Technology for Seniors

Technology for Seniors

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[MUSIC] Hello. Welcome to the panel on technology for seniors, which is the next one coming up. My name is Ramesh Rao, I will be the moderator. I wanted to take just a minute to acknowledge the influence of my 90 year-old mom has had in helping me develop deeper understanding of how invaluable technology has become the older Adults. Our daily routine, much to my pleasant surprise, includes spending a few hours online, keeping up with her many multi-generational friends from all around the world. I get to keep up with her just in time WhatsApp audio messages.

We have two speakers in this session. First up is Dr. Tom Kamber. He's the founder and Executive Director of Older Adults Technology Services and Senior Planet.

He's a leading expert on aging and technology, and he's regularly featured in national media. Under his leadership, OATS and Senior Planet have developed award-winning programs for older adults across America and are now charitable affiliates of the AARP. Tom is a man of many talents. He has taught courses on technology, urban studies and philanthropy at Columbia University, he's widely published in professional and academic journals and has presented his work on five continents. He's also a co-founder of the Afro Latin Jazz Alliance, which has distinguished itself by winning multiple Grammy Awards and serves on several non-profit boards of directors and public commission.

Tom, delighted to have you back with us again. The floor is yours. Thank you and thanks for the wonderful introduction. I think I need to shorten my bio. It's too long. Too many things going on there.

But I'm thrilled to be here today and be talking about this really critical issue of technology and in Older Adults. I wanted to do a quick presentation of just little bit about the work that we're doing. But I'll begin just with a brief snapshot about myself so that it's not just the PowerPoint and what we've been doing in OATS for the last 17 years. About 17 years ago, 2004, I got together here in New York City with a group of other volunteers and activists, and we started a non-profit organization that was dedicated to helping older people learn how to use technology and get on the Internet. We worked together for about five or six years, really just connecting with community organizations around New York and developing different models to help people get engaged.

It eventually culminated in a program called Senior Planet, which is the main framework that we've been using going forward around aging and technology. I'm going to tell you, show a few slides, tell the story of that. Getting right to the point here, this is a quick timeline of what we've been doing here.

OATS is a non-profit organization. We are a social impact organization. Our goal here is not simply to judge ourselves by whether or not people are learning technology as market activity. But really what we're interested in is making sure that the work we do has some relevance to EJ into social outcomes that we're interested in. Several years ago, almost 10 years ago now, we did a strategic plan with our board of directors, and we found that our mission, which had been focusing more on technology, should be adapted to focus more on aging.

Our current mission statement for the last nearly 10 years is we harness the power of technology to change the way that we age. That focus has really helped us zero in on the linkages between teaching and training on the one hand, and outcomes such as social determinants of health and social engagement. People's health and wellness, things like sleep patterns, financial security, civic engagement and participation, and even creative expression.

We have people doing book clubs and music events and writing plays and being active in different engagements. When we first started out with this program all the way back in 2004, we didn't have our own centers, we didn't fill up needed to, because New York City has 240 senior centers and there are plenty of operations that have computer labs, places to work. But as we got developing with the different models, we found that there was a need to showcase what was possible with technology. We started this center in Manhattan called Senior Planet. Ever since then, our Senior Planet model has been to grow these technology engagements for older people, focusing on what we call these five impact areas. Social engagement and health and wellness and such like.

We've actually created before and after surveys and evaluated the impact of programs and use that as a way of building back more impactful models for growth and development with our initiatives. By 2014, we had taught over 10,000 classes. All of our programs are free to the end user, and a typical engagement would be between five and 10 weeks, a person would come in. We target programs that people over the age of 60, and they would come in twice a week for five weeks or twice a week for 10 weeks if they were part of a series of courses. At the end of that, they would be very successful and confident using email and Internet and being able to activate a device of some sort.

It's typically a PC or an iPad or Chromebook. Then we develop that course into five different languages, so we teach it. Our basic courses are in English and Spanish, and Chinese and Russian and also Bengali.

Recently we started teaching in Vietnamese and other translated languages around the country. A few years ago, we expanded outside of New York into programs and upstate in a rural area which incubated our interest in focusing on rural older adults, and then launch programs at San Antonio, Texas, Palo Alto, California, and Montgomery County, Maryland. We were beginning to expand nationally.

