Episode 101: Technology and Aging

Dr. Logan DuBose is co-founder of Olera, Inc. He writes about dementia, Alzheimer's, and other age-related conditions. He is a Texas A&M MD/MBA alum. Olera specializes in merging clinical practice with innovative solutions for the aging population.

https://olera.care/

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[00:00:04] Welcome to Informed Aging, a podcast about health, help and hard decisions for older adults. I'm Robin Rountree. I'm a former family caregiver. I have worked in the home care industry and now work for the Alzheimer's and Dementia Resource Center. The thoughts and opinions expressed on this podcast belong to myself and my guest, not our wonderful employers and sponsors before making any significant changes in your life or your person's life.

[00:00:30] Please consult your own experts. Today we're talking to Dr. Logan Debose about technology, what needs to be done in terms of our aging population, and how things can get better. It's a pretty great conversation. Stay tuned.

Robin Rountree: We are back and we are talking with Dr. Logan Dubose

[00:02:03] and you've got

[00:02:04] MD and an MBA after your name. Yes. Are you an overachiever?

[00:02:09] Logan Dubose: I would, uh, I've probably been referred to as that. Yes. I went to Texas a and m for medical school and they offered a joint MD MBA program.

[00:02:18] Robin Rountree: You doing both at the same time? 

[00:02:20] Logan Dubose: Well, they do it in a five year span

[00:02:24] so after those five years you graduate with your MD and your MBA and then I went to Washington DC, the George Washington University Hospital and I did my first year of internship, um, in internal medicine. And since then I've actually transitioned to kind of a extended leave of absence to work on the project with the National Institute of Aging.

[00:02:44] Robin Rountree: Yes. So the National Institute of Aging has asked you and your company

[00:02:48] to create innovative products and services that cater to the evolving needs of the aging population.

[00:02:54] It's a long way to say we need a little help from technology as we age.

[00:03:00] the new stuff on the horizon? 

[00:03:01] Logan Dubose: Yeah, absolutely. And that's kind of a more broad description of what Olera, which is the company that I started in medical school with my partner tj.

[00:03:09] Um, what we're doing is we're, is we're looking at some of the biggest problems in aging. We are seeing the changing demographics of a rapidly aging population. So more people over the age of 65 than than ever before compared to

[00:03:24] the, people under 65.

[00:03:26] So essentially we're starting with the basics. Like we currently don't have a very great indexed, um, online directory of all of the different, what we call players in the elder care ecosystem.

[00:03:39] So this is home health agencies. This is, care facilities like memory care centers or nursing homes or rehab centers. It's very broad, the eldercare ecosystem, the players in the ecosystem are not indexed well online. There's not a great directory that's up to date with accurate information that is useful in the sense that it can help you initiate and compare and choose.

[00:04:03] So that was kind of the first problem that we said, you know, it was, there's a lot of things that we want to do. But can we first index the system so we know what, what can we do with what exists? What players are in the game? How can we connect people to those easier? And we proposed that to the National Institute of Aging.

[00:04:19] They said, Hey, you know what? The long-term service and support industry is a mess. And people are confused. Maybe you guys should index that and put that online in a, in a software as a service, a SaaS tool. So maybe I'll stop there, but there's lots, lots more that we can talk about. There's so much technology innovation right now in the space.

[00:04:37] Robin Rountree: I think that

[00:04:37] is a great place for you to start because

[00:04:40] at the A DRC, Alzheimer's and Dementia Resource Center, we're trying to connect people

[00:04:46] with the resources that are out there, and

[00:04:50] you gotta come to us and even we get confused. Oh my goodness. It's a full-time job. It's such a, a maze of information.

[00:04:58] Logan Dubose: Absolutely. It is a maze of information and the eligibility criteria, the jargon is very difficult. For example, I'm sure you run into this all the time, what is the difference between home care and home health?

[00:05:11] Or what is the difference between assisted living and a nursing home?

[00:05:16] So the industry's very confusing, the jargon. And, and then of course it's also both public and privately funded. So you have certain insurance companies that have Medicare Advantage plans versus Medicaid and Medicare, and what is covered and what is not covered.

[00:05:31] And is my home healthcare is my skilled nursing home care, my PT and ot, my physical therapy and occupational therapy. Is that covered or is it not? Is my personal care aid covered or not? These are questions that are just so confusing in, in my clinical experience, discharging patients from an inpatient setting at the hospital.

[00:05:51] Um, these were the kinds of questions they confused practitioners, social workers were full-time fielding these questions. They're the, you know, saints of the industry in a lot of ways. And yes, trying navigate this craziness. But, the A DRC and, and and your colleagues and what you guys are doing, what we're trying to work on, it all kind of goes towards this making sense of the the elder care ecosystem in America.

