Aaron Iny

20172053
GLPH 385 Final Exam Notes

Module 1: Introduction to Aging, Biohacking, and Gerontechnology

Section 1: Normal Aging

Ageism
- Discrimination and devaluing of older adults
- Leads to barriers, preventing older people from finding employment

Video: Countering ageism by countering segregation

- Creating space and opportunities for interaction amongst ages is key
- Age-heterogeneous settings are essential to combating ageism
- Placing preschool children in nursing home has benefits to everyone

Diversity of Elders
- Median age is increasing everywhere
- More Black and LGBTQ+ elders

Demographic of older population

Older adults: 65 +
Old-Old: between 75 and 84
Oldest-Old: anyone 85 years or older
Centenarian: 100 +
Super-Centenarian: 110 +

Oldest-Old
- Majority women
- More widowed women than men
- Personal income is lower than rest of older population
- Disproportionately represented in hospitals and LTC settings – due to poverty
and lack of
social support as much as physical limitations

Chronological Ages vs Inside age

- Many older adults feel younger inside
- 20-40 years younger
- Despite looks they may feel the same age as you on the inside

*older adults with illness report their health is “good” or “very good” despite
presence of illness

Successful aging: requires combo of physical health and functional ability, high
cognitive
function, and active involvement with society
- Removed ‘physical health’ requirement
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Self-Efficacy: reflects confidence in the ability to exert control over one’s own
motivation,
behaviour, and social environment

Well-Being: the state of being happy, healthy, or prosperous

Resilience: ability to thrive under difficult situations, turning adversity into a

catalyst for growth
and emotional well being

Positive Aging: characterized by being adaptive and proactive in coping with

change, taking life
in stride.

Older adults with illness and pain still see themselves as aging well and
successfully with good
health

Lifestyle of Older Adults

- Mirror activities they engaged in when they were younger adults, if
financially and
physically able
- Many live on fixed income – like pension or investments/RRSP
- Many continue to work into older age, volunteer, religious, organizational
activities,
engage with technology, TV, internet, streaming….

Social Class and Economic Status

- Social class is result of economic status
- Social class shapes what is possible in old age

Major sources of Income for Older adults

- Canada pension and social security (USA)
- Other pensions
- Assets, such as interest-bearing savings and checking accounts, investments,
home
equity, and personal property
- Employment earnings
- Welfare
*older adults need 80% of their preretirement income to maintain their standard of
living in
retirement

Changing Conceptions of Work and Retirement

1. Encore Careers: new retirement jobs -emphasis on working by choice and for
employment. As well as careers to supplement income, encore careers include
non-
profit groups/programs.
2. Gliding Out: phased retirement. Slowly transition from workplace to
retirement. Also
associated with age-related discrimination including:
a. Failure to be offered training
b. Change in status from senior position to managerial position with less
authority
c. Transfer, even with the same pay, to a dead end job
d. Gradual demotion by taking away responsibility
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e. Poor evaluations for same quality of work

*high unemployment rates in older adults due to ageist stereotypes.

Social Gerontological Theory Basics

- Gerontology: the study of older adults
- Social gerontology highlights social theories of aging:
o Age Norms: open up or close off the roles that people of a given
chronological
age can play. There are assumptions we all make about age-related
capacities
and limitations
o Socialization: the lifelong process where individuals learn to perform
new roles,
adjust to changing roles, relinquish old ones, learn a “social clock”
of what is age
appropriate and thereby become integrated into society
o Role Discontinuity: means that what was learned at one age may be
useless or in
conflict with role expectations at a later age

Social Theories of Aging

- 4 theories of aging
1. Modernization and Aging Theory: factors in the current economic and societal
structures
have changed the way younger generations value older adults (ex: families in
the
modern era have little interest in caring for or supporting older adults)
2. Life Course Perspective: aims to bridge structural/societal level and
individual
psychological level factors that affect human development. Age cohort, time,
location,
agency, and relationships all affect the experience of aging. Takes into
account individual
decisions that affects one’s future along with accumulation of risks and
resources
3. Social Constructionism: idea that knowledge and meaning are socially created
and thus
is not an objective representation of aging. Means that aging is defined as
a “problem”
by cultures and society, rather than by biology and the biological changes
that occur
4. Feminist Gerontology: experiences of women are often ignored in understanding
the
human condition. Sex and or gender is a primary factor when considering
implications of
aging.

Module 1: Section 2: Introduction to Biotechnology and Biohacking

Evolution of Technology
- Technology is often though about as computers, cellphones, and wearables, but
in fact,
from the first time a human used a stone tool or a stick to paint on the
wall of a cave,
they were using technology
- Older generations may seem to some as being slow in embracing new technology
but
remember, they used the first phones that were developed and computers that
took up
entire rooms

Background of Hacking
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- In the 1960s, students and researchers at Massachusetts Institute of
Technology (MIT)-
people who are now older adults- gained the moniker of “hackers” as they
developed
technology that improved the operation of software and hardware in the early
days of
computers
- The original goal of hacking was simply to advance computing and networking
for the
challenge of it
- This goal fell to the wayside as some hackers searched for ways to illicitly
gain from their
skills
- Current goals of hacking generally fall into one of three categories
- Goals of hacking
o Permanently destroying data, software, or hardware in attacks
o Procuring information and access
o Disrupting computer activity

Defining ‘Biotechnology’
- The term biotechnology was originally used to refer to the use of living
organisms to
enhance crops, fuels, medical treatments, and other tools
- Over time the term has become an umbrella for many types of technologies
- The term biotechnology had been extended to include pharmaceutical
biotechnology-
the application of the principles of biotechnology to the development of
drugs- and-
implanted technology such as the cochlear implant and pacemaker- one of the
most
common biotechnologies used by older adults
- Over 20 years ago researchers and gerontologists suggested that,
“biotechnology holds
out the promise of significantly improving elderly health and quality of
life by alleviating
disabling conditions which plague our later years”
- Advances or learnings in biotechnology often affect experiments in biohacking
and vice
versa
- Biotechnologists often look to experiments done by biohackers to inform
directions in
biotechnology research, while many biohackers use breakthroughs in
biotechnology for
ideas and data

Defining ‘Biohacking’
- Biohacking is defined as, “biological experimentation (as by gene editing or
the use of
drugs or implants) done to improve the qualities or capabilities of living
organisms
especially by individuals and groups working outside a traditional medical
or scientific
research environment”
- In simple terms, biohacking can be described as citizen or do-it-yourself
biological
experimentation
- It can be something as simple as diet or lifestyle changes, to make small
improvements
in your health and well-being
- Additionally, biohacking is used to describe the application of technology to
biological
systems, most prominently the human body, but really it could be applied to
anything in
the biosphere
- Possible biohack’s
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o Simple tweaks like keto diet or intermittent fasting
o Computer chip implanted in the body
o Gene editing

Video: The Biohacking Industry

- Biohacking is now profit driven
- Dave Asprey, a biohacker and CEO of bulletproof 360, built a multimillion-
dollar brand
from his quest to live until 180
- He has used biohacking, new technical measurement tools, and a low-toxic
(bulletproof)
coffee he produces to alter his cognition, weight, and general health
- He takes supplements and applies electricity to his brain and muscles, to
improve his
body and mind

Examples of Biohacking
- Nutrigenomics
o Nutrigenomics is the science of how food interacts with individual
function and
health (how food you eat interacts with your genes)
o This area of biohacking also looks at how different nutrients affect how
you feel,
think, and behave
- DIY Biology
o BIY bio is a type of biohacking spearheaded by people with education and
experience in scientific fields
- Grinders and Makers
o Grinders are a biohacking subculture that hack their own bodies in a
number of
different ways including through implantation
o Makers create things, using technology like 3D printing, and are often
self-taught

Understanding Nutrigenomics
- Biohacking with nutrigenomics occurs when you manipulate what you eat to
influence
gene expression over time
- For example, altering your diet to avoid developing a disease you are
genetically
predisposed to get
- It has been demonstrated through various studies in humans, animals, and cell
cultures
that micronutrients, macronutrients, and naturally occurring bio-reactive
chemicals
regulate gene expression in diverse ways
- It is important to note that although nutrigenomics research suggests there may
be
some interaction between nutrition and minor gene expression, non-genetic
factors
(e.g., sedentary lifestyle, stress) have also been shown to influence health
outcomes
Controversy of Nutrigenomics
- The lack of scientific evidence to support the use of nutrigenomics in everyday
life
o There is currently no definite association between the genes examined
in
nutrigenomics testing many diet-related diseases
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o The many ethical considerations with the application of
nutrigenomics, including
the emotional/mental toll this information could take and whether
these
individuals are considered to be on a special diet

Nootropics
- Nootropics are a group of over-the-counter supplements that are marketed as
cognitive
enhancers, aimed at improving memory, focus, and concentration
- Some nootropics lie within the category of nutrigenomics
- Ginkgo Biloba
o Gink bilboba, a tree native to China, seems to show protective effects
against
diseases like Alzheimer’s, in bother human and animal models
o Research also suggests that this plant has antioxidant and anti-cancer
effects
- Methylene Blue
o Research has indicated that methylene blue has the ability to help
protect the
brain against some neurodegenerative disorders, along with cases of
traumatic
brain injury

DIY Biology
- Generally spearheaded by people with a scientific background
- Can also involve people with very little knowledge of biology
- This area of biohacking can involve diet, drugs, electronic technology,
software, DNA and
genes
- Examples of DIY biology include manipulating a plant’s genome to make it glow
in the
dark, or genetically modifying bugs and animals
- These biohackers share tips and techniques to help non-experts conduct
structured
experiments on themselves outside of a controlled experiment environment,
like labs or
medical offices
- Individuals performing these types of experiments are termed grinders

Grinders and Makers

- Closely related to DIY biologists (biohackers), are grinders and makers
- They are differentiated from DIY biologists because they are less regulated
and tend to
be more ad hoc
- Grinders and makers “hack” their own personal biologies “at home” and often
don’t
have the same educational/scientific background as a DIY biologist

Grinders
- Grinders are included in their own subculture of biohacking
- They often integrate technology into their bodies to try to improve their
health or
function
- In 2018, as article was produced by the New York Times that focused on grinder
culture
- Individuals highlighted in this article included a nurse who had radio
frequency
identification (RFID) chips implanted in order to access certain areas of the
hospital
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- Other individuals implanted sound-enhancing magnets in their ears to have
“built-in”
headphones
- Health concerns associated with implanting technology
o Increase risk of developing cancer and infections
o Silicone breast implants have been shown to have a connection to
anaplastic
large cell lymphoma (ALCL), a rare type of fast-growing non-Hodgkin
lymphoma

Non-Hodgkin lymphoma: a cancer that originate in your lymphatic system. Tumours

primarily
develop from lymphocytes, a type of white blood cell

Makers
- Makers are a subculture within the field of biohacking
- Makers create things and are often self-taught
- Makers extend beyond the scope of DIY biologists with the use of technology
- They often intersect with hacker culture, with the creation of new
technological devices
as well as tinkering with existing ones
- Makers and biohackers converge at the 3D printer
- Makers become biohackers when, instead of using plastics, they’re using
biomaterials to
build three-dimensional structures, for example, using bioinks made of living
cells

Bioinks- substances made of living cells that can be used for 3D printing of
complex tissue
models

Differing Opinions
- DIY science involves, “entangling different views on themes such as
innovation, ethics,
new technologies, education, employment, and risk assessment”
- Currently, some individuals believe that biotechnology/biohacking is the key
to
curing/preventing genetic illness and/or disease and extending life
- Others continue to show increased concerns surrounding the ethical
implications and
risks associated with certain ‘biohacks’

Section 3- Geotechnology
- Gerontechnology is technology designed to be used by older adults
- Stereotypically, gerontechnology is generally associated with illness or lack
of capacity in
some area
- Recall that most older adults are physically fit, competent adults, who are
capable of
caring for themselves
- Therefore, when considering aging and technology, it is important to take a
problem-
based approach rather than an aged-based approach
- Current anti-aging technology includes innovations like stem cell therapy,
gene therapy
and gene editing and cybernetics (e.g., Cochlear implants, artificial
retinas, prosthetic
 limbs)
- Technological devices can further assist older adults to age in place, by
monitoring
health, supporting social connection, and providing activities for leisure
time
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- On the cutting edge of the technology of aging is nanotechnology, cell
regeneration, and
whole brain emulation

Smartphones and Tablets

- Used by all ages
- By using these for communication, entertainment, education, and intellectual
stimulation, they have helped older adults overcome loneliness, relieve
stress, and
promoted independence and self-efficacy
- However, it is important to recognise that smartphones and tablets often have
apps that
can be utilized to track and monitor older adults behaviour, physiological
states and
location, which can have both helpful and sinister connotations
- Knowing where an older adult is and what they are doing, as transmitted by GPS
locator
and/or biofeedback applications, is a form of surveillance that allows
caregivers and
family members to ensure that they are made aware of any change in health
status
- Although his may be beneficial for family members, many older adults find the
tracking
aspect of smart phones to be a privacy invasion

Wearables for Older adults

- Personal fitness trackers (PFT) and smart watches (i.e. fitbit, apple watch)
are wearable
devices that record data, such as physical movement (i.e. steps, sexual
activity),
physiological data (i.e. respiration and/or heart rate, blood pressure), and
user inputted
data (i.e. calories ingested)
- They are worn on the body and record data 24-hours a day
- They may have additional functions such as sleep trackers, GPS locator/tracker,
some are
substitutes for a cell phone, or will alert the wearer of phone calls on your
cell phone,
social media modifications, and even have the ability to make payments
- Overall, these devices have similar uses for both older and younger adults

How wearables have been used similarly by older and younger adults
- Receive biofeedback to better understand their body’s physiology
- Receive calendar and appointment reminders
- Track physical activity to address fitness goals
- Provides social media updates

Issues with wearables

- They have the potential to be used for surveillance via GPS monitoring or
just by
text/email/phone contact, with or without the older adult’s permission
- A study by Rosenberger et al. (2015), which looked at nine different wearable
devices
reported the devices they studied had a tendency to over report sleep, and
many
devices did not accurately record moderate activity
- This is important because active older adults may move more slowly or less
vigorously
than younger adults
- If this movement is not captured correctly captured by the device, it results
in readings
that suggest the wearing is less active than they actually are
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Home Monitoring Systems

- Home monitoring systems, sometimes called ambient assisted living (ALL)
systems, are
generally used for older adults who are perceived to need monitoring 24/7
- Private spaces can be fitted with sensors that record data and can alert a
caregiver if the
older adult being monitored is perceived to be in need of assistance

Role of Sensors
- Sensors can be placed throughout the home of an older adult to monitor various
activities and detect signs of concern
o Detect when the refrigerator, medicine cabinet, or other door us open
or closed
o Detect if the stove is on or if the water is left running
o Record activities in bed, including respiration, heart rate, and
movements
o Detect stumbling and/or falls
o Video recording of a room

Cost Effective method of monitoring

- Home monitoring systems are considered cost effective for care providers, who
might
otherwise need to be with the older adult client 24 hours a day
- All information gathered by these systems are evaluated by algorithms designed
to alert
caregivers and/or family if an alert is triggered
- Although these systems require a database server and web portal to provide
caregivers
and family with the ability to review the data, this cost is usually less
than hiring
someone to be with the older adult 24/7

Issues with AAL Systems

- As with the other types of gerontechnology discussed, privacy concerns have
been
reported by older adult clients of AAL systems, by researchers and
caregivers
- These devices collect data on the activities of older adults under
surveillance, including
what they do in the bedroom
- The ‘personal life’ of the older adult becomes known to their caregivers and
even family
members
- For example, a surveillance alert triggered by an older adult spending too
long in the
bathroom, turned out to just be that the older adult loved to take long
bubble baths

Ethics of Gerontechnology
- As you just learned, various products are available to monitor the daily lives
of older
adults
- Although this is beneficial from a health care prospective, it is important to
think about
the ethical considerations or obtaining this data and where it may end up
 - Technologies, such as wearables, tablets, and home monitoring systems, collect
and
combine small pieces of personal, wellness, and health data throughout the
day
- During data transmission and storage, there is potential for issues to occur
during
transmission from the decide collecting the information to the
analysis/storage site
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- For example, health surveillance data in some cases is sent via wireless
connection and
transmitted to the webserver via Bluetooth, making too vulnerable to
unauthorized
access

LISC 385 – Module 2

Section 1 – Biohacking and the Functional Changes of Ages

Why fight aging?