Big grants from different foundation funders and also philanthropic sources like the Humana Foundation enabled us to do these growth, engage in these growth efforts, and then very excitingly, this year we affiliated with AARP. We've gone from being a small literally a tiny little program, one location in Bedford-Stuyvesant with me sitting in a lab with a bunch of older adults trying to figure out what people wanted to learn with a notebook and sketching out curriculum to the point today where we have over 100 staff working out in the country. We're working to develop a 50 state model with AARP teams around the country. We've been able to really make a difference for actually hundreds of thousands of people that have come to the programs and participated in person and online.

It's really made a big difference in terms of its footprint here. Currently, this gives you a sense of where we started with our footprint in our initial engagements. These senior planet centers exist now in the different locations marked here.

San Antonio, actually doesn't have a center yet, but they will eventually. The city of San Antonio just engaged in a long-term partnership with us. We're excited about that. In each of those areas, we first of all work next to the older folks that we're working with. There's a lot of co-design going on in the centers and in the labs.

We tend to focus on mainstream devices and applications so that people are learning. Not just a program that's senior focus, but also something broader that may have application that's more mainstream that there's friends and family and neighbors and people that they're looking at on television are using. Then finally, virtually all of the Odds programs are partnerships with some partner in the community. With COVID happening like everybody else, we did what everybody is calling the digital pivot, where we converted all of our courses online.

Since doing that, we've had a phenomenal participation in classes. We've got health courses that have over 400 people at a time taking, participating in them or huge about 22,000 engagements a month. Some of those come more than once during the period but we're definitely working with tens of thousands of people around the country.

Our net promoter scoring programs like this has actually gone up to, actually just last month it was a 90. People are very positive about the courses they're taking. We'd been doing advocacy work, helping build programs around the country to help people get access to technology and connectivity. The training has been a central part of everything that we're doing. On the program impact, we've done 7,300 virtual programs since COVID started, we've had 361,000 engagements, which is people coming on to the sessions and participating. We've been doing capacity-building sessions increasingly with partners around the country, helping people learn how the digital channels to work with their partners and their constituents themselves.

That's been very successful, and we're running for the first time ever. A series of programs to licensing your planet programs and content to partners who can help implement it in their communities. I could talk more about that in a moment. As I mentioned, we have these five impact areas. This is a quick snapshot of what they are.

These are all photographs, by the way, of actual participants at Senior Planet programs on our advocacy, one of the women here in our entrepreneurship program. We've done all work with libraries and museums, and then our fitness programs where we've trained thousands of older adults to get connected with their bodies and go out and even gone to fitness centers in groups and gotten people able to feel more safe and comfortable working, exercising in groups in fitness environments. That's been one of our main programs. Our morning stretch class has about 400 people participating per day. We've been adding recently things on Tai Chi and Fit Fusion workouts and different things. We're finding that this wellness and fitness programming is a real high priority for people once they learn the technology basics.

That's the direction that a lot of people are taking it. Most recently we've been highlighting stories of older adults that are fit and active, and we just had a neat breakthrough this last, about two weeks ago. We sponsor five athletes each year, they don't have to be very high level in terms of competitiveness, some of them are folks that are recovering from an injury or simply doing something like one of them just lawn bowling, but he's really excited about sharing that with other people and sharing his fitness journey.

One of our Senior Planet-sponsored athletes got a silver medal in the World Championships about two weeks ago in powerlifting. This is her, her name's Abby, and she's really helping set the standard for people creating a real positive perspective on older adults using not just being fit, but also using technology to help evangelize and share their stories and learn from others as well. We wrap a lot of technology programming into the outcomes that we're looking for. Recently, we asked people what they were doing with the Internet, why it was important to them during the quarantine. Of course, lots of people said Zoom, but interestingly, we got a lot of people talking about connections with friends and family. A lot of people talked about exercise classes, but roughly equal numbers talked about going to church services and being spiritual online.

Many people asked about vaccination information on the news. Lots of people doing Facebook, but not quite as many as some of these other elements and cultural events. Then there's really a whole range of other activities, online banking and shopping, and social activities and things like that. We're finding a real diversity of activities that people are participating in online. Then most recently we sponsored a thing called Aging connected it's supported by the Humana Foundation, it's a national effort to get older people signed up for the Internet at home. We did a research report and we found that large numbers of older people are not participating at the same rates as the younger population in terms of using different types of technology, Internet use is lower.

Most of these elements are 20 to almost 30 percent lower in terms of participation by older adults. Particularly the broadband gap at home is something that we're zeroing in on. Fifty eight percent of older people in America have Internet at home, which means that 42 percent do not.

Of that group, that's about 21.8 million people that are currently still needing to get broadband at home in order to participate in the initiatives that so many people are using in their daily lives. We've been advocating around the country to get people more active about this. Also showcasing that they're equity issues where a lot of the people that are not online are disproportionately Medicaid enrollees are people with functional impairments or they report frequently depressive symptoms, all more likely to be off the Internet and need help getting online at home.