[00:06:15] Robin Rountree: That is, uh, quite a challenge you've given yourself because it's,

[00:06:20] It's

[00:06:20] big. 

[00:06:21] So

[00:06:22] how do you make it 

[00:06:23] how 

[00:06:24] and accessible to the older adults?

[00:06:28] Logan Dubose: Thank you for that question. Yeah. That is the major focus of what we call our build, measure, learn development cycle.

[00:06:34] . So what we do, what we've been doing, is we bring in families very early on.

[00:06:40] You know, we'll bring in 25 families to look at a mockup designs of a webpage. They're looking at the words we use, the font we use, what, what the buttons say, where the buttons take you. We're tracking load times, if the colors are, are confusing, if there's too overwhelming of a user interface. We can't just put out a directory without asking families if it's usable. And so the, uh, site itself is, is starting to really become what we believe to be the most usable directory, or at least the most user centered directory. But we're, we're, you know, it's a work in progress,

[00:07:17] Robin Rountree: thank you

[00:07:18] because you say you can't do this without.

[00:07:23] but

[00:07:23] Input, but

[00:07:25] they tried

[00:07:26] and you get on that website and you're like, Nope, no thank you. 

[00:07:29] Logan Dubose: Oh my goodness. We've been blessed to be able to optimize for the user experience of families that search online. So this is individuals who may not be tech savvy, who may not want to read a 5,000 word article.

[00:07:46] Robin Rountree: are you starting like on the national level

[00:07:50] moving

[00:07:50] down to states? 'cause those are two very different things. 

[00:07:53] Logan Dubose: Oh, goodness, yes. And the state's differences in what's paid for and what's not. For example, like Medicaid waivers for assisted living in certain states and not in others, so we're taking a city by city approach. Our first phase, we looked at all the major cities in the United States and we did, maybe 20, 30 of each category of, provider.

[00:08:16] And that was just really to get experience. And now we're taking a step back and we're going slowly from one city at a time, to refine and to expand cities that we've already tackled across the nation.

[00:08:29] Robin Rountree: Well,

[00:08:29] I hope Orlando is high up on that list. 

[00:08:31] Logan Dubose: Oh yeah. Oh yeah. Definitely is, definitely is. 

[00:08:34] Robin Rountree: So.

[00:08:35] Alright, 

[00:08:36] this is up and running, let's say I live in Texas. Where do I find this? On the web? 

[00:08:41] Logan Dubose: Absolutely. You can just type in ra O-L-E-R-A ra.care. You can type in homecare near me and we're working on optimizing our search engine ranking, so we come up at the top.

[00:08:52] You can also just search for the name of a home care agency, assisted living facility, memory care, and an Olera page or an Olera listing, you might see pop up.

[00:09:02] Robin Rountree: Olera.care, not dot com? 

[00:09:04] Logan Dubose: Exactly. Olera.care. Olera.care. And , that is, uh, an important point. Olera.care. Hopefully. It's a little bit easier to remember.

[00:09:14] Robin Rountree: So what other technology do you think is coming? 

[00:09:18] Logan Dubose: Oh, yeah, that's a, that's a really great question.

[00:09:20] , On the horizon, so I'm seeing several categories. Of course, there's the category of wearables, so this is like watches or medical alerts and, and pendants and, and necklaces. Um, there's also artificial intelligence, so that can apply to many different types.

[00:09:37] One thing we're working on, for example, is what's called a large language model, which is like chatGPT or perplexity, these things that have become rather adopted, uh, that's specific to screening people for eligibility, for benefits, or for insurance coverage. So do you qualify for SSI, for example, or snap or does your insurance policy, if you uploaded it to our large language model and ask it a question, is this covered by this or that, or you talked to the,, I call it the AI social worker. That's something that we're working on right now. 

[00:10:11] Robin Rountree: Yes.

[00:10:11] I want you to start drinking a lot more coffee and get this stuff done. 

[00:10:14] Logan Dubose: Yeah. That that's something. So we're hoping that, the application of artificial intelligence to these sorts of use cases to mass eligibility screen

[00:10:21] people over 65 to make sure, there was a statistic that we wrote about that really kind of launched us into this direction. Something close to over $30 billion of aid for adults 65 and older goes unutilized because there's such barriers to understanding the eligibility criteria, applying and managing the application process to get these funds.

[00:10:45] We just thought, oh well this is a perfect problem to solve with these new technologies, like large language models that can screen mass amounts of text and forms and can even perform functions like call and email people for you. These sorts of advanced functionalities that's on the horizon.

[00:11:01] Robin Rountree: That's

[00:11:02] great. 