 Modernization and aging theory: propose that families have little interest in
caring for or
supporting older adults
 Social constructionism: proposes that aging is a problem because societies
define it as a
problem, not because of intrinsic issues such as physiological changes
 Older adults may be faced with family rejection/society rendering them
obsolescent and
stave off age-related changes or find workarounds for common issues faced
while aging
(i.e. reduced mobility) is very attractive

Primary and Secondary Aging

 Aging is the progressive decline in the body’s ability to maintain
physiological
homeostasis, ultimately causing death
 Primary aging: accumulation of macromolecular damage throughout lifespan which
impact physical performance and fitness
 Secondary aging: based on external factors such as diseases, environmental
exposures,
and lifestyle (e.g., overeating, sedentary behaviour)
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Biohacking
 Optogenetics, neurogenesis, nutrition, nutrigenomics, calorie restriction,
CRIPSR-Cas9

Optogenetics
 Uses light to control neurons in the brain, involves light sensitive ion
channels
 Scientists have generated modified neurons in mice to add light sensitive
channel
o When shine light on mouse, causes neurons to fire and send signals in
the brain
o Enables control over which neurons are activated, thus controlling the
brain
 Relatively new field, huge potential for neurodegenerative disorders such as
Parkinson’s
 Study looked at use of optogenetics in degenerative eye conditions
o Five participants with retinitis pigmentosa were injected in the eye
with a virus
carrying the gene for a light-sensitive protein
o Idea that retinal ganglion cells would respond to red light projected
into eye,
results for proof of concept and to explore this in a larger group

Neurogenesis
 Brain’s ability to grow new neurons, rate declines with age but it is still
occurring
 Research on mice suggests that simple ‘life hacks’ can improve health and may
increase
neuron growth
 To increase neurogenesis according to Ted Talk, older adults can:
o Keep brains active through learning and education
o Decrease stress
o Adequate sleep
o Regular sex
o Regular exercise
o Alter diet to include nutrients such as omega-3 fatty acids or folic
acids, can
engage in calorie restriction
 Benefits of increasing neurogenesis in older adults:
o Increasing production of new neurons; role remains unclear but thought
to play a
role in learning and memory, depression, and to protect against
Alzheimer’s
o Study in which diet changes to increase neurogenesis also resulted in
increased
memory capacity and improved mood

Biohacking through Nutrition

 One of the a ways to biohack age, certain food slows effects of primary aging
 Omega-3 fatty acids: fights chronic inflammation (which makes cells divide
faster and
prematurely wears down telomeres)
o At least 1000 omerga-3 fatty acids a day from sources such as fish
(salmon) or an
algae supplement is recommended to prevent premature aging
 Fibre: fights chronic inflammation by preventing insulin spikes
o 25g per day from legumes, produce, and grains
  Vitamin c: protects cells from oxidative damage (which can shorten telomeres)
and helps
increase bone and muscle growth
o From citrus, fruit berries, and bell peppers
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Nutrigenomics
 Biohack that falls under umbrella of nutrition but is more focused
 Aims to improve health and functioning by individualizing diets according to
people’s
genomes, currently only a theory and needs further research
o Evidence that genetic mutations in enzymes that influence metabolism
can alter
health
 Uses investigative tools on the genome to understand how the response to a
certain diet
may vary between an individual and a group
 Hypothesize that diets will be designed based on individual genomes
 Evidence for nutrigenesis in genetic diseases that are influenced by diet:
o Vitamin D deficiency seems to play a role in Crohn’s disease
o Phenylketonuria, celiac disease, and lactose intolerance are examples
of nutrient
and gene interactions
 Concept for nutrigenomics rests on two assumptions:
o Influence gene expression: food you consume can have direct or indirect
influence on the human genome, and influence the expression of genes
o Modify cellular processes: b/c of influence on gene expression, dietary
patterns
and/or specific dietary components may modify multiple cellular
processes
including aging

Calorie Restriction
 Diet-based biohack that focuses on a behavioural change more than what you are
consuming
 Reduction in caloric intake while maintaining nutritional balance
 Most studied method for biohacking age through diet
 Continuous calorie restriction (CCR): sustained reduction of 20-50% of normal
calorie
intake
o Most widely recommended calorie restriction regimen for weight loss
and
prevention of obesity-associated diseases
 Intermittent calorie restriction (ICR): phases of severe energy restriction
and regular
energy intake, e.g. five days on a normal diet and two days reducing
calories 75%
 Study compared CCR and newer ICR found that both result in similar
improvements to
metabolic functions over 50 weeks
 Excess fat combined with lower levels of physical activity results in loss of
skeletal
muscle strength, mass, and quality, which increase secondary aging by
impairing
metabolic function
o Calorie restriction to lose weight and reduce fat composition to
counteract the
metabolic dysfunction and secondary aging
o Animal studies show that calorie restriction increases lifespan
significantly and
stops or delays the onset of chronic diseases such as obesity, T2D,
cancer
 CRONIES: Members of the calorie restriction society voluntarily restrict
calories to 50%
of a typical western diet, found to have very low risk factors for secondary
aging
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o They have cell indicators which resemble younger individuals,
suggesting that CR
can prevent primary againg too

Calorie Restriction Vs. Exercise

 Other effects (some deleterious):

 CR: decrease bone density, increase risk of frailty, decrease
cardiorespiratory fitness,
decrease muscle strength, mass and quality, good for initial weight loss but
if
discontinued there is weight gain
 Exercise: increase bone density, decrease risk of frailty, increase
cardiorespiratory
fitness, increase muscle strength, mass, and quality, bad for initial weight
loss but good
for maintaining
 CR and Exercise together:
o Do not necessarily have an additive effect
o In general, combined exercise and CR regime had no increased effect on
weight
loss, fat loss, insulin sensitivity, glucose tolerance, BP, or HR
variability compared
to CR
o Combination does have better effects in older adults because CR
counters
primary and secondary aging while exercise decreases fragility and
increases
aerobic capacity

Gene Editing: CRISPR-Cas9

 Two main threats to longevity are illness and age-related declines
o Gene-editing can address both these threats with CRISPR-Cas9
 Can biohack aging using telomerase and myostatin
o Can be delivered to cell via a modified bacteriophage that carries the
corresponding gene to inject it into host cell and cause
transcription
 Telomerase: enzyme that restores telomeres, which shorten as we age
o In mice, this gene therapy has extended longevity by 24%
 Myostatin: protein produced and released by muscle cells that inhibits muscle
cell
growth and differentiation
o Myostatin inhibition gene therapy (using follistatin) has been shown to
promote
muscle growth in some people with a type of muscular dystrophy
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Access to Biohacking
 Diet-based biohacking is more accessible but still limited by SDH
o Income and social status: nutrition and nutrigenomics can be expensive
and not
available to those of lower SES
o Education and literacy: influence ability to understand information
o Physical environment: influences ability to hack diet, may not be
geographically
accessible or are restricted by times when they can eat
 Optogenetics is only accessible through educational financial resources

Section 2: Diet and Body Modifications

Biohacking through body modifications

 Body modifications are “procedures to achieve permanent alterations of the
human
body”
o Tattoos, piercings, etc. are body modification but not anti-aging
techniques
 Three key elements of body modification:
o Voluntary: individual voluntarily makes these modifications to their
body
o Aesthetic: body modifications intended to alter appearance of the body
o Non-medical: do not change functional/physiological processes of body

Timeline of Aesthetic Surgery

*body modifications are used to make bodies conform to a socially constructed image
of the
ideal
 The Huns in Europe: 4th century AD, used two-bandage system to intentionally
modify
cranial structure, did this to differentiate form other nomadic groups
 Colonialism in Africa: aesthetic surgery to change shape of nose or eyes to
modify
“African” features to produce bodies more closely like those of white
colonizers
 Maori: 13th century, New Zealand natives tattooed faces and body to mark
identity and
social standing, very well documented, integral part of tribe
 Modern perspective: body modification has become a multimillion-dollar
industry over
last few year, in part due to development of non-invasive options for
treating fat
deposits, cellulite, and skin laxity
o Also, surgical procedures to alter appearance and remove physical
signs of aging

Motivations for Body Modification

 Body modifications used to be stigmatized, now normalized, all genders do it
 Expression of Agency: one reason for body modification is to establish/maintain
identity
o Makeover culture promotes idea that anyone has the right to express
themselves
to the world in a way that matches inner person
o Aesthetic surgery is part of this culture when it is marketed and
undergone with
the purpose of self-making
o Body modifiers are now considered consumers of a product, not patients
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o Advertising says body modification acts a solution by “correcting”
undesirable
features
o Choosing to modify the body can be seen as the expression of agency,
with the
consumer engaging in modification to create a body that reflects how
they see
themselves
 Psychological Healing: 2010 study of body modifications in Brazil, found it
promoted as
a type of psychological healing
o There are advocates for body modifications to be implemented into
public health
care system as a therapeutic intervention
o Expectation that after aesthetic surgery, individual will be more
accepted by
social groups because they meet societal standards of beauty
 Body Modifiers: changing physical appearance purely to fit normative beauty
ideal, not
to express their personality
o Done for utilitarian reasons (e.g., job where older appearance result
in
discrimination)

Types of Surgical Body Modifications

 Results in physical change to help individual develop/complete sense of self
of identity,
feel as though their appearance does not reflect the age of inner self
 Hair transplants: counter balding
 Shaping implants and lifts: counter loss of tissue, stretching, sagging
(implant), lift and
tighten or remove excess skin to smooth out folds and wrinkles (lift)
o Cost of implant is 7000-10000
 Body Sculpting, Liposuction, and Fat transfer
o Removal of fat to shape body into more culturally acceptable form
o Cost of liposuction to entire abdomen can be $10000
 Cosmetic surgeries are done at high rates around the world
o In 2016, global breast implant market was worth 1.2 billion USD
 Expected to grow because of prevalence of breast cancer

Complications associated with shaping implants

 Temporary: implants themselves are temporary must be surgically replaced
periodically
o Complications include swelling, bruising, bleeding, accumulation of
fluid under
the skin
 Permanent: asymmetry, implant shifting, cosmetic dissatisfaction, scarring,
leakage,
muscle, or nerve damage
o Can be corrected by further surgical procedures
 Life-threatening: infection, pooling of blood outside of blood vessel

Non-Surgical procedures:
 Uses emerging technologies to change appearance without surgery
 Ultrasound technology: increases skin elasticity over 3-6 months
o Works by necrosis, targeted cells die from high-intensity focused
ultrasound
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o 1-2 treatments are required, painful, may cause temporary damage to
superficial
skin layers (bruising and tenderness for up to 2 weeks)
 Microwave technology: uses radiation to treat fat deposits, cellulitis, and
skin laxity,
significantly reduces abdominal circumference
o Positive influence on skin tone and texture, not shown to change BMI
o Targeted fat cells absorb energy which causes irreversible damage,
destroyed
cells are removed from body, cooling system used to prevent damage
to
surrounding skin from radiation
 Cryolipolysis: applying cold to fat cells to cause apoptosis
o Significantly reduce far at target site from a single low pain
treatment
o Can result in numbness and bruising around target area for 7 days
Regulation of Aesthetic Procedures
 Not as carefully regulated as medical procedures because considered cosmetic
 Implants are approved without proper investigation into their safety
o Non-medical implants are even less regulated
 Issues with aesthetic surgeries & lack of regulation:
o Medical/legal support when complications arise
o Accessibility to those with lower incomes

Effectiveness of Body Modifications

 Can increase confidence when successful
 Sometimes problems with modifications, leaving them disfigured or requiring
another
surgery
 Do not prevent aging, there will be new wrinkles and skin will sag
o No way to halt age-related changes at this point

Global Access to Body Modification

 Not an option for low-income individuals or countries without extensive
medical
infrastructure
 In some cultures, older adults are respected, so there is little interest in
body
modifications

Emergence of Medical Tourism

 Individuals traveling abroad to obtain medical treatment, usually to a less-
developed
country where the procedure is offered for less money and healthcare system
is less
regulated (e.g. global south)
 Top eight countries:
o Thailand (1%)
o Germany – 2.7%
o Japan – 2.7%
o Italy – 2.8%
o Columbia – 3.2%
o Mexico – 4.8%
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o Brazil – 13.6%
o USA – 14.5%
 Implications of medical tourism
o Increases global access to healthcare, but poses a number of
challenges:
o Lack of follow up care, increasing risk of complication
o Increase demand in home country when complications arise, may not have
adequate facilities to fix complications, difficult to treat
complications b/c lack of
medical records in home country
o Procedures are cheaper but increased cost for extended stay abroad
o Language and communication barriers

LISC 385 – Module 3

Senescence- The condition or process of deterioration with age

Section 1- Implants

Introduction to Biotechnology
- In the simplest terms, biotechnology is the application of technology to
solve problems
in biology
- Biotechnology is an umbrella term
o Biohackers, biopharma and Bioengineering fall under the umbrella
- Biohacking focuses on the less technical aspect and often involves working
outside
traditional medicine
- Biopharma refers to the biotechnology-based development of drugs
- Bioengineering refers to implanted technology and bionics

Motivations for Biotechnology in the Context of Aging

- To remain active
o Older adults may use biotechnology to help them remain socially,
intellectually,
and physically active
o For example, joint replacements can help an older adult continue to
participate
in their favourite sport
- Moderate impacts of Aging
o Older adults facing challenges in terms of mobility, vision, hearing,
etc., may wish
to moderate the impacts of these challenges using biotechnology
o For example, cochlear implants can help to mitigate hearing loss and
enable
older adults to communicate better

Bioengineering Examples
- Implants (focus for rest of section)
o Cochlear implants
o Retinal implants
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o Pacemakers
o Neurological implants
- Bionic Prostheses
o Joint replacement
o Bionics
o Cyborgs
- 3D printing and wearable Robotics
o 3D printed organs
o 3D printed limbs
o Exosuits

Introduction to Implants
- In the context of biotechnology, an implant refers to a piece of technology
that has been
placed inside the body
- Introduction to implants
o Cochlear Implants, which function to improve hearing
o Artificial vision, which functions to improve eyesight
o Pacemakers, which function to manage heart arrhythmias
o Neurological implants, which aim to improve brain functioning

