Leveraging Community for Successful Aging-in-Place

Posted on Jul 21, 2014

This blog post is part two of an interview with Martin Entwistle, Executive Director of the David Druker Center for Health Systems Innovation at Palo Alto Medical Foundation (PAMF). The Innovation Center team is working “to create disruptive solutions that tackle the pressing health challenges of our time,” Entwistle explains. “We think through real problems, build prototypes to address them, and develop solutions at the enterprise level for wider deployment.”

One such pressing issue is the impact of aging on seniors, their families and the wider community. Here, Entwistle offers a closer look at linkAges and its potential for activating communities to better care for and support aging individuals. He also shares insights into PAMF’s process for discovering and refining innovative solutions to our most pressing healthcare problems.

What does the PAMF innovation process look like?

We innovate by human-centered design which means peeling back the onion of the problem.  For example, in evaluating the issues faced by seniors, we may identify access to transportation as the problem, but this is a solution to one part of a bigger problem.  The real underlying issue is isolation and loneliness, which is multi-dimensional and requires solutions that provide a more systemic approach than just providing transport.

Our approach is heavily informed by ethnographic studies of the people who are the subject of our solutions. We use this approach to provide an in-depth understanding of the issues people face in their day-to-day lives, in this case seniors and their caregivers. This process helped us understand the importance of community and community-level support to address the issues of successful aging, and to begin to develop solutions that would directly tackle the identified underlying problems.

Further careful planning and execution is required. Solutions need to be designed and tested, typically through a process of prototyping, and sometimes these prototypes don’t get the expected results. In innovation you try something and you might have to throw it away, but even when you do create a successful prototype you have to think about how to deploy it, build it out and scale it, all the while making sure that the various components fit together and work as a seamless system. Going from prototype to actual deployment is one of the hardest steps in the process.

How is the Innovation Center approaching health care for a growing aging population?

As described above, our analysis of the barriers to successful aging identified the need to create a community of support for the aging process, and to enable people to grow old and remain valuable in society.  How do you get the support of the community when there is a lack of neighbors helping neighbors and your family is scattered across the country?  The experience was succinctly described by one of the participants in the ethnographic studies who reported “in older people their world dies before they do.”  They’d like it to be bigger and more expansive–have more people and hobbies in their lives, or simply be able to go to the store.  We realized the solution needed to be community focused and address social context and behavioral issues, including access and the ability to interact with others. It’s all about life continuing to be meaningful as people age.

It appears that many of the issues older people experience are driven by loneliness or isolation.  The focus of our linkAges program is to address these challenges and help people age in place successfully.

In what ways is linkAges innovating to change the current healthcare model?

Healthcare providers have extensive and in-depth information about the medical issues faced by patients, but frequently more detailed and current social information is lacking. There are significant direct and indirect opportunities for use of such social information; identification of people who have difficulty getting to appointments or to the store for food, alerting an individual’s physician that her patient is largely unsupported in their day-to-day life.

In linkAges we want to identify the people in need of interaction and activate community in a way that enables them to get support from other people.

One barrier for aging seniors could be their inability to pay for things. How do you access services if you don’t have money?  Our solution to this problem is time banking. Time banking creates an interconnected community of people who support each other with offers and requests for services where time, not dollars, is the currency.  Could someone come and cook a meal or mow the senior’s lawn, while the senior may offer to give knitting lessons or teach younger people skills like wood-working?  A key idea is to actively links across all ages in the community, not just seniors.

Another innovation component of linkAges is to try to identify people who are declining and provide support, before an adverse event happens. Can we build a detection system that tells the caregiver if a senior’s pattern of living is different?  We put out a developer challenge: how do you identify patterns and get alerts that something is not quite right with the senior?  We’re working with a company called Vevity. They had the idea to use utility smart meters which can tell you about energy usage within a household.  We could use that information to determine if the stove or lights are going on and off and use these patterns of activity to tell caregivers when the normal pattern of daily living habits has changed.

Finally, seniors have difficulty activating resources. Google and Yelp are typically well tailored to the specific needs of seniors. For example, a senior may want to know if a restaurant is wheelchair accessible, or which pharmacy will spend time to help them find just the right cane to help their mobility.  If they can’t find that out they won’t go.  If we start a database for this kind of information how do we maintain it? Can we get the community to support this?  We’re using our own internal team to do the analysis and find out if this is another part of the system we should tackle.


There’s a fundamental thirst for some kind of new community engagement for the aging population. Society has an appetite to address this challenge but it hard for organic solutions since communities are more and more fragmented. Even in younger people there’s a great desire to interact with older people.  They want to be part of giving; there’s a level of altruism.  It isn’t all about profiteering.  There’s a great interest in linkAges and it is very exciting to be creating a community model that could scale to significant size and have a major impact on successful aging, one of the most pressing issue of our time.

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