[00:11:03] Um,

[00:11:03] and then you talk about wearables, and I've seen the technology improve a lot.

[00:11:09] but you gotta get the buy-in.

[00:11:12] From the older adult.

[00:11:14] from 

[00:11:14] Do you have any magic tricks? 

[00:11:16] have 

[00:11:17] Logan Dubose: Well, you've got to optimize for lightweight, comfortable, because the biggest issue with wearables is putting them on each morning.

[00:11:24] Um, yeah, and taking 'em off at night. And if it's not something that's comfortable, that's, that you think is good looking, that's lightweight, there's no way that. I mean, I, I forget to put my watch on a lot of times in the morning too. You know, and it's, it's fairly comfortable and

[00:11:39] I think it's stylish. So wearables are they're imperfect. There's some other solutions that I think are, are more user friendly, for example, ways to kind of hack your home. Like with an I, I like Alexa. There's also Google mm-hmm. And then there's even specific senior focused, voice activated like hubs.

[00:11:58] And, but, but what's cool about them is you can say Hey Alexa. Call so and so, and you can make a call immediately. Your family members can drop in. It's a function that Alexa has where they can use their app and drop in and, and check on you and just say, Hey, how are you doing? And you'll hear it kind of broadcasted across your house.

[00:12:17] there's a lot of things besides just wearables that you can use to hack your house that I'd suggest. So yeah, Alexas, Google Homes Smart Lighting.

[00:12:25] There's motion detectors. Wearables, of course. If you are working with all four of those, then you've really covered a lot of the kind of crisis scenario or maybe you've mitigated the risks for crises quite a bit with those four things.

[00:12:39] Robin Rountree: I had never thought, but yeah. The security camera that I have outside my door,

[00:12:45] if I had that attached to

[00:12:47] an older person's house, 

[00:12:48] older 

[00:12:49] then the wandering at 3:00 AM I may get an alert that.

[00:12:53] What have they done to leave the house and then, you know, absolutely you can start solving that

[00:12:57] problem before it's

[00:12:59] 10:00 AM and you realize they've left. 

[00:13:02] Logan Dubose: Oh yeah. All of these things are ways that families can, check in that older adults can remain independent in the house, peace of mind and mitigating risks of falls and

[00:13:13] other crises forgetting medications, for example that's a large one. Lots on the horizon. And one other thing, robotics, this might be a few years from now,

[00:13:24] there's a world out there where you can see activities of daily living assistance being performed by different robotic assistance: transferring from bed to standing, for example.

[00:13:34] Or going to the restroom, with the assistance of maybe a, uh, literally a robot helping you kind of move across. Yeah. So that, that might be a little bit in the future, but I like to kind of think 10 years ahead. That might be something that we see as well.

[00:13:48] Robin Rountree: Yeah,

[00:13:49] And probably some people are cringing at the thought of a robot helping with something so personal.

[00:13:54] Sure. But I know the staffing issues that are assisted living memory cares are having.

[00:14:00] So 

[00:14:01] a person,

[00:14:03] maybe it's less embarrassing in front of a robot.

[00:14:06] Logan Dubose: You know, I'm staying in Austin this weekend and I've seen the self-driving cars, the Waymo's.

[00:14:12] It's absolutely. Crazy to me, and I still haven't taken one myself, but my friend did the other day and he said, oh, I would never have done this. But once I did it, I felt, I felt okay. I felt almost safer. It, it's crazy how we adopt these things. It seems crazy at first, but I don't know. We might see that it works out better in some cases.

[00:14:30] It's safer to work with technology to assist with some of these activities of daily living and such.

[00:14:35] Robin Rountree: I dunno if a robot will ever give a really good hug, 

[00:14:38] Logan Dubose: but that's fair. That's fair.

[00:14:40] you, you mentioned the staffing issue, and one thing that I've noticed talking to providers across the ecosystem is that is one of their biggest, if not their biggest concern, I might ask them.

[00:14:53] Hey, our, our directory can bring you some more families interested in seeking care with your facility. Are you interested in listing on our site? And they might say, yes, of course, but if you send them to me, I might not be able to staff the shifts. I need staff. I'm sure you've seen this. Yeah, 

[00:15:12] Robin Rountree: Yeah, it's a scary time.

[00:15:13] it's 

[00:15:14] I think there's a solution coming,

[00:15:16] but we don't

[00:15:17] have it yet. 

[00:15:17] Logan Dubose: Not yet. Um, and maybe this is for another time, but we are actively thinking about ways that we can mobilize and train more family caregivers of course, but also professional caregivers, to meet this need.

[00:15:32] Robin Rountree: And

[00:15:32] equitable pay would also be lovely. 