Hearing Loss and Cochlear Implants

- The Canadian hearing services reports that nearly ¼ adult Canadians report
having some
hearing loss, and hearing loss is the third most prevalent chronic condition
in older
adults
- Hearing loss among older adults can be associated with social isolation,
depression, poor
health outcomes, cognitive impairment, increased risk of fall and
hospitalization, and
excess medical costs
- Since age-related changes are the most common cause of hearing loss, the
incidence of
hearing loss is predicted to climb as the world population ages
- Biotechnologies can offer the opportunity to counter hearing loss for those
who wish to
do so
- When hearing loss is beyond the capability of hearing aids, cochlear implant
biotechnology can be used for those with moderate-to-profound hearing loss
and has
been an effective management option for decades

Implication of Cochlear Implants for Older Adults

- Only about 20% of older adults with hearing loss buy a hearing aid and many of
those
are rarely used
- Common reasons given for not trying or using a hearing aid are
o Association with age
o Too complicated
o Friends with hearing aids say they don’t work
o Cost (one hearing aid may cost around $2500)
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Vision Loss and Artificial Vision

- The loss of vision can be debilitating for an older adult
- Biotechnology devices that can supply artificial vision are under development
- This biotechnology generally involves the transfer of signals from a camera
(usually built
into a pair of glasses) to a cluster of electrodes at the back of the eye
- Two examples of biotechnology devices that can supply artificial vision
o Argus II (https://www.science.org/content/article/new-technologies-
promise-
sharper-artificial-vision-blind-people )
o PRIMA Bionic Vision System (https://www.pixium-vision.com/)

Cardiac Implants
- Cardiac implants are a form of biotechnology that have been used for decades
to
mitigate heart-related functional losses
- These devices are typically used alongside medication to manage irregularities
in cardiac
rhythm
- They type of cardiac implant chosen for an individual depends on the severity
of the
arrhythmia they present with
- Pacemakers have been 3D printed
- Two examples of cardiac implants:
o Pacemaker
 A small device implanted in the chest to monitor an
individual’s heart rate
 When an irregular heart rate is detected, such as a heart rate
that is too
high or low, electrical impulses will be send from the device
to the
individual’s heart to stimulate a normal rate of contraction
o Implantable Cardioverter Defibrillators (ICDs)
 ICDs are a more recent form of cardiac implants, developed to
prevent
sudden cardiac death syndrome (an unexpected death caused by
a
change in heart rhythm)
 ICDs are implanted under the skin and monitor cardiac rhythm
 An ICD can respond to sudden life-threatening irregularities in
cardiac
rhythm by delivering a shock to reset the hearts rhythm back
to a normal
pace

Living with a Cardiac Implant

- Risks associated with pacemaker system implant include, but are not limited
to, infection
at the surgical site and/or sensitivity to the device material, failure to
deliver therapy
when it is needed, or receiving extra therapy when it is not needed
- After receiving an implantable pacemaker system, the individual will have
limitations
with respect to magnetic and electromagnetic fields, electric or gas powered
appliances,
 and tools with which they are allowed to be in contact

Neurological Implants
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- Neurological implants involve electrodes that sit on the surface of the
brain, which then
transmit this information to an external device
- The brain computer interface (BCI) is a computer-based system that acquires
brain
signals and wirelessly transmits them to an output device, which then
carries out the
desired action
- BCIs aim to help people with a variety of different conditions., including
helping older
adults with communication and mobility

BCIs for Communication

- Speech requires many structures in the throat, such as the lips, tongue,
larynx and jaw
- When these structures fail to function (e.g. due to stroke) communication is
hampered
- Brain-computer interfaces (BCIs) aim to help improve communication for people
with
paralysis by ’reading’ their intention directly from the brain and using
that information
to control external devices or move paralyzed limbs
- BCIs that facilitate communication initially had successes with brain-
controlled typing at
a speed of about 8 word/min
- This had been extended further, with additional research leading to the
development of
a process whereby neuron signals can be translated into vocal tract movement
and
subsequently into speech

BCIs for Mobility

- Neurodegenerative diseases (a group of disorders that are characterised by the
progressive degeneration of the structure and function of the central
nervous system or
peripheral nervous system), stroke, or catastrophic loss of mobility due to
an accident
can result in loss of bodily control
- BCIs have been utilized to control robotic arms by targeting brain signals
from the cortex
- BCIs can only function effectively if neuronal data recordings are made with
high
temporal resolution
- This is accomplished by using intracortical recordings
- Similarly, BCIs can also be sued to control external devices (like bionic or
cyborg units) to
help people with paralysis by ‘reading’ their intentions directly from the
brain to move
paralysed limbs

Video: BCIs and Communication

- BCIs aim to provide individuals with an alternative form of audio
communication
- video on how BCIs are being developed to help with speech
- generating synthesized speech from brain signals
Transcranial Magnetic Stimulation
- Dementia and memory loss are not inevitable aspects of aging
- Most older adults will not suffer memory loss, through the fear of losing ones
memory
can be terrifying
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- A current biotechnology underdevelopment is looking at the use of
transcranial
magnetic stimulation (TMS) to treat neurological and neurodegenerative
disroders, such
as depression, Alzheimer’s, Parkinson, and stroke
- TMS involves the use of an electromagnetic coil that is places on the scalp
of an
individual
- This produces a magnetic field which can then stimulate specific areas of
the brain
- Previous research indicates that repetitive stimulation through TMS has
shown improved
stabilized cognition in Alzheimer’s patients

Neurohacking
- A form of biohacking
- Technically a DIY neuroimplant, without a doctors supervision, that is
intended to
stimulate the brain and improve mental acuity
- Individuals partaking in this biohack, such as grinders and makers, apply
electricity to the
brain either through a homemade gadget or a device that can be purchased
online
- This form of biohacking is less regulated and is typically done in private
spaces without
medical supervision
- Side effects of this method can include tingling, headache, dizziness, and
skin redness

Video: Your Body vs. Implants

- Video provides an overwide of implanted biotechnology
- Immune system tries to destroy things that shouldn’t be there
- Triggers a foreign body response
- Scientists try to find ways to trick the immune system

Potential Issues with Neural Implants

- Variety of potential issues due to their proximity to the brain
- There are some very serious problems associated with stimulating brain
activity through
magnetic fields
- Core issues associated with neuronal implants s
o Risk of seizure: Due to the relatively strong current required to
activate target
neurons, activating multiple electrodes at once risks triggering a
seizure
o Risk of Vision Distortion: Activating neighboring electrodes can
stimulate the
tissue between them, fusing two discrete visual points and blurring
vision
o Risk of infection: implanted biotechnology could result in scarring
of the
surrounding brain tissue, potentially leading to an infection.
Further
complications, such as tissue damage, could occur if the implanted
device is
attached to external wires. This could be prevented if wireless
connections can
 be utilized to power devices and transfer data

Global Health Perspective

Precision Medicine- Medical care designed to optimize efficacy or therapeutic
benefit for groups
of patients, especially by using genetic or molecular profiling. This includes
bioinformatics,
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genomic sequencing, drug discovery, companion diagnostics, big data analytic
software, and
others.
- The global precision medicine market, Bioinformatics, genomic sequencing,
drug
discovery, companion diagnostics, big data analytics software, and others
was 43.98
billion USD in 2018 and is anticipated to reach around USD 86.25 billion by
2025
- North America’s aging population, which suffers from chronic diseases, have
high
adoption rates for technological advancements
- This along with developed health care infrastructure are driving the
precision medicine
market in the US
- Europe also shows a high level of technology use due to their developed
healthcare
system, insurance, research, development support and strong adoption rates
among
healthcare professionals
- Germany has demonstrated an increased demand for targeted therapy
- Areas like the Asian Pacific region, including China, are expected to
increase their
utilization of technology over the next few years due to increases in the
prevalence of
cancer and large number of older adults
- India is also expected to increase the use of technology
- Latin America, especially Brazil, is expected to have moderate growth over
the forecast
time period
- The middle east and Africa precision medicine market will register slow
growth in the
upcoming years, owing to the underdeveloped healthcare infrastructure and
lack of
advanced technologies in the region

Section 2: Joint Replacements, Bionics, and Cyborgs

 Made to restore functioning to those whose mobility has been impaired (common
challenge with aging)
 Joint replacements: surgical procedure, arthritic or dysfunctional joint
surface is replaced
with an orthopedic prosthesis
 Bionic prosthetics: replacement of a limb or body part by an artificial limb
or part that is
electronically or mechanically powered
 Cyborgs: person whose physiological functioning is aided by or dependent upon
a
mechanical or electronic device

Joint Replacements
 Allowed older adults with painful chronic diseases such as osteoarthritis to
regain
mobility and enables them to remain active in their daily lives
 Three most common joint replacements in older adults:
o Knee replacements
o Hip replacements
 o Shoulder replacements

Demand for Joint Replacements

 Hundreds of thousands performed yearly (globally)
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 Canadian registry: in 2016-2017 there were 55981 hip replacements and 67169
knee
replacements performed in Canada
o Represents increases of 17.8% and 15.5% than 5 years earlier
 Demand is expected to increase as population ages
 Expensive without healthcare coverage
o Average cost of 10,000 per joint replacement surgery in Canada
o Also expensive to healthcare system, need to look for opportunities to
avoid
surgeries/avoid negative outcomes after surgery
o Need to be replaced every 20 years, creates additional cost

Materials of Joint Replacements

 Originally was a metal joint and socket that would rub together and release
metal ions
into blood stream
o Ions would lead to issues such as kidney disease and neurological
damage
o Replaced by metal on ceramic or metal on polyethylene, but also
subject to wear
and release of metal particles
 Now most popular composition is ceramic on polyethylene or ceramic on ceramic
(but
known to squeak)
 Technology is constantly evolving, researchers try to combat issues such as
post-
operative infection and joint loosening over time
 Since late 1990s, patient info and info on joint replacements stored in
registries around
the world, allows for identification of people through serial number on
replaced joint
o Vital when there are mass causalities since human identification is
possible

Bionics
 Special type of artificial limb, also called prosthetics, that are engineered
with the goal of
biological functionality
o Different from basic prosthetics, which are supportive or cosmetic
 Used to replicate natural human function, been around since WWII, when
electronically
driven hand prostheses were developed
 Bionics can be any limb

Challenges with Bionics

 Attachment: challenging to design a bionic limb that is both secure when
attached to the
body but also comfortable
 Control: challenging, especially for neurological control which would allow
seamless
movement of limb
 Sensation: most do not have a way to sense different stimuli in the
environment (i.e.,
ability to sense touch). Most prosthetics, even sophisticated ones, do not
enable
amputees to feel the ground under foot
 Every technology has a trade-off
 o May be heavy, expensive, have long/difficult rehabilitation regimes,
or only work
for certain residual limbs
 E.g., work for below elbow amputation, but not above
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 If proven beneficial, may be added to insurance coverage and rehabilitation
regimens or
may remain accessible only to the elite

Examples of Bionic Limbs

 I-Limb
 MIT biomechatronics group: developed system of 24 sensors and 6 micropressors
to
have prosthetic limbs move like human limbs
o Still cannot feel limb moving or when it encounters the group
o Also developed a “neuro-embodied design” that integrates the wearer’s
nervous
system, including tendons and nerve endings, with the prosthetic to
produce
more cyborg-like experience
 Utah knee: designed specifically for amputees who cant use regular prostheses
o Only 6 pounds (lighter than others), so beneficial for older adults
because
doesn’t require good balance or strength to move prosthesis
o Gone through testing stage with 10 participants and is expected to be
widely
available starting b/w 2024-2029
o Battery powered electronic system that operates the sensors instead of
detecting
signals from residual muscles
 Sensors communicate with AI system to determine type of movement
being attempted
 AI signals the motors to move like human muscles walking,
running,
climbing stairs, or standing up

Bionics and Aging

 After age of 60, increased risk of inadequate circulation in legs
(dysvascularity), which
can result in leg amputations with comorbidities including diabetes and
cardiovascular
disease
 Extra exertion needed for artificial leg is important factor in older adults
ability to use
prosthesis
o Fear of falling, number of falls, social circumstances, and whether
there is help
available is important when choosing bionics
 Common difficulties older adults have with traditional prostheses
o Usage: an above- or through-knee artificial limb can be difficult to
use, heavy,
frustrating, so much that many choose a wheelchair instead
o Pain: stump pain, pressure ulcers, and infections can lead older
adults to
discontinue use after initial interest

Bionics vs. Limb Transplants

 Transplantation is a well-known solution for dysfunctional organs such as
heart
o Limb transplants are not as common
 Pros and cons of bionics:
o Lots of engineering required to create, successful use varies
depending on how
much of the limb needs to be replace (e.g. above or below the elbow)
o May be time limited due to degradation of bionic limb
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o Younger ppl require new limbs as they grow
o Rehabilitation can be long process with differing degrees of success
 Rejection rate of 1/5
 Pros and cons of limb transplants:
o Replaces missing body part with real limb from a donor
o Limbs are warm to touch and have self-repairing qualities of biological
tissue
o Silent (unlike bionics), more aesthetically pleasing, and unable to
take on/off
o Requires immunosuppressants and carries risk of rejection among other
issues

Cyborgs
 Refers to complete integration of technology into biological system,
technology is a full
part of body with two-way communication to nervous system
 Integration of human body and technology is not a 1-time event, forgotten
after
installation; interaction continues

Older adults
 Many older adults who lose a lower limb are initially interested in
prostheses, however
stump pain, pressure ulcers and infections can lead to discontinued use
 New bionic and cyborg style prostheses are lighter and better fitted, which
can enhance
mobility, facilitate social interaction, and prevent social isolation

Global Health Perspective

 Globally, bionics market valued at 20.3 billion USD in 2019, expected to reach
32.7 billion
by 2025
 Geographically bionics market can be split into North America, Europe, Asia
Pacific, and
the rest of the world
 North America expected to control market for next 6 years, but global
distribution of
aging population is expected to increase demand
o Japans high prevalence of eye-related diseases makes it an ideal
market for
country’s eye bionics
 Presence of well-funded healthcare system is key to the availability of
bionics since they
generally require a high level of sophistication in terms of eh facilities
where they are
installed (and highly trained installers)
o Due to rise of key economies such as India, Japan, and China, Asia
pacific is
expected to be the fastest developing region

Section 3: 3D Printing and Wearable Robotics

 3D printers are 3D objectives from a computer-aided design

o Can fabricate various biomedical materials, organs, and prosthetics
 Wearable robotics are external structures that are integrated with robotics
to create
powered clothing
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3D Printing Complex Organs
 Bioprinted using patients own cells rather than synthetic materials
o Cells are biopsied from patient then placed into growth medium
o Organ is printed to a certain point then tissue is left to grow
 3D printing of organs is not ready to supply transport list
o Qui and McAlpine 2018 suggests that early prototypes can be helpful in
preoperative planning and rehearsal
 Organs such as heart and lungs are challenging to print due to presence of
blood vessels
and capillaries that are required to supply blood to body
o Research still being performed to determine how to print these

3D Printed Prosthetics
 Still in its infancy, quite costly, not available to most people
 Variety of organizations aiming to make 3D printed prosthetics available for
everyone
(cheaper, easily distributed)
o Enabling the future: volunteer organization providing open-source
plans for
volunteers to print, assemble, and distribute free 3D printed upper
limbs,
~20,000 members, has provided hands and arms to 8000 people
 Cyborg Beast is one design developed by a volunteer for low-
cost 3D
printed prosthetic hand for children in need
 Appearance is customizable to mimic aesthetic of superheroes
 Lighter models, easier for children to maneuver
o Exceed: addressed shortage of trained people around the world to fit
prosthetic
devices and train others to use them
 Addressed shortage by establishing schools in Cambodia, Sri
Lanka,
Indonesia, the Philippines, and Myanmar to educate
prosthetists and
orthotists
o Project Daniel: developed in Sudan during a civil war that left
50,000+ Sudanese
with lost limbs, provides 3D printers to continue printing limbs for
their
communities