There are all these elements around demographics and race and income and rural residents that tend to predict people being offline. It's become a real social justice challenge for people to close that digital divide for older adults. Obviously, COVID has magnified the impact of this because so many of the people that have passed away from COVID obviously are older, but connectivity and the lack of access to information and support through digital channels makes it harder for people and harder for people to stay safe. We identified a series of paths forward, obviously helping people learn about the value of broadband. Expanding access to low-cost offers. There are new subsidy programs available, the emergency broadband benefit, and other sources of resources for older people to get online in many cases with government funding and support.

Also prioritizing the social equity components of this and helping other communities out there develop content and support localized efforts to bring people online and support people when they go online. For people to want to get in touch. Here's a quick rundown of ways to connect with Senior Planet just so that you can find us online. is the best place to start if you're looking for programming. Again, all of our programs are free.

They're generally targeted at people over the age of 60. Although we get many people between the ages of 50 and 60 to participate. We get people all the way up into over 100 years old that have participated in programs. You'll find a real range of things on,

but classes are there, book clubs programming, it's a great place to start learning more about OATS the organization. You can take a peek at and learn about our licensing program, if there are people in communities that want to get involved, different client projects that we do, and learn more about the affiliation with the ERP and how that's been developing. Then the Aging Connected Initiative is helping people get online. We do have tech hotlines available for people that need direct sport and referrals in terms of what to do while they're trying to connect to the Internet.

That's pretty much the story that I want to share. I will stop sharing my screen and we will go back to the format with the Webinar. Thank you folks for listening to that. Thank you, Tom. It's now my pleasure to introduce Dr. Erick Granholm,

Professor of Psychiatry and Chief of the Psychology Service at the VA San Diego Health Care System. He received his Ph.D in clinical psychology at UCLA and joined the Department of Psychiatry at UC San Diego in 1993. Today Dr. Granholm is an active researcher in ecological momentary assessment, which I dare say has something to do with being able to track time and location precisely, and mobile interventions for schizophrenia and Alzheimer's.

He is the director of the UC San Diego Center for Mental Health technologies , image Tech. He developed a psychosocial intervention for schizophrenia called cognitive-behavioral social skills training and conducted five NIMH and VA-funded clinical trials to test out CBSST for schizophrenia. Its treatment manual has been published in multiple languages and delivered in North America, Europe, and Asia. His current research combined CBSST with mobile, smartphone interventions for CDS, mental illnesses. Doctor Granholm.

Well, I'd like to thank Dr. Jesty if you're invited me to come and talk about technology interventions for older people with serious mental illness. I'm going to talk about some of my own work in this area, but it's more going to be a tour of different technology approaches to help people with serious mental illnesses. What are serious mental illnesses? These are schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder. Very often, this includes psychosis, which are hallucinations or hearing voices, and delusions, which are firmly held beliefs that you really can't talk people out of despite conflicting evidence, like being watched or followed. These are very common illnesses.

Over 13 million people in the United States have serious mental illnesses. They are actually a little more common in younger people than older people possibly because there's a higher mortality in these illnesses with people dying from suicide and other health problems that accompany these illnesses like cardiovascular. The lifetime burden of these illnesses is $1.85 million per person for each of those 13 million people. There's a huge public health burden of these illnesses and despite all of this, only about 65 percent of people actually receive any treatments for these illnesses. Technologies might help us close that gap and get access to treatment for more people.

What technologies? We heard about smart phone apps from Dr. Tory's earlier today. I'll talk a little bit more about those for serious mental illness and there's also virtual reality or what they call serious gaming, I guess, as opposed to fun gaming, but games that are meant to teach or help. I'm going to talk a little bit about neuro feedback and augmented reality and robots. There's all kinds of technology approaches that might be helpful. Smartphones are probably the most common and there's lots of ways smartphones might be able to help close this gap. They can increase access to treatments by having people do therapies and talk to their therapist on their phone, chat, text, FaceTime, use apps to help.

They can increase access for people in rural areas and move the clinic to wherever the people are really. They can reduce the burden of therapist time. We have a tremendous shortage of psychiatrists, psychologists in this country. If apps shorten the length of treatment, maybe by strengthening those treatments so that the number of sessions to be delivered to be lower. Apps could increase access that way.