[00:15:34] Logan Dubose: Absolutely. It would be nice to use software and, and maybe artificial intelligence to increase the margins of a home care agency, right. So that the care providers themselves can be paid more.

[00:15:48] Robin Rountree: Yeah. 

[00:15:48] Logan Dubose: And have more career advancement opportunities as well.

[00:15:51] That's a big issue.

[00:15:52] quite frankly, more standardized training. Right now, I hate this term, it's called unskilled versus skilled caregivers. Have you heard this? I hate that too. Mm-hmm. Yeah. What's probably better is nursing and licensed care versus personal care.

[00:16:08] Personal care would be things helping with bathing, cooking, cleaning, um, transportation, things that might not require a registered nursing degree or a bachelor's of nursing degree. Right now is termed unskilled. Even though those things require a lot of skills, a lot of bedside manner, a lot of care, a lot of time, and prevent injury and acute crisis.

[00:16:29] Yeah. So we need more focus on this personal care, ADL assistance, um, and more staff in that regard.

[00:16:36] Robin Rountree: So what is on the horizon for dementia

[00:16:40] Logan Dubose: Yeah, so I think aging in place is a very great, phrase and rallying cry.

[00:16:49] For not just dementia care, but , for the aging population. The reason being is people prefer it.

[00:16:56] Yes, it's cost efficient. So why is it so hard? Why is it so hard? Um, especially for dementia patients. Well, patients with dementia wander. Falls are a concern. So to to dementia proof a house and to provide that support is not an easy task. And our family caregivers know that. So I think what's on the horizon is smart people with user-focused build, measure, learn product development cycles, coming up with solutions for each of these things to help people age in place.

[00:17:31] And then of course there's a stage where memory care centers are required. And so it's when we do need to go to a memory care center or an assisted living facility, how do we make that experience personalized? Where we have lower rates of delirium and sundowning and staffing issues or staff changes.

[00:17:53] These are all things that are huge risks for dementia patients. We need smart people solving these specific dementia related problems. Um. But that's a kind of a high level, vague answer.

[00:18:05] You know, we could dive into any one of those for a whole podcast, probably.

[00:18:09] Robin Rountree: Yes. 

[00:18:10] Logan Dubose: But there's lots of work to do. There's lots of work in this space. That's why there's such a motivation for young startups like ours, baby startups, and the National Institute of Aging, investing in us to try and solve even just one of these problems.

[00:18:24] I talk to lots of like founders and researchers, um, and, and doctors and clinicians who are very ,very interested in solving these problems. cause we all see what's coming. We see, we see a changing demographic , in front of us, so we need to get ahead of it.

[00:18:40] Robin Rountree: Yeah.

[00:18:41] Dr. Debo, I have to be nosy.

[00:18:44] Are your parents still with you? 

[00:18:46] Logan Dubose: Thanks for asking. Yes, they are. my grandparents, some of them are with us still.

[00:18:52] Okay.

[00:18:53] But if the question was going towards, have I had any experience with dementia personally?

[00:18:57] Robin Rountree: Yes. 

[00:18:57] Logan Dubose: My grandfather has vascular dementia, which is, hmm. A form of dementia that you get, um, after multiple strokes.

[00:19:04] So parts of the brain, um, become unhealthy after a stroke and, and that can accelerate some of the signs and symptoms of memory loss or behavioral change or mobility issues. So my grandfather has this he's about 81 now and my grandmother is his primary caregiver. And, I've been able to walk this journey in a sense as much as you can as the grandchild.

[00:19:29] And it's a lot of the things that you might read and research or hear about from a friend who's going through this. You know, it's, it's, it's a tough job you know, this is an individual who needs 24 7.

[00:19:42] Is dependent almost 24 7 for their basic needs so I've had that experience talking with my grandmother weekly about these scenarios. She sees, she sees every product feature on the website. She, she's the first user of most of our work.

[00:19:57] Robin Rountree: Well,

[00:19:58] I, I'm so appreciative that you have taken this break, you know,

[00:20:03] on.

[00:20:04] focus 

[00:20:05] Logan Dubose: the 

[00:20:05] technology around aging, and you'll also have that heart with that intelligence. So, you know,

[00:20:12] go

[00:20:12] forth and conquer Dr. Dubose. Well, I sure do appreciate you and your colleagues for the research referral that you all do. And hopefully we can all work together to make sense of this ecosystem for families. 

[00:20:28] Please make sure to subscribe to our podcast Informed Aging and tell your family and friends about us. If you'd like to support the work that we do at the Alzheimer's and Dementia Resource Center, please go to adrc cares.org/donate. That's it for now. We're looking forward to our next visit.

[00:20:50]