3D Printed Skin
 Sunnybrook and UofT developed handheld 3D printer that can print synthetic
skin
directly onto wounds
Synthetic and Artificial Skin
 Biological Microelectromechanical Systems (BioMEMS) and related devices can be
incorporated into artificial skin to help make it look more realistic
o Synthetic skin substitutes, constructed out of polymers that are not
present in
normal skin
o Biodegradable so can be used for people with burns/situations where a
temporary skin layer is needed

Wearable Robotics and Exosuits

 External structures that have been integrated with robotics
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 Body devices that are powered and provide support/power or torque to a body
part
 Mechanical systems worn on body to improve/maintain individual’s ability to
perform
required tasks
 One manufacturer claims that exoskeleton units not only provide mobility,
but help
relieve symptoms associated with sitting all day such as pressure sores
 Commonly for military purposes or to assist individuals experiencing some
type of
paralysis or mobility issues

Examples of Wearable Robotics

 Devices that address mobility challenges accompanying aging, including ones
brought on
by sudden events such as stroke or chronic diseases like arthritis
 Soft robotic glove: Wyss Institute’s soft robotic glove was developed to
assist in
rehabilitation after a stroke by using inflatable chambers to move user’s
fingers at low
cost compared to in clinic tools
 Robotic Shoulder Support: Wyss institute also developed a soft robotic
shoulder support
for stroke rehabilitation which uses inflation to lift arm and strengthen
shoulder
 Keego Knee Braces: monitors your lower body position, interprets your intended
movement, then the motors by your knee help you along the way
o Does not initiate any movement, you are in control

Considerations for Exosuits

 Number of challenges associated with availability of exosuits
 Expensive: $10,000-100,000+
 Decreased motility: can cause slow walking speeds, some are unable to turn
when
wearing the suit
o For older adults who are frail, may make exosuit impossible to use
 Long wait times: slow transition from prototype to end users b/c experimental
nature
o Therefore long wait time before they are made commercially available
o Most exosuits are considered investigational devices (including
suitX’s Phoenix)
and are not currently available in the US (where company is located)

Global Health Perspective: 3D Printing and Wearable Robotics

 3D printing market is mostly segmented into North America, Europe, Asia
Pacific, Latin
America, and Middle East and Africa
o Each market is worth millions of dollars
o E.g., Asia pacific 3D printing medical device market is anticipated to
be worth
around $600 million USD during the assessment period 2019-2026
 Quadriplegics living in south Africa are learning to walk again because of
robotic
exoskeleton, called the Ekso Suit, costs $100,000
 In japan, country’s population is rapidly aging, led to shortage of workers in
manual
labour industries like construction and farming
 o To counter the problem, companies have offered muscle-enhancing
exoskeletons
for older Japanese workers to continue working into old age
 North America is most dominant market in terms of revenue
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o Due to well-established infrastructure for technology and factors
such as growing
geriatric population, advent of robotic technologies, growing
purchasing power
of patients and increased investment towards exoskeleton technology
o Asia pacific region is expected to increase due to growing geriatric
population
and increasing prevalence of stroke, presence of large pool of
patients, increasing
disposable income, availability of government funding

Cosmeceuticals and Nanotechnology

 Cosmetic products with bioactive ingredients purported to have medical
benefits
 Used for skin, hair, nail, and lip care
o For wrinkles, photoaging, hyperpigmentation, dandruff, and hair damage
 Nanocosmeceuticals: cosmeceutical w particle dimensions on nanoscale (below
100m)
o Considered that the smaller the particle size, the more ready the
absorption and
efficiency of damage repair
Newer forms of nanocosmeceuticals:
 Liposomes: for delivery of fragrances, vitamins, and anti-aging creams
 Niosomes: for anti-wrinkle and whitening creams, hair repairing shampoos
 Solid Lipid nanoparticle: composed of biodegradable and physiological lipids
that exhibit
low toxicity and used in sunscreens and day creams
 Nanostructured lipid carriers: high drug-loading capacity for entrapped
bioactive
compound, fewer side effects than SLN
 Nanoemulsions: used in deodorants, shampoos, hair conditioners
 Gold nanoparticles: help with blood circulation, anti-inflammatory and
antiseptic
properties, improves firmness and elasticity of skin, delays aging process,
vitalizing skin
metabolism
Issues with Nanoparticles in Cosmeceuticals
 Long and short term side effects unclear
 Some with poor solubility have been shown to cause cancer and exhibit more
pronounced toxicity
 Inhalation can transport nanoparticles into the respiratory system and even
the brain
 Ingestion can occur from application to lips (through lipstick)
 Categorized as aesthetic products so they avoid testing requirements for OTC
drugs

Module 4: Autonomy or Control?

Introduction

Recall: gerontechnology refers to technology designed to be used by older adults.

It is an inter
and multidisciplinary academic and professional field that combines gerontology and
technology
- Older adults = age 65 and older
Gerontology: the study of aging
- Empowers older adults
- Helps them stay in homes longer
- Surveillance of older adults (watching, tracking, listening)
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o Is this an invasion of privacy? – yes

Learning outcomes:
- Describe gerontechnology tools and techniques currently in use and in
development.
- Describe the ways that gerontechnology can be used to empower older adults and
maintain their autonomy.
- Explain the privacy issues associated with gerontechnologies

Module 4 Section 1: Gerontechnology and Aging in Place

Canada’s changing population

- Canada’s population is experiencing a shift towards larger proportion of older
adults (the
world too)
- More people living longer = demographic change
- Many of these older adults are looking at technology to help them live
independently and
active lives

Older adult stats

“On July 1, 2019, older adults accounted for 17.5% of the Canadian population,
while children aged 0 to
14 made up 16.0% of the population. Although the proportion of older adults in
Canada has been
increasing over time, it remains lower than the proportion observed in the other G7
countries, except the
United States (16%). With nearly 3 in 10 people (28%) aged 65 and older, Japan has
one of the oldest
populations in the world.

In 2019 Canada had 10,795 centenarians, topping 10,000 for the first time. The
number of
centenarians has more than tripled since 2001 as a result of increased life
expectancy. Because women
have a higher life expectancy than men, the vast majority of Canadian centenarians
were women
(82.0%)”

Aging in Place
Definition: a person’s ability to continue living independently at home and/or in
their community and is
supported/facilitated through the provision of necessary supports and services
- Majority of older adults want to live out their lives at home, in a community
they know and are
known in
- Aging in place enables older adults to continue to participate in their
community
- Learn about gerontechnologies that support older adults to age in place
- Ex: surveillance systems and ambient monitoring, traditional supportive
technologies, and
internet-based gerontechnology smartphone apps

Technology Use Among Older Adults

- AARP study noted 51% of older adults purchased some form of technology in the
past year.
- Majority of older adults are using their technology to maintain social
connections, find
information, and for entertainment
- 42% of older adults report using streaming services on their devices

The types of technology purchased by older adults

Aaron Iny
20172053
7% wearable devices
10% tablet
11% smart television
12% smart phone or talking device
13% computer or laptop
23% smartphone
25% other (security, remote car starters)

Aging in Place: Social Connection Through Technology

- Recall: some older adults experience loneliness or social isolation despite
being healthy,
independent, and able to age in place relatively incident free
- Technology (especially gerontechnology) can help address feelings of social
isolation in both
traditional ways and non-traditional ways:

Traditional Gerontechnologies
- Cell phones, tablets, and other technologies that facilitate human contact can
be used to connect
(through social media or video conferencing) or for travel (e.g.
ridesharing applications

Non-Traditional Gerontechnologies
- Robots and voice-first technology (like Alexa and Elli Q) can be used to
connect with
loved ones (when enabled with programming that can send an email or make a
call)

Gerontechnological solutions for aging in place

- To age in place, need to be safe in their homes in case of emergency. Also
need to be able
to live in their homes
- Ambient Assisted Living (AAL) systems and smart home devices can assist in
these
functions = useful gerontechnology tools
- They support independence and to reduce reliance on other people, especially
for those
older adults living alone
- Devices are subset of Internet of Things (IoT) devices that connect home
devices through
cloud platforms to provide real-time feedback to users, manufacturers, and
3rd parties

2 Common gerontechnologies for aging in place:

1. AAL Systems: comprised of various sensors that use artificial

intelligence (A I) to analyze behaviour and compare it to established
patterns, identify
divergences (e.g. longer time than usual in bathroom that may indicate the
person has
fallen), and call caregivers as needed.
2. Smart Home Devices: Google Home and Amazon Alexa are examples of Smart Home
devices. The device is voice activated and can be linked to wifi-capable
appliances to
create a smart home system, providing autonomy for those facing challenges
to
independent living. These devices can take the place of a caregiver for
tasks like
adjusting the thermostat, lights, or setting reminders for things like
taking medications.

Question:
Aaron Iny
20172053
Imagine you are working with older adults who want to use technology to support
aging in
place. Considering the information in this module on aging in place, voice -
first technology,
smart home devices, and AAL, how would you respond to the inquiry?
Answer:
Your responses may vary. AAL systems’ primary function is to monitor
behaviour and/or activities, and alert caregivers about potential safety
concerns.
Voice-first technology can be used to interface with Smart Home devices to
control
appliances, lights, temperature, surveillance system, etc. Both A A L and Smart
Home
devices can assist with contacting emergency response. Voice-first and Smart
Home device
have some social connectedness functions. The bottom line is these are not
mutually
exclusive and your client could start with voice-first moving on to smart home
and even AAL
as needed. Or you could design an integrated system for them.

Example: AAL Systems

- AAL home monitor systems – used in private spaces where sensors are installed
that are
intended to record data that can be used by the monitoring caregiver or
system to
determine if the older adult is in need of assistance

1. Sensors to detect open doors: fridge, medicine cabinet, or front door

2. Sensors to detect activity in the bed: respiration, heart rate, and movements
including
sexual activity. Similar types of sensors can be installed in other places
around the house
to detect stumbling and/or falls
3. Sensors in the kitchen: if stove is left on, water is left running, or
excessive smoke.

Video: advances in AAL systems

- Emerald: a wall mounted unit that utilizes wifi and LTE around us to detect
activity
- Any time we move we create waves in the sea of wireless signals
- Emerald’s sensor and AI algorithms analyze these waves to reverse engineer our
motion
- The unit can determine mobility, time spent in bed, and a person’s social and
sleep
schedule
- Device in in trial stage of development
- Emerging research: device can determine measurements and outcomes that are
more
accurate than current AAL systems
AAL Surveillance Systems and Acceptance
- While they may help, older adults have concerns about their loss of autonomy
or the
stigma associated with this type of surveillance

Concerns with health-related surveillance among older adults

1. Stigma: Many older adults express that there is stigma attached to living with
 surveillance, especially in the most private aspects of their lives.
2. Loss of Human Contact: Older adults are also concerned that the utilization of
technology
for monitoring will result in less human-to-human contact.
3. Loss of Privacy: Privacy violations may occur when a connected device informs
a family
member that the adult engaged in an activity that they want kept private
(e.g. sexual or
other personal activities).
Aaron Iny
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Hacking Traditional Supportive Technology
- Many traditional supportive technologies are being “hacked” to improve aging
in place
- Ex: wheelchairs with a standing position, enabling users to mobilize body
parts and
provide physical and mental health benefits
- Standing wheelchairs

UPnRIDE Robotics
- Created a wheeled robotic device which provides both upright and seated
mobility for
people who have any difficulty standing or walking and wish to stay mobile.

Advantages of Hacking Traditional Tech: UPnRIDE

- Through the hacking of traditional supportive technology, much like UP n RIDE
Robotics
has done through their standing wheelchair, multiple new and desirable
advantages are
granted to the older adult.

Advantages of UPnRIDE:
1. Increase independence: Through built-in automatic balancing assurances, the
user is able
to safely ride uphill, downhill, and on slanted surfaces, typically without
worrying about
losing control, falling, or gaining unsafe speeds which have been deemed
suitable for
most current wheelchair users.
2. Enhances dignity: For many people who rely on a wheelchair as their primary
mobility
aid, a standing wheeled robotic device can allow for social interactions at
eye-level. For
those confined to a wheelchair, this change in height can enhance dignity,
social
inclusion, and self-esteem, and heighten the user’s overall quality of life.
3. Reduces medical costs: Using a standing wheeled robotic device reduces many
secondary
complications of long -term sitting, which can lower the need for
hospitalization,
medications, and physiotherapy. This is a significant saving for health
insurers, users, and
their families.
4. Improve health: A considerable amount of research has concluded that standing
up
vertically is more beneficial to your health compared to the impact of
prolonged sitting.
Standing increases engagement in new functional activities and allows for an
increase in
calorie expenditure.

Global View of Gerontechnology

- Global implications of these technologies – not every country has equitable
access to
gerontechnology

Examples of how gerontechnology is used around the world

- India: focus on implementing telehealth to extend health services to distant
territories,
enhancing accessibility, affordability, and quality of healthcare services
- Japan: invest in use of social robots to assist with an aging population yet
faces shortage
of care workers for elderly.
- Central and western Europe: Piekut (2020), notes that, “in many countries of
Central and
Eastern Europe, including Poland, there are more one-person households at
the retirement age
than at the working age ... [and] the analysis of the income situation for
Czech and Slovak
households showed that the group of seniors living alone appears to be the
most vulnerable in
terms of income insufficiency.”
Aaron Iny
20172053
o This may mean that these older adults do not have the funds to buy
gerontechnology
- Canada: smart doorbells, locks, and thermostats, as well as bed, chair, and
motion sensors
that could send loved ones or caregivers notices for events such as if they
slip or fall.

Question:

Considering the global perspective, would you say that gerontechnology is:
• Most appropriately promoted in countries where technology is widely accepted and
there are
large numbers of older adults aging in place.
• A priority to introduce in all parts of the world.
• Most appropriately promoted in countries with strong family bonds and
intergenerational
housing.
• Most important to introduce in First Nations and Aboriginal communities

Answer:
• Most appropriately promoted in countries where technology is widely accepted and
there are
large numbers of older adults aging in place.

Explanation: We need to keep in mind that in many parts of the world, older adults
live with their
extended family and do not need technology to keep them connected or help them with
the activities of
daily living. In other places the average life span is 40-50 years old, and those
who reach old age may be
raising their grandchildren. So these technologies are most appropriate in
countries with high levels of
acceptance of technology and large numbers of older adults living alone or with
another older person.

