & companionship

For these companies, one of the key challenges will be achieving their mission at scale. Handling volume will require automation capabilities and layers of data to enable seamless and efficient experiences while maintaining a high-quality level and ensuring that a significant human element is preserved.

Ernesti— France

ERNESTI connects healthcare students (medical & paramedical) with elderly individuals or those with reduced autonomy to provide specifically night shift and support at home. This innovative approach not only reduces hospital stays, promotes aging in place, and fosters intergenerational connections to prevent senior isolation, but also significantly increases the affordability of night care. It offers a sought-after alternative for families concerned about ensuring a secure and pleasant environment for their loved ones.

Helppy — Finland

Helppy has developed various tools “designed with family members in mind.” From a dedicated helper app for nurses and nurses assistants, a family app for relatives, and a guidance portal that enables family members to efficiently manage various tasks such as organizing paperwork, daily routines, and staying connected between visits. Helppy claims to be reimbursed by many public funding schemes and is currently being regulated as a care provider in Finland and Germany and is operating in 50+ cities in Europe.

Gubbe — Finland

Gubbe is a company that creates a service to assist seniors in carrying out daily tasks and maintaining an active lifestyle through intergenerational connections. Through a subscription model, Gubbe facilitates pairing elderly individuals with compatible young companions and organizes regular visits.

thesis #4 — medication management

The experiences and challenges older individuals face in managing their medications are all too familiar to many. This issue has been well-documented in the medical literature. The most frequent medication nonadherence-related factors pointed out by the elderly are forgetfulness and difficulties in managing medication. Finding comprehensive and compassionate solutions to address these imperious needs of complex older patients to ensure effective medication management is a true challenge.

IMA Contigo — Spain — a portfolio company

Thanks to IMA’s technology-enabled services, thousands of patients in Spain receive their medications at home, presorted by a pharmacist, with no additional costs. This represents a significant quality of life improvement for them and their informal caregivers. With an innovative business model aligning the incentives of all the stakeholders involved, Ima Contigo is well positioned to become a new way to efficiently serve one of healthcare’s most vulnerable and neglected populations.

Livmeds — France

Livmed offers a platform solution for delivering medications and healthcare products. With a network of nearly 2300 pharmacists and 15,000 couriers, Livmed’s value proposition is to provide rapid and efficient delivery within 30 minutes in approximately 200 cities across France. Livmed offers its service to pharmacists free of charge and has signed contracts with some insurance companies. We believe that at-home delivery systems could improve how drugs are delivered to polymedicated patients.

Alongside delivering medications through pre-sorting and at-home delivery to help patients become more compliant, we also identified the significance of addressing overprescription for complex and elderly patients. Thus, solutions that help reduce, prioritize, or discontinue medications that are no longer necessary or may be causing harm to the patient are also an area we are looking at. Besides the pure clinical outcomes, for these solutions of deprescribing, entrepreneurs and payers will probably need to find a value-based care approach to ensure that the financial incentives are correctly aligned for all the stakeholders involved. Some companies, such as Cherub (UK), Arine (US), and Cureatr (UK), are currently emerging.

this is a call to action!

Caring for older patients with multimorbidity is a timely and compelling need. If you are a founder addressing the complex needs of elderly patients, reach out to us at Nina Capital.

We are looking forward to meeting you!

Marc Subirats & Adrien Ezerzer