Apps just help us not forget to take our medicines and do what we need to be doing, to go out and exercise or whatever, but apps can prompt a lot of beneficial activities. Then here's all those sensors like Ramesh mentioned. You can pretty much measure a lot of things.

You can do an EKG with your wrist, with your Fitbit or your Apple Watch, you can mine someone's GPS coordinates, know if people are staying home and alone all the time or are leaving the house, measure heart rate, all health-related things with steps and sleep. When you measure these things and have access to them on the phone, you could do what's called a just-in-time intervention, which is if someone's home all the time, you could prompt them to leave just in time. That's what that means. Mobile-assisted cognitive-behavioral social skills training is an intervention that as Ramesh said in the introduction, I developed this intervention with John McQuaid here at UC San Diego, called cognitive behavioral social skills training, and it combines cognitive behavioral theory with therapy, which is basically checking out your thoughts about things that might make you sad or not, do what you need to do and role-plays like communication skills training, which is social skills training. We've done a bunch of RCTs. This one I'm going to tell you here is in older adults where we try to strengthen and shorten the intervention by using an app.

CBSST is a long intervention. It's 24 to 36 weeks, which is a long time to go to therapy or to these group classes for two hours a week in a clinic. We thought maybe if we added an app, we could cut the work of the sessions they're on. The app prompted homework and skill, told people to do the skills that were trained in the group and had symptom monitoring features. Then we use as a control group, another app which is just monitoring symptoms only and not doing anything with skills and no groups to learn skills, but they stayed in their medications and other treatments.

Well, what happened is, this blue line here is the full CBSST intervention which improved functioning well, and then this red line here is the intervention plus the app. It's about half the therapist's time but despite that, it still improved functioning better than just your regular treatment and just monitoring symptoms. However, not quite as good. These two lines don't really differ but both of them do differ from this one down here. It worked but not quite as good.

I think apps help therapists do the therapy. Maybe they can't work quite as well as all the therapy time, but with a lot less burden it worked pretty well. Other people are doing these, what are called, blended interventions.

There are actually are a few for older people with serious mental illness. This is by the Steve Bartels group at Dartmouth and Fortuna is the lead author. They've been piloting this interesting intervention called PeerTECH, which is peer so other people with serious mental illness who are doing well and know this intervention called Illness Management and Recovery, which is teaching people skills in order to recover and has a lot of the similar things in CBSST, which checking out thoughts and doing role-plays with them.

They added an app to that that prompted them to do the skills much like we did in our study. It's interesting because there's no therapists, so we have a shortage of psychologists, but we don't need them to run this. These are the patients themselves running the groups. It worked pretty well in this pilot study where people engaged with the app and showed some improvements in their daily life in the intervention.

I think there's some promise for serious mental illness for these apps combined with in-person therapies. The phones can also measure all those things I mentioned. One, one of the things we started measuring with these phones is pupillary responses and I'll tell you why in a minute. I know that sounds strange. But you can measure someone's dilation while they sit in front of a computer and do certain tests using these cameras that just videotape the eye basically and digitize it and turned it into a diameter and you can measure people's pupil responses well. Phones have cameras too, and so you can do the same thing and Edward Wang and his graduate student Colin Barry here at UC San Diego have developed an app for that and we'd been testing it.

Why would you measure pupillary dilation? It turns out it might be a good digital bio-marker that might help us [NOISE] identify risk for dementia, like Alzheimer's disease. How could that work? Your pupil actually dilates more and more the harder you work. If you try to remember more numbers, your pupil gets bigger each number you try to remember.

The more effortful processing or cognitive effort you put in, the bigger your pupil gets. It's a way to measure how hard someone's trying to do a test. How could that help you with Alzheimer's disease? Well, when you're trying to identify someone who might be having a memory impairment, we give the memory test. Well, we look at their scores and see if their scores are changing or if they're different from normative samples.

But sometimes people can have the same score but work harder to get that score. The idea is that if you had to work harder to get the same number of numbers correct, for example, then you might be closer to decline in your memory because your memory's starting to fail and you have to work harder to do the test. We've had people remember three digits, six digits, and nine digits.

Nine's like impossible, super hard. We found that people who have amnestic MCI, which is they're starting to have some memory problems but they don't have Alzheimer's disease, are trying harder to get these numbers right. Everyone can remember three digits, but in order to get those three digits right, the people who are at higher risk for Alzheimer's disease are having to work harder. The pupil provides an index of how much effort you put in and might help us identify early risk for Alzheimer's disease.