Aging in Place for First Nations, Metis, and Inuit Peoples

- Challenges in place that hinder first nations, metis, and Inuit Peoples
ability to
successfully age in place

Challenges facing First Nations, Metis, and Inuit Communities in Canada and USA
regarding Aging in Place
1. Canada: Note: they are at high risk of overall poor health outcomes as a
result of
historical and structural injustices. safe housing, safe/clean water,
adequate health care,
and education are a higher priority than introducing gerontechnology.
Further, the use of
gerontechnology may be hampered by geography, limited economic resources, or
the
intergenerational impacts of systemic oppression that may create a reluctance
to engage
with healthcare in ways that include surveillance and threats to self-
determination.
2. USA: In the U S A, aging in place within Native American, Métis, and Inuit
communities
is limited by:
 a. A lack of adequate health care on land under the sovereignty of
Native American,
Métis, and Inuit peoples.
b. Higher rates of chronic diseases (which make aging in place more
challenging)
among Native American, Métis, and Inuit older adults when compared to
the
general population of the U S A

Gerontechnology: The influence of SDoH

Aaron Iny
20172053
- Older adults are heterogenous group with varied characteristics and needs
and who use,
modify, and interact with technologies in diverse ways

Factors that Contribute to Lower Engagement Levels with Gerontechnology

1. Lack of Skills: lack of skills and familiarity with the technology. Maybe
because
technologies were developed after they left the school and/or the workforce,
or due to
their socioeconomic backgrounds.
2. Lack of Income: some older adults cannot purchase gerontechnology since they
cannot
afford to buy it. They don’t learn to use it effectively.
3. Lower Education: associated with lower income. Results in decreased
opportunities to
interact with these technologies. This can result in the lack of utilization
due to an inability to
pay for gerontechnology or disinterest in adoption due to lack of
familiarity.

Ethical Considerations and Other concerns

- Cameras and voice-monitoring equipment are becoming more common in the home
environment (and not just long term care homes and hospitals) which can
raise privacy
concerns for older adults.
- Ex: if person in watched environment engages in singing, dancing, intimacy, or
crying
and then realizes that family members of caregivers can see and hear them,
they may be
less likely to engage in these activities, which negatively impacts their
well-being

Question: Search online for an emerging gerontechnology, either in development or

currently
available, then search the academic literature for articles that researched this
gerontechnology.
What does this research say about the gerontechnology you found? What are the
positives and
negatives of this gerontechnology?
Answer: Gerontechnologies are constantly evolving and researchers may be slow to
test their
efficacy. Many products marketed to older adults claim to be supported by research,
but are in
fact unfounded in their claim that they can make a difference in mobility, memory,
independence,
etc. It is important to consider whether the technology you found is driven by a
desire to
capitalize on the market represented by older adults or to meet a need.

Section 1 summary: In this section, you learned about a variety of traditional and
non-
traditional technology that help older adults age in place. Aging in place refers
to a person's
ability to continue living independently at home and/or in their community through
the provision
of necessary supports and serv ices, and can lead to improved emotional, physical,
and mental
well-being for an older adult. Gerontechnologies that can help an older adult age
in place include
AAL systems, Smart Home systems, standing wheelchairs, and more. What these
technologies
have in common is that they are intended to help older adults stay in their homes
and
independent.

Module 4 Section 2: Age-Tech, Wearables, and Independence

Introduction to Facilitating Independence in Older Adults

- Recall: gerontechnology supports older adults to age in place
- Learn about current tech used to facilitate independence, focusing on age-
tech services
and wearables
Aaron Iny
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Age-Tech: term mostly used by investors, entrepreneurs, corporations, and social -
impact
groups to refer to the intersection of digital innovation and longevity - “Age-
Tech” is about
digitally-enabling the Longevity Economy.

Wearables: worn on the body (wrist, ankle, or belt) and record data such as
physical movement
(i.e. steps, sexual activity), physiology data (i.e. respiration and/or heart rate,
blood pressure),
and user -inputted data (i.e. calories ingested)

Age-Tech Services
- Longevity economy is worth trillions of dollars = creates incentive for
development of
new services and tech directed at older adults
- Longevity economy = total sum of all economic activity that results from the
needs of
Americans over the age of 50

Examples of Digital Innovation that have been developed to address issues

associated with
aging
1. Services Purchased by older people: inexpensive, require little to no
assembly and are
easy to learn. Ex: Automatic pill dispenser (sort and dispense daily doses.
Many have
audible and visual reminders and some type of locking mechanism that keeps
pills safe
until its time to take them) and home digitization (addition of devices and
subscription
services such as voice-first tech, that can act as an in-home assistant).
2. Services purchased on behalf of older people: purchased on behalf of older
adult by an
agency or family/friends. Ex: Meal services (meals on wheels, online or over
phone and
are delivered to older adult’s door. MoW delivers affordable and nutritious
meals to those
who are unable to prepare their own food. In addition to M o W, other food
services such
as online meal programs marketed primarily to busy, health conscious,
professionals, are
an option for older adults) and Home Care Services (allows someone with
special needs
to stay home. Home care services provide assistance with activities of daily
living for
people with chronic illness or recovering from surgery. They are personal
care services
including help bathing, washing hair, getting dressed).
3. Services traded between older and younger people: connect both young and
older
adults for programs that may be beneficial for both. Services that encourage
connections
between older and younger people. Ex: Vocational Mentoring (Many older adults
have
skills and expertise that they are willing to share with younger people,
sometimes in exchange for common household chores. For example, an older
adult whose career
was in the financial sector could provide investment advice or help with
setting up a business in
exchange for help with mowing their lawn or pet care) and Supported Co-
Living - In cities
where many older people are living alone, some services aim to pair up older
adults with
young students in shared accommodations. Generations United is a web -based
organization that works to bring older adults (mostly in the U S A) together
with younger
people. Older adults can connect with the organization online to find
programs in their
area. In Ontario, a provincially funded partnership between the National
Initiative for the
Care of the Elderly and the City of Toronto matched 12 Toronto post-
secondary students
with older adults willing to rent their unused space for the academic year.
The student
pays reduced rent to the older adult in exchange for household help.
Additionally, there
are apps such as Papa which link older adults with
college students to provide paid help or general companionship.
Aaron Iny
20172053
4. Services for future older people: Future old people are today’s younger
people. Services
for future older people reflects the reality that preparing for a healthy old
age begins very
early in life. As we prepare for a demographic wave that will easily run
until mid-century,
we know that issues such as childhood obesity and activity levels will impact
the aging
reality far into the future.
a. Many future older people already use technology like smart watches and
other
wearable technology to promote healthy activity and/or monitor risk
factors for
future illness (e.g. heart monitor, pulse rate).

Question: As a future older person what age-tech could you adopt to increase your
chances of
living to become a healthy older adult?

Answer: It is known that people who engage in healthy habits when they are young
adults (healthy eating, exercise, etc.) are more likely to continue those
activities in older age.
Any technology you chose is only helpful if you use it to establish healthy habits
now that you
can carry over into older age.

Wearable Devices
- Recall: Internet of Things (I o T). You can consider wearable devices, or
wearables, to be
the point where humans begin to physically, and consistently, interact and
integrate
electronics, software, and sensors on the body, as indicated in the I o T.
- Wearables can include a wide variety of different technologies.

Examples of Wearable Devices

- Fitness trackers
- Smart watches
- Body sensors
- Smart glasses
- Body cameras
- Smart clothing and accessories
- Virtual reality headsets

Video: Smart Watch and Falls

- Wearable devices can be used as gerontechnology by employing the fall
detection and
emergency SOS features of smart watches, or through collecting shareable
activity and
caloric data via a Fitbit

Wearable Devices: Fitness Trackers

- Since 2014, personal fitness trackers and smartwatches have saturated the
consumer
market, with many devices explicitly created and marketed to older adults. For
active
older adults, fitness trackers support healthy behaviour in exactly the same
way as
 younger adults use them; for example, counting steps, measuring workout
intensity,
tracking their sleep pattern, and avoiding sedentary behaviour. They can even
record and
report on sexual activity.

Wristband:
Aaron Iny
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- Several companies have created wristbands designed specifically for older
adults. These
have sensors, AI, and monitor sleeping and eating habits. They can detect
whether a trip
or fall happened. They record data 24/7. Any sort of change, whether minor
or major, is
relayed to a caregiver.
- It should be noted that this is a surveillance device, providing feedback
and surveillance
data to the caregivers and not to the older adult.
- All of the data it collects is stored on its cloud platform and can be
shared with a medical
professional in real-time, 24 hours a day

Question about Wristbands: To find examples of wristbands on the market now, try a
search
for “monitoring wristbands” (you can add “older adults” if you need to narrow the
search).
Provide one example of a monitoring wristband currently on the market.

Next Generation Wearable: The Sensor Tattoo

- Sensor tattoo – example of the next generation of wearable tech
- Wearable sensors are similar to temporary, or false, tattoos in that once the
tattoo is
pressed into the skin, the visible sensors appear like a normal tattoo on the
body.
- The tattoo can then function like a computer sensor by monitoring vital signs
in the
person.
- Reports from the tattoo can be generated and sent to medical professionals,
families, and
caregivers, much like a traditional wearable device

Wearables for GPS Tracking

- Wearables specifically designed to track the location of older adults
- Costly, including monthly fees
- Aim to ensure monitoring is done without relying on the older adult to carry
the tracker
- Reassure both family and caregivers as to their whereabouts
- There are privacy issues associated with tracking devices

2 Examples of GPS tracking wearables

1. GPS Smart Sole: tracks an older adult’s location through a rechargeable
Bluetooth shoe
sole insert. This insert sends location updates every five minutes to anyone
who has the
application on a mobile device and has synced the insert to the application.
2. GPS Tracking Apps: apps on smartphones allow caregivers to keep an eye on
their loved
ones when they are out and about, helping to ensure their safety. G P S
trackers
specifically designed for older adults put an emphasis on functions that
enhance safety,
including emergency notifications and health metrics.
Question:
Aaron Iny
20172053
Think about older adults in your life. Which of these age -tech would best help
them to maintain
independence? Would you be willing to wear the wearable device that you would
recommend to
your family member? Why or why not?

Answer:
There is no right answer - the important thing to consider is how you would
feel about wearing this device. It is likely that the older adult you are thinking
it would be good
for feels the same way you do.

Ethical And Privacy Concerns with Wearable Devices

- Being monitored 24/7 can create sense of hypervigilance in many people
regardless of
their age
- Monitoring, either through AAL or wearable devices can be interpreted as
threatening
older adult’s autonomy
- Threat of data being sold or leaked, malicious hacking, or sensitive health
information
being available to the provider or partner companies

Section 2 Summary: In this section, you learned about a variety of different

services and
wearable devices that may help to increase independence in older adults. These
include services
designed specifically for older adults, services purchased on behalf/for older
adults, services to
connect older adults and younger people, and services for future older adults.

Wearable devices, such as smart watches and fitness trackers, can also help to
increase the
independence of older adults. However, it’s important to keep in mind the ethical
and privacy
issues associated with the data that is collected via a wearable device and who has
access to it
(i.e. third party company, healthcare team, family member, etc.)

Module 4 Section 3: Social Participation Through Technology

Geotechnology and Social Participation

- When social interaction is lost older adults can experience a variety of
negative effects
- Most technology is focused on connecting older adults with friends and/or
family or
volunteers who will spend time with them
- Going forward it’s important to consider older adults as contributors to
society and find
ways to use technology to support their continued participation in society
- Types of geotechnology used by older adults to combat social isolation
o Smartphone apps
o Voice-first technology
o Social robots
o Robopets
o Virtual reality
Convenient Geotechnology: Apps
Aaron Iny
20172053
- Quick and convenient method for older adults to stay connected with family
and to
receive both social and medical supports electronically

Older Adults and Caregivers

- Apps can help older adults and caregivers by providing services such as
playing pre-
recorded reminders and messages
- In people living with Alzheimer’s, apps can show photos of familiar people and
places,
play recognizable music and provide a night light
- Examples
o Honor- enables caregivers to communicate with families, exchange notes,
and
ask/answer questions
o Ask Mervee- allows people to send a message to friends/family
requesting visits,
getting messages from others, or just letting people know that they
are doing ok
o Ask my buddy- can send an alert to a list of people through a smart
speaker
o Life Pod- reminds them to take their medication or drink water or it
will play
music for them

Aid with Visual impairment

- A company from Israel, RightHear, has developed a system for visually impaired
users
specifically for indoor places such as malls, hospitals, grocery stores,
restaurants,
museums, and universities
- RightHear’s technology contains three components: a phone, Bluetooth-powered
beacons (sensors) that are pre-installed at the location, and the management
platform
- Venues are subscribers and buildings, and locations are pre-mapped and
installed with
RightHear sensors and the information is uploaded to the app which narrates
the
surroundings and navigates the user
- The free app tracks the movements of the user and issues real-time voice
prompts and
warnings, such as of stairs ahead or if the sliding door in front of them is
automatic

Rideshare Apps
- Rideshare apps are important in places like north America where more than 80%
of
transportation needs for older adults are provided by family caregivers
- As a result, older adults are increasingly turning to rideshare apps to allow
them to
independently manage their transportation
- SilverRide is an app that was developed for older adults in select regions in
the San
Francisco area
- Generally, these ridesharing apps are used for social visits with friends and
family,
leisurely outings, or to increase physical activity
 - However, they can also be used for medical appointments, where drivers attend
appointments or help with grocery shopping
- One study has linked the used of ridesharing apps with a 92% increase in
perceived
quality of life among app users

Internet-Based Gerontechnology: Volunteer Services

Aaron Iny
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The Canadian Red Cross
- The Canadian red cross hosts a friendly visiting program, which works to
reduce social
isolation by offering one-one-one personal visits
- A trained volunteer visits older adults for an hour at least once every two
weeks to chat,
play a game, do a craft or discuss the news

Bergen Volunteers
- They offer various services to older adults in Bergen County, New Jersey
- This includes
o Chore- a program that proves handyperson services (often older adults
helping
older adults) to do tasks like installing grab bars, replacing outlets
etc..
o Cheer- a program where volunteer provide companionship by weekly visits
to
homebound older adults

Voice Activated Technology

- Voice activated technology associated with smart home devices can automate
many
appliances in the house
- Since they are connected to the internet themselves, they can be used for the
social
functions of smartphones with a highly sophisticated voice interface
- The ease of this interface relative to screen devices may encourage use among
older
adults, making them tools to combat social isolation
- Initial studies have shown that the majority of older adults provided with
voice activated
technology engage with it daily and over 70% said it helped them to feel
more
connected to family
- Voice-activated home devices can help older adults remain social by
o Providing assistance with tasks like making calls, sending emails and
texts,
reminding them when to take medications, letting them know the
weather or
sports scores, and reading audio books to them
o Enabling family members to update to-do lists and prompt for updates
o Sending reminders to family members as well as updates on the older
adult it is
living with

Social Robots: ElliQ

- Social robots are also aimed at reducing loneliness by creating an interactive
environment and proactively suggesting prompts based on daily activities of
the users
- Social robots go beyond pure voice activated technology and introduce movement
and
responsiveness
- Social robots have the same capabilities as voice-first technology, but they
also have a
screen and a personified figure that moves
- An example of a social robot that can be used to counter loneliness and social
isolation is
 ElliQ

Features of ElliQ
- Designed to look like a piece of technology
Aaron Iny
20172053
- ElliQ contains two important elements, the body and the screen, which allows
the age
tech this piece of
- to perform both technological and social functions
o body- performs social functions and can move the ‘head’ up and down
when
‘excited’ and hangs the ‘head’ when to express ‘sadness’. ElliQ
engages, ‘looking’
at pictures that come in, responding to the users voice
o Screen-the screen performs technological functions and helps users
read and
respond to messages, share pictures, make appointments, and remember
to take
medications

Robopets
- Robopets are advances animatronics that have been suggested as a substitute
‘pet’ for
those who may have difficulty taking care of a living pet
- They’re designed to endear themselves to humans, and to behave in ways that
suggests
they’re alive
- Similar to social robots, robopets are referred to with the pronouns she and
he,
encouraging consumers to talk about them as if they are living beings

Robot Dog Features

- The company Tombot has developed a robopet named Jennie, which they state is
the
“most realistic robot animal in the world”, due to features such as an
interactive sensor,
voice command, and a smartphone app
o Interactive sensors- it wags the tail and leans into a hand when
patted. It is
intended to look cute and have a realistic appearance. The touch
sensors allow it
to react to you based on how and where it is being touched
o Voice Commands- voice activation software allows the ‘puppy’ to react
to your
commands
o Smartphone app- there is a smartphone app that allows you to name your
puppy, customize functionality, and track user interactions with it on
a day-to-day
basis. As the robopet ages and is ‘trained’, the app can be used to
change the
robot’s abilities by adding new actions and commands

Human-Animal Bond and Robopets

- The human-animal bond provides health benefits to both humans and animals based
on
reciprocity
o Human provides love and care for animals, animal shows appreciation and
affection towards human
- Initial research suggests that most animal lovers would rather have nothing
than replace
their dog or cat with a robot pet
- However many manufacturers, including Tombot have been hear that the robot is
 intended to comfort and entertain, like a responsive stuffed toy, not to
pretend to be a
real animal

Reasoning to Support Robopets

Aaron Iny
20172053
- They can help sooth agitation, promote social interactions, and provide a
sense of
comfort
- Jennie the robopet is designed to manipulate human emotions to stimulate the
production of oxytocin- stimulating the attachment that people feel when
they are
bonded to a companion animals or human child

Reasoning Against Robopets

- Dr. Carver did a survey during covid in which respondents were asked whether
given the
choice they would choose a robot pet or a live animal
- 102 participants, no one wanted the robopet, majority would choose a live pet,
a few
would not want a pet at all
- When asked why, they all said things like “it’s not about the companionship
alone, it is
about the emotional connection. To get that from a robotic creation is not
love. We need
the love that comes with these pets.”
- Dr. Lee Kai-Fu, the presidents of Sinovation ventures artificial intelligence
institute points
out “elderly people really want to connect with other people and I think
giving them
primitive, fake, inanimate and non-emotional robots to interact with is a
cruel thing that
we should not do.”

Artificial Companionship
Question: Is there any difference between replacing a live animal with a robot pet
and replacing
a human caregiver with a robot?

Answer
- A caring relationship with another human or a per is reciprocal for all humans
- Both animals and other humans react genuinely to the things we say/do
- A robot’s reaction are programmed and cannot be sincere
- Robot pets and humanoid robots have value for entertainment and/or monitoring
of the
living space and/or the older adult
- If programmed to do so, they can also be used to facilitate interact with
friends and
family (by assisting with calls or emails) which is of value

Virtual Reality for Older Adults

- VR is an emerging technology that can stimulate reality or create a fantasy
world
- Geotechnology has adopted the use of VR to maintain or improve functioning
with age
- For example, the company rendever creates VR for older adults by using
algorithms to
convert their own photos to 360 panoramic experiences which help people
relive some
of their favourite memories

Benefits of VR in Gerontechnology
- The use of VR images are typically designed to combat the isolation of older
adults by
providing images of the world outside of their immediate environment and
enabling the
user to form new relationships through shared VR experiences
Aaron Iny
20172053
- For older adults living with, or at risk of, Alzheimer’s, new research has
begun to observe
a link between the use of VR and an increase in cognitive function
- Additionally, the use of VR in older adults may help increase balance and
improve spatial
awareness and navigation
- Being able to improve spatial awareness and navigation through VR is
particularly
exciting as the older adult does not have to be in a standing position to
increase these
skills

Limitations of VR in Gerontechnology
- As with many simulated interactions (i.e. robot pets), it is important that
the product
does not pretend to be real
- Some experts have expressed concerns that it may be unethical to try and make
people
believe they are interacting with family or back in their family home
- In addition to the ethical concerns, VR can be expensive for some older adults
or long-
term care facilities to purchase
- Even when it is available some older adults may be uninterested in engaging
with VR
technology- not because it is ‘technology’ but because it is not real and
they don’t want
to play ‘lets pretend’

Emotion Analysis and Loss of Privacy

- Many of the emerging technologies mentioned in this section are intended to
provide an
interactive emotionally responsive experience, involving data collection and
emotional
analysis
- Protecting the privacy of emotional data can be a concern, since social robots
(including
robopets) collect data on the users emotions and social patterns, as well as
the other
data through various sensors
- The sensitive data is stored on the social robot and in “the cloud”; facing
challenges of
securely protecting the data which is scattered in multiple locations
- Many people do not want their deepest feelings recorded and vulnerable to
exploitation- either through the robot itself of unintended uses of the data

Gerontechnologies: Empowerment or Control?

- Gerontechnology can empower older adults to stay in their homes longer by
o Making tasks like getting up or down the stairs easier
o Turning on or off the lights
o Monitoring heart rates and/or respiration
o Preventing the stove from being left on to avoid accidental fires
- Gerontechnologes can control older adults by
o Locking doors to keep them inside
o Surveilling them by watching older adults through the camera lens
o Listening to them
o Tracking their location via GPS
Module 5 Section 1: Socio-Philosophical Implications of Life-Extension
Aaron Iny
20172053

Anti-Aging Science
- Modern anti-aging strategies include both commercial and clinical enterprises
and
research and development
- Two anti-aging strategies
o Commercial and clinical: Commercial and Clinical enterprises that offer
anti-
aging products
o Non-traditional Technologies: Research and Development efforts of
biogerontologists- scientists who study the biology of aging

History of Anti-Aging Strategies

- The field of anti-aging research has to consider the morality of interfering
with the
“natural” process of aging as well as the colourful history of anti-aging
strategies
- Historically, anti-aging strategies included alchemy, extracts from the
testicles, ovaries,
or glands of animals, as well as a variety of elixirs, ointments, and
medications
- The modern ”anti-aging” movement was established in the 1960s and 1970s in
Europe,
and served wealthy clients from Europe and Adia
- Currently, there are advanced anti-aging centers in France, Belgium, and other
parts of
Europe, Japan and other parts of the Asian/Pacific region, and, of course,
North and
South America
- Many anti-aging scientists found that traditional gerontology did not welcome
their
research and strategies initially
- Over time the boundaries between the two field have blurred and both
biogerontology
and gerontechnolgy have made their way into the mainstream

Socio-Philosophical Implication of Longevity

- Natural lifespan varies, influenced by social determinant of health and the
country you
live- including access to healthcare, clean water, and healthy food
- Extending life beyond the average is influenced is influenced by many factors
including
justice, relationships, meaning and social values

Justice
- In some African countries the average lifespan is only 40 years old whereas in
developed
countries it is between 70-80 years old
- Differential access to adequate healthy food, clean water, employment, as well
as the
impact of HIV/AIDS all contribute to unequal opportunities for longevity

Relationships
- Since humans are social beings, meaningful relationships with others are
essential to
living a human life
 - Extension of biological age is only valuable if it also extends our life as
communal beings,
resulting in longer, meaningful relationships

Meaning
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- Engagement in activities that give satisfaction and happiness results in a
more
meaningful life
- From this, Pijenburg and Leget (2007) infer “what we basically seek as human
beings is
not more time to live, but meaningful experiences”

Social Values
- When we save a life, by whatever means, we simply postpone death
- Therefore, life-extending therapies are, and must always be, life-saving
therapies and
must share whatever priority life-saving has in your morality and in social
values

Justice
- Contemporary bioethics cannot limit itself to how, and under what conditions,
new
scientific developments may be applied, but must also confront the question
of whether
these developments contribute to a more just world
- Pijenenburg & Leget state that treatments that exist but are not available to
everyone
raise questions of distributive justice.
- Harris (2004) states “if immortality or increased life expectancy is a good,
it is doubtful
ethics to deny palpable goods to some people because we cannot provide them
for all”
- The ethics to prolong life, therefore, ought not to be separated from the
more
fundamental questions relating to integrity

Two fundamental questions relating to integrity

- Unequal death: Given the problem of unequal death, can we morally afford to
invest in
research to extend life?
- Distribution of Resources: given that there are countries where there is the
risk of dying
at what others might consider ‘mid-life’ (who could be saved by simple low-
tech
solutions), how do we justify pouring billions of dollars into extending the
lives of the
oldest old and ignoring the needs of these people dying young?

Relationships and Meaning

- Human lives and meaningfulness are experienced in large part through
relationships
- Close relationships with family and friends and broader relationships in
schools,
workplaces, societies and even as part of the global community give vital
feelings of
connection and meaning
- There are two anthropological viewpoints on the purpose of life extension
o Liberal anthropology: according to Pijnenburg and Leget “a liberal
anthropology
perceives human beings as primarily individuals who relate to each
other by
contract and negotiations, motivated by self-interest. The other
person has an
instrumental value, and can appear as a friend, a competitor, or
even an enemy”
o Communitarian Anthropology: Pijenburg and Leget (2007) further state
that in
communitarian anthropology, “human beings are viewed as social
beings:
relations with others belong to the essentials of what it is to live
a human life”
Aaron Iny
20172053

Social Values
- Someday life may be lengthened by altering DNA in embryos, but currently
radical life
extension would likely require health care interventions, high quality food,
and freedom
from a toxic environment, resulting in a substantial cost
- Social norms in most groups are based on the idea that, where possible, lives
should be
saved
- When you translate the social norm of saving lives to life-extending
therapies, many
would claim that “you have a moral imperative to save the life when
possible, because
failure to do this would make you responsible for the resulting death”

Socio-Philosophical Implications of Anti-Aging Technology

- Anti-aging technology is a profit drive, innovative market that is embraced by
many
individuals seeking longer life or even immortality
- However, the rush to enhance, improve, and extend life leaves complex
sociotechnical
trade-offs, unaddressed, including privacy and data ownership

‘Free’ Apps or Services

- In many contexts, ‘free’ apps or services are enhanced, ignoring the well-
known reality
that ‘free’ technology means your data is the price you pay
- There is a trade-off between a vague uneasiness stemming from the
understanding that
personal data is being harvested with the fact that you don’t have to pay
for an app or
game
- Is the price still worth it when the technology you are embracing is
harvesting data from
within your own body or the body of an older adult that you care about?

Embodied Technology
- Implanted or ‘embodied’ technology has the potential to extract data or is
specifically
designed for that purpose
- This data can be combined with data from other implanted technology or even the
data
from our phones, tablets, and smart household technology

Embodied Technology
- Implanted or “embodied” technology had the potential to extract data or is
specifically
designed for that purpose
- This data can be combined with data from other implanted technology or even the
data
from our phones, tablets, and smart household technology
- These data sources, once combined, create an unprecedented and accurate view of
an
individual’s life
Embodied Computing Technology and Their Unintended Consequences
- According to Dr. Pedersen, a Canadian Research Chair in digital life, media,
and culture,
disruptive embodied computing technology is being proposed that will create
remotely
monitored networked human bodies- which raises issues in terms of personal
privacy,
Aaron Iny
20172053
human agency, creativity, consent, social connection, cultural values, and
ethics-
including those surrounding the unintended consequences of early=phase
embodied
technologies that may arise in the future
- Dr. Pederson suggests that there is a continuum from mobile devices such as
smartphones to wearable devices, like smart watches, that will culminate in
implantables
- Data from these devices are combined in body area networks to be utilized
- There is a subtext that includes the possibility that data harvested from
these always
on/always attached devices is being fed to military and police databases
and/or
marketing and/or hackers/phishers/the dark web/ other criminal activity for
exploitation.

Embodied Computing
- Embodies computer components include those that are carried, worn, implanted,
ingested, or ambiently interfacing with the body, all of which are a data
source for
harvesters
- Some embodied computing is done by choice- you decide if you want to use a
smartphone or wear a smart device
- With ambient technology, you are observed and your data is collected by
technology
that surrounds you- video, thermal imaging- and through third party apps that
are
embedded in apps we download for other purposes
- If they combine that data with harvested information from your bank or credit
card or
points along with smart warch data on your temperature, heart rate, activity
levels
and/or text messages/emails etc- a fully developed picture emerges of where
you are,
what you are doing and even who you are with

Body Area Networks

- Perderson suggests that the body will become a computer platform- a body area
network
- Overview of the pars of the body area network
o On the body: this is the technology that we choose to wear or carry-
smart
phones, watches, glasses
o In the body: the technology that we choose to implant or ingest-
pacemakers,
neural implants, ingestible sensors (pill sized sensors that measure
gut activity,
pH levels, temperature, etc..)
o Around the body: the technology that surrounds us, including sensors
and
sensor networks, pervasive computing, and artificial intelligence that
are
sensitive and responsive to the presence of living things (humans
and/or non-
human animals)
o Body Data Communities: a concept that Dr. Carver is developing- the
idea that
 the data from on, in, and around our bodies is combined with data from
other
embodied networks within our communities
Aaron Iny
20172053
 At the micro level (our families or smaller friend networks)
or at the
macro level (our neighbourhood, cultural community, or
colleagues at
work or at school)
 Combining data from embodied computing in a community could
provide
unprecedented information about ourselves and our
communities,
exposing vulnerabilities that are already inherent in the
social
determinants of health that could be leveraged to serve
public health
initiatives or maintain inequities

Privacy and Body Area Networks/Embodied Technologies

- Data from the on-body, embedded, and ambient technologies (in BANs) are
collected in
the cloud
- This data is then available for use to monitor health related data (e,g,
blood pressure,
heart rate), to track location, and to ascertain activities
- In the future, body data communities containing multitudes of body area
networks
might connect personal data from hundreds, thousands or millions of devices
- Intra-body communication uses signals to send data from one-device to another
within
the body
- Information is transferred and used without the user’s specific knowledge of
what data
is being utilized and usually without their ability to edit the data that is
shared
- By agreeing to the wearing or implanting of a device, the user loses their
rights to
control their own data

Justice, Aging, and Embodied Technologies

- Availability of technology to people is variable and often depends on the
social
determinants of health
- For example, those who are older, have less income, less education, are of
certain
genders, who live in developing regions or whose race or abilities are
disadvantaged will
be faced with inequity in access to technology and also in the power to
prevent being
commoditized

Embodied technologies and older adults

- Aging people can be vulnerable to the implantation of embodied technologies
without
fully understanding the data amalgamation from various technologies into
eHealthcare
systems
- Additionally, aging persons are usually left out of the conversation regarding
development and risk being further marginalized by these products; despite
being the
 users they are not brought in as co-designers

Module 5 Section 2 – Anti-aging or Enhancing Aging

Introduction to Jeanne Louise Calment

 Worlds oldest (documented) person, died in 1997 at age 122 and 164 days
Aaron Iny
20172053
 Lived a privileged life, father was a shipbuilder who lived until age 93 and
mother was
from family of millers and lived to 86
o Brother lived to age 97
 Childhood: woke up at t8am, had coffee or hot chocolate for breakfast, went
to school
locally, went home for lunch every day
 Adolescence: finished high school and lived with parents until married at
age 21
 Adulthood: lived with husband above family store, did not work, had
servants, hobbies
included fencing, cycling, tennis, roller skating, mountaineering
 Parenthood: one daughter who died at age 36, shared raising of her grandson
with
widowed father who lived next door
 Senior years: lived independently in same apartment until 110 years, on 120
th birthday
she said “I only have one wrinkle and I’m sitting on it”