The earlier you can identify someone who might end up declining, the earlier you can do interventions and we might have more effectiveness of those interventions the earlier we try them. With a smartphone, we might be able to have people measure their own pupil dilation at home. We've been doing that with people to test out this new smartphone device or in your primary care doctor's clinic and you could have information about how much effort you had to do to do a memory test.

I'm going to leave smartphones now and move on the virtual reality. Well, what's that? Usually, you put on those Oculus goggles or you can do it like in this picture here where this woman is doing a virtual reality training on a computer screen. You're embedded in the picture and you play a game where you can move your hands around and move around in this virtual reality space. This is a study out of China with older adults.

There's very little work done in older people with serious mental illness. This is another small pilot study where they've been doing cognitive training where you have to do things like point where a yellow bird will appear and you have to remember where it was and then you point where it was, practicing memory skills like that. They showed some improvement in memory during this virtual reality intervention. We did a virtual reality study in people with schizophrenia. This was done with Sohee Park who's at Vanderbilt University in her group. They developed this interesting virtual reality social skills training intervention where people explore these environments, like in this case here, it's a cafeteria.

They learn how to do communication skills and engage with people in these artificial environments so that might make them more ready to try it in the real world. They'd have to go on these quests like find out someone's name. They go into the cafeteria or here's one at a bus stop where they can choose anyone to approach.

The quest here might be to find out when the next bus is coming. To introduce yourself and ask a question and start and maintain a conversation with these avatars. The platform also measures where the person's looking using those kind of pupillometry devices. You could tell where someone's looking on the screen. One of the things we teach in social skills training is to make eye contact. Their job is to look at the green face here and make eye contact with this person and you could tell whether they're doing it or not.

If they're not, you could say don't forget to make eye contact. This is an example of how you teach some of these social skills using these virtual platforms. All these lines here just show that whether the test was easy, not so easy, and then difficult, people make fewer errors on what they say to people and learning the specific skills and getting the quest. This is how long it took them to fixate on the person's eyes to make good eye contact. You could see that's going down as they practice on this virtual platform. Another totally different technology now that we've been using in Fiza Singh and I-Wei Shu's lab, they do a lot of EEG, electroencephalogram work.

What's happened in the world of EEG is that you used to have to put wet electrodes on all over your head. It took a long time. It's yucky. Your hair gets gooey. Now, you could just put on this headband, which is dry electrode, there's no wires, or this one which is very popular, it's called the Muse. It basically measures your brainwaves. It does an EEG.

It Bluetooths or through a wireless connection, sends the information to a computer or a tablet or a smartphone. The Muse is basically done for meditation or mindfulness work where it measures whether you're doing alpha, which is a calm. When you're calm, your brain goes into this alpha brainwave. You basically can teach yourself to put yourself into alpha because you get feedback from the device about whether you're in it or not. This one has more electrodes from a local company called Cognionics that we've been using and can measure things like frontal gamma, which is a faster wave form with more electrodes. I'll tell you what neurofeedback is now.

Neurofeedback is a kind of biofeedback. This has been around for decades. Basically, you can learn how to change your biological signal through just practice and reinforcing yourself. If you know whether your heart's beating faster, you can beat it faster.

It's the same for brainwaves. You measure people's brainwaves and the computer sorts out what state they're in. Is it alpha or gamma, what kind of frequency are neurons firing in your brain? You extract that. If you want to train someone to increase alpha, you give them feedback when they're in alpha. If you want to train them to increase gamma, which is a faster brainwave, you could increase your gamma.

Well, how do you do that and how do you make it fun? Well, you have an application like game. These are snowboarders racing down the hill and your snowboarder won't move unless you go into gamma. When you put yourself in gamma, you can win the race. It's a weird thing if you ever sit down and do it. The instruction to the participant is put yourself in gamma.

Make the snowboarder win the race and you don't know what you're doing but you do learn how to do it [LAUGHTER] by just having feedback to whether you're doing it or not. You could train yourself to go faster down the hill over. We have them come in twice a week for a half hour each and do this in the lab. But with the promise of these head bands, we might be able to do it from home. Why do we train gamma? It turns out gamma is linked, these gamma oscillations, which are fast, 40 times a second in the frontal lobes, are linked to something called working memory, which essentially is working with memory.

You have to remember what things in order to manipulate information and do things like where am I on my recipe or telephone number. It's limited. Telephone numbers are seven plus or minus two or seven numbers for a reason because you really can't remember much more than seven things at the time. It's about the average memory limit. We thought, if we gamma is linked to memory, what if we teach people to increase gamma? Maybe their working memory will improve. This is Singh's idea and it's a great one.