Anti-aging and enhancing aging bodies

 Senescence is the part of ‘normal’ aging that anti-aging and enhanced aging
seek to
counter
 Ageism drives the debate about financial and ethical burdens of aging bodies
to
healthcare system, anti-aging has also emerged as a popular movement for
promoting
activity, mobility, and lifestyle choice to counter traditional images of
decline and
decrepitude
 Anti-aging is based on biomedical model, suggesting that medical techniques
can
prevent aging process from occurring or slow it down, because aging is
“undesirable”
 Enhanced aging is not necessarily about slowing or stopping aging, but focuses
on
painless functionality and timeless performance

Anti-Aging
 Focused on preventing appearance of getting older and other age-related
changes
 Involves medicalization of bodily changes that occur with aging that are
“treated”
 E.g., surgical repair to remove wrinkles, testosterone/estrogen supplements,
surgical
modification, neurogenesis, pharmacotherapy
 Market driven, often focuses on female aging
 Movement shows older adults as active, involved, and modern to counter
stereotype of
decrepit old age
 Aim to disrupt natural course of senescence with goal of painless
functionality and
timeless performance
 Responsibility to prevent aging is placed on older adults, making
presence/absence of
disease up to them, with expectation that they will take care of themselves
o Notion that if an older adult becomes ill, due to lack of care on their
part

Anti-Aging as Disease Prevention

 Some researchers suggest that socio-philosophical issues associated with
radical life
extension could be avoided if techniques used to extend life are considered
disease
prevention
o Idea being that if you don’t get a terminal illness, you can live
indefinitely
Aaron Iny
20172053
o If this type of disease prevention could be combined with prevention
of
molecular damage (e.g., DNA mutation), then theoretically it might be
able to
prevent emergence of senescent cells or dysfunctional mitochondria,
which
contribute to a feedback loop of damage and dysfunction

Examples of Anti-Aging Intervention

 Nutrients: nutrient signalling pathways have been activated to turn on
endogenous
repair and rejuvenation pathways
 Metformin (diabetes drug): appears to activate aging-related nutrient
signalling
pathways
 Inflammation reduction: senescent cells have been eliminated by reducing
damaging
inflammation
 Stem cells: can be rejuvenated by infusion with healthy stem cells (at least,
in the lab)

Anti-aging technology for disease prevention

 If goal is less controversial disease prevention rather than “life extension”,
could be
considered mainstream necessity rather than controversial and possible
elitist
 Examples or emerging technologies:
o Robotics: used for surgical procedures to improve accuracy
o AI: applied to diagnose and treat ailments and disease using
algorithms
o Advances in technology-assisted rehabilitation to augment
neuroplasticity during
recovery periods after a stroke can be accelerated through use of
exoskeleton
robotics
o Technology to prevent or automatically report falls, accidents, or
acute medical
conditions in order to provide a life-saving medical response

Enhancing Aging
 Focused on improving quality of life during natural lifespan
 E.g., providing physiotherapy or supporting exercise regime to maintain
mobility, or
maintaining and nurturing relationships to enhance meaning and purpose in
later years
 May lead to extended lifespan due to access to better nutrition, mobility
assistance, and
maintenance of meaning and purpose
o But extended lifespan is not the goal
 When we aspire to enhance natural aging, we have to acknowledge the
heterogeneity in
human experience, as well as in physical condition, and accept that not every
life will be
enhanced in the same way or to the same effect
o All we can hope to do is improve quality of ‘normal’ lifespan and
compress
morbidity
  Goals of enhanced aging:
o Good quality of life
o Achieving best possible health and mobility for that individual
o Compressed morbidity (reducing length of time person spends
sick/disabled)
Enhanced Aging to address the ‘Symptoms’ of Aging
 Intended to address changes in functionality, such as yoga or Tai Chi for
mobility
Aaron Iny
20172053
 Healthy eating, nutrigenomics, and calorie restriction are all strategies
that can enhance
aging by improving nutritionally aggravated symptoms and encouraging
neurogenesis
 Common steps to enhance aging and promote healthy aging:
o Remain physically active
o Change diet by reducing caloric intake and adding fruits and
vegetables
o Moderate use of alcohol
o Cease tobacco use
o Build and maintain support systems and close friendships
o Manage stress
o Seek meaning and maintain sense of purpose

Mixing and Matching: Anti-aging + enhanced aging

 Hybrid approach, relevant now as we don’t actually have immortality drug, so
aging is
inevitable
 For example, older adult could be supported to engage in activities that
encourage
neurogenesis such as exercise as well as encouraging the use of surgery to
enhance
function (e.g., hip replacement)

Ethics of Age-Related Use of Technology

 What are the overall benefits, and how will those be distributed?
o Depends on research and development and technology, and social
structure and
makeup of each society (SES, education, healthcare systems, etc. )
 What is the likely effect on health inequality, and would alternative ways of
using
resources affect inequality differently?
o Depends on research and development and technology, and social
structure and
makeup of each society (SES, education, healthcare systems, etc. )
 How should we balance increases in wellbeing against increases in inequality
where
these occur?
o Moral, ethical concern that needs to be addressed uniquely in each
culture
 How do we balance different values when they come into conflict?
o Moral, ethical concern that needs to be addressed uniquely in each
culture

Mental Health and Enhanced/Anti-Aging Strategies

 Aging research suggests that challenges to mental wellness (stress) can
contribute to
age-related changes (such as shortening of telomeres)
 Might therefore consider biohacking/biotechnological intervention to be a
mental
health strategy

Module 5 Section 3 – Inequity in Aging - Ageism and the SDoH

SDoH
Aaron Iny
20172053

 Climate change is an increasingly important SDoH

Inequity in Aging
 Can influence experience of aging based on age, gender dynamics, social, and
economic
differences, role of media in forming and shaping anti-aging and biomedicine
discourses
 When is considered within a culture that idolizes youth and health, it is
devalued
o Anti-aging culture’s focus on decline and immobility as ‘bad’ and
activity and
mobility as ‘good’, it places natural aging in the position of being
despised
o As a result, those that don’t embrace the ‘fight’ against aging
become
marginalized/ostracized/devalued
 Employment becomes difficult for older adults because ageist stereotypes
suggest they
are feeble and have loss of mental acuity
o For many, poverty is the natural consequence of long life
o Poverty results in further inequity as medical care and tools of
anti-aging are not
accessible
 Aging older adult is judged to have failed to age well

Radical Life Extension and Ethical Considerations

 Interventions in biological aging are interested in prolonging life by
slowing/arresting
aging, or combating diseases that are intrinsically connected with aging
 What are the societal consequences of extending lives of some but not others?
 Should access to anti-aging meds and procedures be an extension of ubiquitous
capitalist ethic, where those who ‘deserve’ can afford these and those who
cannot afford
don’t ‘deserve’?
o Or should they only be available to some if they are available to all
older adults

Media, Ageism, and Sex/Gender

 Ageism is shaped by prejudice and stereotypes, demonstrated by media
 Image of aging has been further altered by a new focus on sex and/or gender
o Media scholars have shown that gender plays large part in older people
representation
 Lack of representation: most mainstream media signal that aging and older
people,
especially women, are not newsworthy, interesting, or desirable
o Can be interpreted symbolic annihilation (underrepresentation of some
group in
media)
o E.g., older women are more likely to appear in media as ordinary
persons,
whereas older men serve as experts/spokespersons
Aaron Iny
20172053
 Negative representation: media images of aging people are often connected to
problems and declining health
o Youth and youthfulness are an important form of capital, especially
for women
 After age 30, women become more invisible as they age
o Misperception that aging women no longer care about looks is
inaccurate
 Older women report greater perceptions of age discrimination,
internalize
negative stereotypes and may assess themselves/bodies in a
negative way
 Representation of privilege: older women in media are well-groomed, without
noticeable wrinkles, and have able bodies in a shape that conforms to
societal norms
o They also have an air of success
o These produce and reproduce ideas and norms of aging and gender as
well as
preferred lifestyles, both at a local and global level
o Much of the media directed at older adults focus on appearance of
female
bodies and the functionality of male bodies

Ageism and Sex/Gender

 Stigma associated with aging has a focus on sex/gender
 Appearance of female bodies, functionality of male bodies
 Male body: identification of “male andropause” is central to age-related
health
problems
o Central to this construction is revival of hormonal model of male body
in which
anti-aging strategies are linked to restoration of ‘lost masculinity’
o In this manner, healthy aging is achieved solely by late-life virility
as measured by
male sexual function
 Female body: women are routinely judged based on appearance of bodies, and
mainstream beauty standards prescribe a youthful appearance
o Visible signs of aging such as wrinkles and gray hair often assign
social value to
individuals, so ageism is grounded in beauty standards that value
youthful body
o Gendered ageism means that, in westernized cultures, older women are
culturally devalued, and older women’s bodies are judged harshly for
showing
signs of age

Ageism can be Hazardous to Women’s Health

 Healthcare professionals also exhibit ageism
o Attitudes towards older adults are ‘complex and mixed’
o May be in part because physicians are trained to ‘cure’ and a portion
of them
prefer to work with patients who have acute illnesses that can be
cured, rather
than patients with chronic illnesses who can only be managed
 Older adults may be aware/suspect that doctors do not like to work with older
people or
are disrespectful/impatient with them
 ‘Leaky’ ageist attitudes can be experienced as microaggressions, and
physician’s negative
attitudes might make elders hesitate to seek or follow medical advice or even
cause
them to cancel appointments
Aaron Iny
20172053
Sex/Gender and Healthcare
 Men receive more thorough examinations, more follow-ups, and more evidence-
based
medical care than women
 Men are more likely to receive preventive care than women
o Given more flu shots, cholesterol screenings, colonoscopies, and
carotid
endarterectomy for stroke prevention than older women
 Joint disease: more older women have knee and hip arthritis and joint
disease/disability
but are less likely to undergo joint replacement surgery
o And they receive replacements later in disease process than men do,
which
means that they suffer
 Heart disease: women are less likely to receive heart bypass, cardiac
resynchronization
therapy, atrial fibrillation ablation, and cardiac catherization even when
conditions are
similar
o Less likely to be prescribed beta-blockers, anticoagulants, and daily
aspirin, less
likely to be referred to rehab program after a heart attack
o Women tend to be older than men when they are diagnosed with cardiac
disease, thus demonstrating age and gender stereotypes
o Women may be disadvantaged in diagnosis of heart attack because
symptoms
may vary from prototypical profile of heart attack, which is based on
male
symptoms

Physician Attitudes towards Older Adults

 Level of concern for patients: physician expressing sympathy for 42 year old
patient in
visible ways and using word tragic, but expressing no concern for 84 year
old with same
diagnosis
 Disrespectful behaviour: depersonalization; discussing a patients case in
front of patient
without addressing them
 Disregarding long-term consequences
o Two surgeons were about to do a hip replacement in an older woman and
realized that prosthesis given was not the right size; they inserted
anyway and
commented “well, I don’t think she will be doing much dancing
anyway”

Ageist Communication
 Withhold info: withhold or don’t explain as much to older adults, perhaps
because they
think they would not understand
o They focus more on reassuring older adults that they will be okay
 Infantilizing: using baby talk (use of simple sentences with childish
vocabulary, spoken in
higher pitch and brighter tone)
o Adults use this with young children and pets
o Terms like sweetie, dearie, young lady, good girl/boy after being
cooperative
  Talking over their head: treated as if they have functional deficits, spoken
to slowly or in
a loud voice, or comments are addressed to family even if older adult is
conscious and
aware
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Intersectionality and Ageism
 Hostile ageism could result in denial of healthcare to elders, especially if
care is
expensive, and could result in coercion of elders into signing DNR orders
o Especially among marginalized groups or those without medical
insurance/ability
to pay
 Many studies on implicit and explicit attitudes towards marginalized groups,
which
intersects with age, race, anti-fat bias, bias against sexual minorities
o African American women have faced lifetime of both overt and subtle
racism and
sexism
 Racialized adults and those in low income, low education, in underserviced
areas, are
likely to have less access to quality healthcare, to health food, and/or a
healthy
environment
o When they get older, challenges they have faced over the life course
are
compounded by impacts of ageism, amplifying the barriers they face

Zero Sum Game

 Zero sum: improvements for one person means a diminishment for others
o Does promoting life extension need to be a zero-sum gain?
 Amount of health available to worlds aging population is not fixed, and
improvements in
health/life expectancy do not create social ills
o Typically, a healthy population is a crucial factor in helping society
remain
economically viable
o There are still societal consequences to consider if we extend human
health
span, such as impact on how long we expect people to work, or the
impact on
population growth, climate change, etc.
o Appropriate response to these concerns is addressing them directly,
rather than
forfeiting health benefits of an applied gerontological intervention

Module 6 Section 1: Expanding Your Understanding of Biohacking, Grinding, and

Gerontechnology

Early Gerontechnology – what are some popular gerontechnology products in the past
that
we’ve since improved?
 Earliest wheelchairs appeared b/w 6th and 4th centuries BCEs as wheeled
furnitues and
used more widely in 12th-17th centuries AD
o Early form of gerontechnology
 Other devices that could be considered gerontechnology have been in
development on a
large scale since the 1870s
o Most were used by people of all ages
o E.g. by 1904 here were 3 million phones in USA alone; primary purpose
for
 business but also allowed families and older parents/grandparents to
stay in
touch and maintain social connections when mobility was problematic
 Hearing devices:
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o 1874 audiophone bone conduction amplifier
o 1876 first portable hearing device
o 1898 first electric hearing aid developed
 Visual impairment:
o 1892 first braille typewriter
o 1928 radios distributed to blind
o 1941 prototype of the Perkins Brailler developed
 Mobility devices:
o 1655 German watchmaker Stephan Farfler made a 3-wheeled chair he could
propel with a rotary handle on the front wheel
o 1750 James Heath, and English inventor, created the bath chair
o 1950 first electric wheelchair developed

Modern History of Gerontechnology

 Jan A.M Graafmans was originator of modern field we call gerontechnology
o In 1988, part of research team in Eindhoven University of Technology to
develop
a program of research and education in gerontechnology to further
integrate
engineering sciences with other disciplines involved in aging studies
 Dutch government’s goal was to facilitate collaboration b/w health and welfare
worker
and engineers, architects and industrial designers to create a better living
environment
for aging/aged people, supporting independent life of choice

Uses of technology
 Can be used to improve quality of life or lengthen lifespan through accident
prevention
or mitigation of effects of age related changes
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Biohacking
 Dave Asprey is the father of biohacking
Video:
 5 biohacks you could do to upgrade your life:
o Cold shower hitting forehead for as long as you can for 3 days in a row
o Limit bright/blue light exposure during day
o Skip breakfast – intermittent fasting, frequency is situational
o Sleep quality – blue blockers before bed, blackout room, raise head of
bed by 6
inches, do not turn on light if you get up
o Expressing gratitude – find 3 things you are grateful for each night
 These could all be used by older adults to attempt to slow age-related changes

Biohacking controversy
 Judging whether a biohack is legit is tough
 Richard Miller, a biogerontologist at Michigan U said that until the early
1990s, it was
laughable that you could develop a pill to slow aging
 Now research shows that mice given molecules such as rapamycin live 20% longer
o Other substances such as 17 alpha estradriol and the diabetes drug
Acarbose has
been show to be effective in mouse studies
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 Important step is to do a literature review searching clinical outcomes of
scientific
studies of compounds in biohack/biotechnology and make own decisions
o Beware of conflict of interest, overlap b/w institutions and
individuals at highest
levels with financial interest in products

Exercise: Fight Age Related Changes

 Most important and simple biohack is exercise
 Tennis player Bob Litwin:
o Age 72, trained in 2020, undefeated in 2019 but then stopped when
COVID hit
o Prolonged gap in exercise is a particular blow for fitness of seniors
who may see
rapid falloff
 Decrease in type 2 fast-twitch muscle fibers (for sprinting and
power) can
be observed at 3-4 weeks
o Litwin stayed in shape by using resistance bands for strength training
and hitting
tennis balls against wall with his wife
 Runner JoAnn Sampson:
o Started running at age 62, now 79
o Improved quickly, ran second-fastest 50m dash in country for age group
in 2017
o Says age doesn’t matter, its your heart
o Trying something new and bring uncomfortable is good for you;
stimulating your
brain as part of developing and learning
 New cognitive and physical challenges spur neuroplasticity
which can
slow cognitive decline

Grinders and Makers

 Makers produce a huge variety of items for electronics to furniture to houses
and
biohacks
o Makerspaces are place where equipment and mentorship is available
o For grinders, makerspaces are where they ca get assistance in
developing
implants
 Grinders intertwine biotechnology with bodies
o Grinders become Makers when they develop technologies for integration
into
their bodies
o Grinders such as Lepht Anonym develop their own technology for
implantation
within their bodies
 Can be simple such as encasing a magnet in non-bioreactive
material
prior to implantation, or can be complex
o Grinders are biohackers but the hardware they are interested in is
their own
body
o Every year, grinders converge to California’s remote Tehachapi
Mountains for
Grindfest, a weekend dedicated to the merger of man and machine
 o They are transhumanists, want to transcend their human form to become
part
machine, to be cyborgs
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o Amal Graafstra has the first and most well-known DIY RFID (radio
frequency
identification) implantees
 Genspace:
o Nonprofit DIYbio lab in New York devoted to citizen science, where
amateurs can
go and tinker with biotechnology
o Offers fun, creative, and practical uses for DIYbio

Deeper Dive into Biohacking Devices, Grinding, and Transhumanists

Sensory Expansion
 Magnets implanted under skin to feel magnetic fields
o Can help with jobs such as electrical engineers
 Full body suit called the SpiderSense suit, covered by sensors that can alert
different
parts of body to proximity of objects in environment
o Can help those with visual impairments navigate space or aid those with
hearing
impairments avoid being surprised by moving objects outside field of
vision

Transcranial Direct Stimulation Device (tDCS)

 Non-invasive, painless brain stimulation treatment uses a constant low
intensity current
passed through electrodes which modulates neuronal activity
 Still experimental, potential advantages over other brain stimulation
techniques
o Cheap, non-invasive, painless, safe
o Easy to administer and equipment is easily portable
o Most common side effect is slight itching/tingling on scalp

Radio Frequency Identification Device (RFID)

 Electromagnetic fields automatically identify, and track tags attached to
objects
 Tag consists of tiny radio transponder, radio receiver and transmitter
 When triggered by electromagnetic interrogation pulse from nearby RFID reader
device,
tag transmits digital data using an identifying inventory number back to the
reader
 Key cards and credit cards use RFID
 RFID implants can perform basic tasks like storing emergency contract details,
opening
office doors, and storing e-tickets for events
o May eventually help lost children find way home or notify doctor if at
risk of
heart attack

Transhumanism
 Grinders specialize in low budget (self-funded) DIY biohacking
 Implants include those focused on sensory expansion, including magnetic RFID
chips
 Lepht Anonym performs surgeries at home
o Been working on developing an implanted haptic feedback (use of touch
to
communicate with users) device to sense direction
o Lepht believes in body sovereignty, that no one else should be able to
control
 things in one’s own body
*All three of these technologies could potentially help older adults
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 Many lose grip strength when they don’t engage in weight bearing activities
or those
with arthritis; RFID devices that allow for opening of doors, logging into
devices, etc.,
could be helpful
 Some suggestion that tDCS may have therapeutic effects for those with
dementia
 Sensory expansion for sight, hearing, sense of direction, etc., could be
helpful

Module 6 Section 2: Applying Biohacking and Biotechnology to Treat Disease/Illness

Threats to Longevity
- Chronic pain, chronic illness, and diseases like cancer and heart disease are all
threats to
longevity
- Along with the effort to create a pill/treatment that will halt/prevent aging,
scientists are
also interested in finding ways to interfere with the negative impacts of pain,
disease, and
illness

Queens’ Scholars Who are Working with Biotechnology to Address pain and Disease

Dr. Ron Levy- Using Electrodes to Scramble Pain

- Ron Levy, MD, PhD, FRCSC, is a clinician scientist neurosurgeon with extensive
neurophysiological and clinical experience in neuromodulation techniques to
treat
movement disorders, pain, and epilepsy
- His lab at Queen’s research how these illnesses affect motor and cognitive
function using
acute and chronic electrophysiology, simultaneous stimulation and recording
techniques,
magnetic resonance imaging, and novel device design

Dr. D.J. Cook- Using Specialized Instruments and Scopes to Treat Aneurysms
- Brain aneurysms can lead to strokes
- Dr. D.J. Cook is a cerebrovascular surgeon-scientists who is developing new
treatments that
minimize trauma related to brain aneurysm surgery, resulting in better
outcomes, shorter
hospital stays, and an earlier return to normal life
- He also runs a parallel research program to develop new treatments to enhance
brain
recovery after stoke
- Dr. Cook’s surgical approach is focused on minimally invasive techniques to treat
brain
aneurysms and skull-based tumours through keyhole openings in the skull. Using
specialized
instruments and scopes
- These techniques have improved outcomes, decreased admission times, and freed up
critical resources

Biotechnology and Cancer

- Cancer is caused by genetic mutations
- These mutations are often at the center of new therapies for cancer
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- Mutations can be very different in each individual tumour
- Biotechnology that addresses the mutations using the immune system in a field
known as
immuno-oncology
- By comparing the DNA sequences of the tumor and of healthy cells the technology
can
identify multiple cancer mutations ad select the ones that are more likely to
provoke a
strong reaction from the immune system
- Vaccines are given in the form of mRNA
- The mRNA vaccine does not edit the DNA, instead it gives cells the instructions
to create a
particular protein, in this case a cancer antigen, that primes the immune
system against the
tumour

CAR-T Cell Therapy

- Technology called CAR-T cell therapy consists of taking immune T-cells from the
patient and
genetically engineering them to target a specific cancer antigen
- CAR-T clinical trials have shown impressive results in patients that relapse and
have
exhausted other treatment options
- 8 patients in the clinical trial remained tumor free for 23 months after
receiving the vaccine
- Five other patients relapsed
- The vaccine has some severe side effects that have led to deaths
- Currently, the technology is not available for treating certain rare forms of
blood cancer and
is not available to countries without sophisticated healthcare systems

Advances in CAR-T Technology

- Next generation CAR-T technology is being developed using T-Cells with the
capacity to
target 80% of cancer cells
- This biotechnology exploits the molecular differences between cancer and healthy
cells,
homing in precisely on the cells that cause disease
- These targeted approaches will hopefully lead to more tolerable treatments with
higher
efficacy and cure rates

Computer Assisted Medical Interventions: Cancer Surgery

- The NaviKnife and iKnife are two closely related computer assisted medical
intervention for
cancer surgery

NaviKnife
- Breast-conserving surgery (BCS) is a mainstay in breast cancer treatment
- For nonpalpable breast cancers, current strategies have limited accuracy,
contributing to
high positive margin rates
- The NaviKnife uses a surgical navigation system based on real-time
electromagnetic (EM)
tracking
- Excisions performed with navigation result in the removal of less breast tissue
without
 compromising positive margin rates

iKnife
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- The “intelligent knife” or iKnife can t3ll surgeons immediately whether the
tissue they are
cutting is cancerous or not
- It uses an electrical current to rapidly hear tissue, cutting through it while
minimizing blood
loss
- The iKnife is connected to a mass spectrometer, an analytical instrument used
to identify
what chemicals are present in a sample
- Different types of cells produce thousands of metabolites in different
concentrations, so the
profile of chemicals in the vapours produced from surgery can reveal
information about the
state of that tissue
- In the first study to test the invention in the operating theatre, the “iknife”
diagnosed tissue
samples from 91 patients with 100% accuracy, instantly providing information
that normally
takes up to half an hour to reveal using laboratory tests

Bionic Pancreas and Other Diabetes Management Technologies

- The bionic pancreas team is a collaborative group from Boston university and
Massachusetts
General Hospital working together to make automated blood glucose control a
reality
- The goal of the bionic pancreas project is to reduce the impact of
diabetes for people
living with it
- To accomplish this, the team of engineers at Boston university is
developing a Bionic
Pancreas to automatically make decisions about insulin and glucagon
dosing every
five minutes
- Other researchers have successfully developed a smart contact lens with
integrated micro-
LED and photodetectors which can measure glucose concentration in the
conjunctival blood
vessels by analysing the NIR light
- This technology can diagnose diabetes
- Furthermore, they put their new smart LED contact lenses on rabbit eyes
with
diabetic retinopathy disease and irradiated light repeatedly for a month
- As a result, they confirmed that there was significant reduction of
angiogenesis in
retina and verified clinical feasibility of the smart LED contact lens
for the diabetic
retinopathy therapy
- This means that this device will not only let diabetic patients monitor
their blood-
sugar level in real time but also enable medical treatment for
retinopathy

Section 3: the future of technology to help manage age-related change

Innovation for the Deaf Community

FAQ: what are some popular gerontechnology products that are used now or being
tested?
- Glove translates sign language into speech in real time. Allows deaf people to
communicate with anyone without a translator
- Contains sensors that run along the 4 fingers and thumb to indicate each
word/phrase/letter in American sign language
- Signals sent to smartphone which speaks the words at rate of 1 word/ second
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“Lead researcher at U C L A, Jun Chen, said "Our hope is that this opens up an easy
way for people who
use sign language to communicate directly with non-signers without needing someone
else to translate for
them," said lead researcher Jun Chen”

Video: Addressing Age-Related Macular Degeneration

- Dr. Laura Wells – KHSC working with human mobility research centre
o Working to create materials used to deliver drugs to hard to reach areas
of the eye,
such as the retina

“The idea is that a patient would have the device inserted once and then the drug
would deliver
over a long period of time - months or years,” she says. “We’re also looking at
having
biomolecules in the eye automatically change the release right from the device, so
that a patient’s
disease itself will actually control the rate of the release of the drug.”

- Dr wells also works on implantable devices such as intraocular lenses (used

for cataract
patients)
- studying how these devices interact with cells and using that information
to make new
materials that will last longer and reduce the need for replacements

Video Notes:
- patients lose vision from centre to outwards, decreases QOL
- cataract patients have original lens removed and is replaced with intraocular
lenses

Video: The Human Mobility Research Centre

- a collaborative hub for researchers and clinician-scientists working in
medicine,
engineering, health sciences, and computer science
- new initiative partners engineering students and health sciences trainees in
an integrated
research team
- interested in improving mobility outcomes and solve clinical problems

Video notes:
- not just mobility, but also clinical issues

Clinical Research at the Human Mobility Research Lab

- Osteoarthritis (OA) = age-related impairment causes pain and physical
disability
- Factors that initiate progression of OA not well understood
- Lack of data on pathomechanics of disease (what causes disease to progress
more rapidly
in some people more than others)
- Severe OA: stride characteristics, joint kinematics, kinetics, and
neuromuscular function
differ
- Moderate OA: importance of joint kinetics and understanding pathomechanics of
OA in
design and treatment options
- Non-surgical treatments improve mechanical environment of knee such as
bracing, heel
wedges, gait modifications
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- Therapeutic techniques have promise in management of symptoms of OA

Wii Board: Preventing Older Adults From Falling

- Claire Davies – lab called Building and Designing Assistive Technology Lab
(BDAT) to
increase assistive technology to increase the independence of persons with
disabilities.
- One program focuses on preventing older adults from falling

“While devices like the Nintendo Wii can potentially increase balance control,
virtual reality
games available for the Wii are not designed as exercise therapy programs for older
people.
Targeted therapies are more likely to increase function and decrease falls risk. A
virtual reality
home-based exercise program with off-the-shelf equipment has been developed,
utilizing
targeted exercise therapy games to encourage at home exercise using novel software
with Wii
balance boards and the Kinect Sensor.”

Question: You have just learned about strategies and developments to improve
quality of life of
older adults and help extend the lifespan by avoiding injury and addressing
mobility challenges.

Using the knowledge you have gained from the course, answer the question.
Do you think that technology to help people communicate, stay active, prevent
falls, etc., is
the best way to increase quality of life and extend the life span (by preventing
injury that
can lead to death)? Is there something you think would be more effective that is
being
overlooked?

Answer: We know that falling is often the prequel to a downward spiral to death for
many older
adults. Another factor correlated with early death is social isolation. So, from
that perspective,
strategies that preserve or promote activity, prevent falls, and devices to
increase the ability to
connect and communicate are all very promising for promoting quality of life and
longer
lifespan. So, yes.

Active Aging Industry FAQ

Question: What are some popular gerontechnology products that in the past that
we've since
improved?
- Active aging industry in the U.S: includes safety and smart-living technologies,
health and remote care, and wellness and fitness technologies
- is expected to triple in the next three years, to nearly $30 billion
 - This report predicts that wellness and fitness technologies for seniors is
expected to reach
$900 million by 2022.
- Over time, innovative designers and engineers will develop devices that
assist older
adults to maintain and increase their activity levels, maintain healthy
nutrition, and
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develop social networks that all support their physical and mental health
directly - instead
of focusing on contactless ways to ensure medication is taken, or to monitor
vitals.
- When these technologies come on board the active aging industry has the
potential to
expand exponentially.
- Robotic technologies that assist with tasks (rather than provide
companionship) is one
area where there is tremendous potential for growth

How Rosa the Robot Will Help Isolated Seniors and Support Aging in Place
- Stairs = problem
- Carrying stuff up and down = risk of falling
- Toronto Startup developed service robot that shuttles household items between
floors
virtually hands free
- Dr. Naccarato, an aerospace engineer who specializes in robotics, was
originally inspired
to develop the stair-assist technology after his aging parents had trouble
managing in their
two -story home and had to move to a long-term care facility
- motorized mechanism that allows it to shuttle items up and down stairs,
adjusting to each
step it encounters while keeping the load level.
- Enter the Robotic Stair-climbing Assistant, or R O S A, a compact cart that
carries items
up to 100 pounds on stairs, which he developed in collaboration with George
Brown
College’s School of Mechanical Engineering Technologies, assisted by AGE-
WELL’s
Strategic Investment Program (S I P)

Section 3 Summary

This section considered technologies that disrupt the idea of helpless aging. These
are
technologies that may be able to help people living with deafness communicate, and
others that
support those with macular degeneration to receive medication. You also saw how
researchers
studying human mobility are developing tools to help older adults to maintain
balance and
stability in order to prevent falls, which can have catastrophic results.
You saw how the active aging industry is poised to take a larger market share as it
produces more
devices to help older adults be active and independent, such as Rosa the robot
helping older
adults maintain independence and support aging in place.