That's exactly what happened in her project. She brought people in and the lab they learn to increase their gamma power by playing these games while hooked up to EEG machines and gamma increases over the 12 sessions that they practiced. Importantly, this is busy, but there's a lot of bars here and the dark bars is before gamma training and the light bar is after. You see increase in a lot of cognitive domains, not just memory, as people learn how to increase their gamma power. We've also tried this more recently in just a few people with mild cognitive impairment, which as I said, is that high-risk state before Alzheimer's disease where people are starting to have some memory problems.

We have some older adults with these problems coming in and doing gamma training and neurofeedback and their memory is improving as they do the training over 12 weeks relative to what's called a sham or a mock where they sit down and they think they're playing the game but there's no accurate feedback about whether they're in gamma or not and the sledder is just randomly going down the hill at different speeds. What's interesting is that change in gamma over the treatment is correlated with the change in memory. It might be that the gamma training is what's the key component here. I'm going to leave neurofeedback.

I told you I was taking you on a quick tour around a bunch of technologies and there's a lot of them. Sorry to be rushing through each one, but I wanted to sort of give you a taste of each one. There's a lot of robotics. There's a lot of different kind of robots people are trying to use to help older adults.

Not so much older adults with serious mental illness yet, but there's a lot of potential with this as well. There's Pearl and HOBBIT and Care-O-bot and ROBOCARE. This one, iCat, which I think is a little creepy. This one has facial expressions to have a more interpersonal communication with you. They do lots of different things.

There's lots of support that they might offer. Just simple activities of daily living like reaching things are carrying heavy objects, helping people get up, helping people walk around. There's some cognitive support like arranging appointments, reminding people of appointments, reminding people to take medications. There's some emergency monitoring. These robots can tell if someone falls and they can contact someone about it. Some of these robots are being used to reduce loneliness by having people interact with robots or sometimes the robot has a screen that can connect with it before the person knows he's not there.

Just some quick tour of some of the robots. There's actually no work in serious mental illness yet. The last one I'm going to tell you about real quick is I'm just out of time is augmented reality. This mixes virtual worlds and real world together. That's what they mean all it's reality, but it's augmented. You might put an animated figure in a screen, or you can put feedback in a screen.

There's some pretty fancy things. Someone might be looking at another person and maybe you have trouble telling whether someone's happy or sad or angry because he can't read emotions and faces very well. This has been done in autism, for example. The eyeglasses is in this case, this is google glasses, if you've heard of google glass, there's a camera here that sees the face of the other person and can actually categorize facial emotions. Then it feeds back to the person that what the emotion of the other person might be.

This can get pretty fancy and do some pretty amazing things. The way is it's been used in older adults, not older adults with SMI yet is there's google glass, for example, can give you directions or accused when the term just like your GPS does on your phone. But more than that, it'll provide feedback of whether you're turning smoothly when you make, say a left turn. Then it can also make shopping suggestions. When you're looking at the food on the shelf that can actually categorize the food and say, don't buy that, you should buy this low sodium item. Make suggestions while you're looking at the shelf with the glasses on separate.

This is the things people are doing with augmented reality. These games to improve balances, like you'll actually walk through a room in practice walking through. Really, this is more of a virtual reality game. Practice walking through a room.

You don't fall when there's stairs and practice different things like that. That's to give you a quick look at augmented reality. Again, nothing in serious mental illness. That's it.

I'd like to thank you for listening, and I'll turn it over to Ramesh for Q&A at this point. Thank you very much. We are starting to see a bunch of questions coming up. But let me pose a question of my own. I mean it in a more general way, but I'll be specific. The question is about the hijacking of attention that can take place on these online platforms.

They are watching how attentive the end-user is and often push adds or beams that can sometimes generate addictive or other adverse behavior. As we get more and more attached to these devices, is there a concern here that there are these unintended ways in which other applications might be interacting with the end-user that we should be paying more attention to? Yes, it's absolutely a consideration and a concern for people. I think it's really important to think a little bit though, where we are in the progression of people engaging with these tools and beginning to adopt them and the unintended consequences that may be coming as a result of it. There are roughly 40 percent of older adults are not using broadband and other digital technologies at the same level as the younger population. There's a group of people that are really in a wait-and-see mood.

Many people who've wanted to be using technology and are feeling really isolated and excluded from it and are very concerned and anxious about the implications. Is this something that's going to result in identity theft or some cognitive crisis for people? There's a lot of concern around privacy and various factors. For that population, our general advice is, try not to be so afraid yet. We're not there yet. We're still trying to get people to use mainstream devices. The real risk that people are facing is non-participation in mainstream activities, which for many older adults, increases isolation, increases the strain on their social and other environmental factors. We're tech enthusiasts for people that are online, there's definitely the concern around not just the addictive qualities of too many puppy videos or, or getting sucked into marketing for companies that might be appealing your wallet away from you over time.

But also things like misinformation. Challenges where people have self-image challenges that we're encountering with. Things like Instagram and looking at so many pictures of people that have been touched up over the years. There are definitely risks and challenges to people using the technologies.

Our position on it has been that for most older people, the main challenges is getting online and beginning to make intentional choices about the technology, and while we're at it in shaping the technology world as well. Privacy restrictions had been part of the changes for how people are using websites and using e-commerce and things like that. Reasonable regulations that have been put into place both in the EU and the United States in recent years.

Considerations around this information, we're teaching workshops on it with AARP, we're having thousands of people participate in these events to learn more about how to stay safe and not be victimized by the technology that we're using think that as people become more active, older people can shape the technology universe as well and help guide these tools into healthier standard areas. Yes, it's a concern for certain individuals that are heavy users that may be struggling with addictive challenges that they have. I think what things that Eric is talking about, treatment, and that self-awareness and community support for people are necessary and there will be ongoing challenges around this. But the bigger picture to me is trying to develop a more fruitful and healthy ecosystem that protects people in reasonable ways, but also allows to participate and be part of this. Thank you. Excellent. There's a question

if I might paraphrase it, on enlisting the retired teachers, nurses, doctors who already have the training, the wisdom the knowledge, and the experience in socializing some of these new possibilities into the older adults population. This is probably right up your alley, Tom. [LAUGHTER] That's true. [LAUGHTER] We've been working a lot with pure training at peer programming for quite a few years.

Several things have happened here. One is, always it's used to do a lot of youth-oriented intergenerational training. A lot of people get excited about the idea of young people training older people on technology because young people are digital natives and older people are digital immigrants, it's there. They didn't grow up with this stuff. It's a wonderful opportunity to close the gap across the generations. In fact, last I heard, there's a lot of foundation support in California for intergenerational programs.

We used to use them a lot and then one year, about seven or eight years ago, we tested a program with youth trainers against an almost identical version that use older adult peer trainers. We found at OATS that the peer training program was more successful. When we were able to work with older adults doing the training and doing the work themselves with each other, there was a higher level of activation of their consciousness as switched on older folks and they began really working on project outcomes in a more intense and exuberant way while the intergenerational model with younger people training was successful, but it was more focused on the technology and less on the social outcomes. We have taken that to heart and really worked hard to hire more older adults in our training pool at OATS.

We're also working with a really cool program at AARP called Experience Corps, helping to train there. Volunteers that are doing that, there's a wonderful program called Encore out there that brings older retirees and people that are volunteers together to do programming around these topics. We're doing third-party licensing training now with organizations that employ into play a lot of older volunteers to do this work. We think that is the best way to do it. Personally from my point of view, I like to pay people. I think if people are doing the work and we can create some income around it, there's a real value add in a social benefit to the work that older people are doing doing this kinds of pure supported training, and if we can employ them, we do and we've been building our employment practices as well and trying to encourage others to do.

But there's really a lot of value to bring older people to the table here as trainers and we've had great success with it. We haven't had almost any problems with people not being able to learn the technology or execute the program. Yes. I'll just add to that or mash. That's a great question. Lots of people develop lots of apps.

You build a robot or you make this new technology, and then you wonder why no one uses it [LAUGHTER] because you didn't ask them what they wanted, you didn't ask them anything during the design phase. Now there's wide recognition that that's not the way to do it and there's user-centered design where you have iterations, where before you even start to build it, you say, "What should we be doing?" Then there's prototypes and you show those to people and you say, "Would you ever use this thing?" There is things that go through this iterative process of user-centered design are way more likely to be helpful to people because you took all the stakeholders and you brought them in and you've got them involved in designing it. Excellent. Eric, there's a question coming your way. I'm going to elaborate on it because I love the question having played with it myself. The question is about the subjective experience with neurofeedback.

What does it actually feel subjectively to increase Gamma power, even though it's a hard measurable thing, what's going through the mind or the thoughts that the person is experiencing to increase something like Gamma power? Absolutely nothing. [LAUGHTER]. You can't feel your brainwaves. You probably could if you were doing biofeedback for heart rate and other things. But it's a very strange experience to do this or to use the muse or whatever because you're just going through and changing the speed of the person in the race and you don't really know what you're doing.

If you ask someone, "What did you do to make your Gamma power go up?" They would say, "I've no idea." They just did it. It doesn't feel like anything. [LAUGHTER]. Is that true about other kinds of activation like Alpha? That's a good question because when you do those, the whole point is to calm yourself. Like when you do the mindfulness things where you're going into Alpha, you might feel calmer. I don't know if I've ever asked everyone, "If you go into Gamma, do you think you might feel stressed and wired."

[LAUGHTER] It's a good question. No one's ever told me that, but I've never asked them either. No one ever said, "I can't do this. I'm going to wired."

[LAUGHTER] They say, "It's great because I'm starting to remember things better sometimes." But they notice changes but not in feelings like that while they're doing it. It's frustrating. People get frustrated because you're told to do this thing and you just get feedback about whether you're doing it or not and you're like, you could get frustrated a little bit at first until you figure it out.

Maybe this is a related question which has to do with, are their AR interventions that might help people who are visually impaired? There's Aira. Does that count? Are you familiar with Aira, Eric? No. Aira is A-I-R-A. For the visual impairment issue.

I think that's what you're asking about Ramesh. It's a subscription service that I learned about from a gentleman as part of the CTA foundation board. CTA is the Consumer Electronic Show organization that runs that gigantic show in Las Vegas every year. They're very interested in technology and disabilities. One of their board members turned me onto this thing called Aira. He's blind.

Basically it's a little camera that goes on his eyeglasses, but you can mount it anywhere on your body and with your smartphone when you want to activate it, you just push a button or you say something to your phone, it switches the camera on and you have an earpiece, a live person on the other hand will just tell you what the camera is showing. It's a classic augmented reality play with a human being involved, but it's augmenting reality by you walk around and if you turn on the Aira system, people will tell you, "Look at that it came from UCSD. Go UCSD for Aira." [LAUGHTER] I'm just seeing this in the chat coming through. But it's an amazing program. I was absolutely bowled over.

The guy was showing me walking around in Manhattan in traffic on the sidewalk and you just turned it on and it said, "You're walking down the sidewalk. There's a garbage can in front of you a few feet, about two feet to your right. About 15 feet you're going to get to the cab and there's a cab cut there." It was literally just narrating what he was looking at.

Whenever you turn the screen, he turned the screen and showed me and they said others, a scruffy looking guy, they're talking to you. [LAUGHTER] It was actually really a great augmented reality tool and I was very impressed with it. We have just a few more minutes left. We have time for one or two questions. But in the meantime, Eric or Tom, if you have some final thoughts that you want to share with the group, now is your time.

I guess I'll go first because I went first in the presentation. First of all, we're just thrilled to be having this conversation. I was at UCSD a bunch of years ago speaking at when the central launched and just I'm thrilled to see so much energy and continuing research.

I learned a lot from Eric already today and I just got back doing meditation workshops at Modern Elder Academy down in Baja, California focused on getting older people to meditate more. I'm a first-timer here, but I thought it was really great on the technology front for older adults. We are working to build a 50 state strategy now, where we've been very successful getting people to learn technology for free. Now with AARP really behind us pushing these changes in terms of our growth and our impact, we're going to be working in all 50 states within the next couple of years.

There are partner organizations out there that we're looking to find that are wanting to use our curriculum and deliver things at the grassroots level. We have found that older people can learn this technology. It's amazing how well people do when they are supported and people come to the table with specific goals and they want to learn the tech.

We get people on iPads, on Chromebooks, and using smartphones, and using AR, and VR, and gaming. There's a lot of enthusiasm once people get started. There's a social dynamic to this in terms of building policy and funding around it.

Feel free to follow up with us. We're really making a lot of progress here and we think it's a good area for people to put some energy into it. I call to action there.

Eric, any final thoughts? Just I'll make a call to action. If anybody wants to do the neurofeedback study, it's ongoing. If you're an older adult and you have concerns about your memory, you might be eligible. [LAUGHTER] You can find out what it feels like to change your Gamma.

You might get randomized to sham, but you might get 50, 50 chance you'll get into the Gamma. [LAUGHTER] Very good. I'm tempted to volunteer. [LAUGHTER]. Yeah, email me.

[LAUGHTER]. Thank you so much to both of our panelists and the questions. These meetings have always been stimulating, if not for ourselves, directly for our loved ones who might be cool. We might be carrying far and thinking of ways of informing ourselves better so that we can be more effective.

Let me thank the panelists and the audience, and move on to the next panel. Thank you. Thank you. Thank you. [MUSIC].

2021-11-18 09:21

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