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International Journal of Pharmaceutical and Healthcare Marketing
Innovation for elderly with dementia – localization technology transfer
Tobias Ebbing, Marzenna Cichosz,
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Innovation for elderly with
dementia –localization
technology transfer
Tobias Ebbing
Technical University Berlin, Berlin, Germany and Warsaw School of Economics,
Warsaw, Poland, and
Marzenna Cichosz
Department of Logistics, Warsaw School of Economics, Warsaw, Poland
Abstract
Purpose –The purpose of this paper is to contribute to the discussion of transferring modern technology
from industries such as logistics to the life of elderly in a way that they can understand, accept and make use
of it.
Design/methodology/approach –This is a conceptual discussion based on findings from a series of
projects in healthcare, IT development and consultancy. The key methodologies considered include
technology assessment, scenario development, listening to people with dementia and their caregivers and
non-participant observation, as well as reviews of good practice, policyand literature.
Findings –The transfer considerations showed unreasonable price differences of similar hardware used for
localization between the logistics and the elderly market. Bluetooth low energy (BLE) was identified as a
promising localization technique. A gap in the marketing of technology for the elderly was identified, virtually
fencing the elderly market.
Practical implications –A lack of transparency fosters market skimming, resulting in deadweight
loss for society and technology being restrained from less-solvent consumers. Corrective actions like
entrepreneurship facilitation and consumer education should be considered to overcome this market
failure. To persevere in a consequently more competitive market, changes in marketing should be
considered.
Originality/value –The work assesses the presence of the innovativeness–needs paradox of Everett
Rogers in the field of innovation for the elderly on the basis of an example and identifies the resulting market
failure. It suggests a market-entry mode and briefly lays out the marketing modes for marketpenetration.
Keywords Health IT, Dementia technology, Elderly marketing, GPS elderly, Innovation transfer,
Localization technology
Paper type Conceptual paper
Introduction
The demographic change towards an aging population is inevitable. The United Nations
(UN) report World Population Aging recently projected that “the number of older persons –
those aged 60 years or over –in the world is expected to grow by 56 per cent, from 901
million to more than 1.4 billion by 2030”(UN, 2015, p. 1). As a consequence of this progress,
half of the “world’s population [of 2050] will live in countries with at least 20
per cent of the population aged 60 years or over, and one in four people will live in countries
where elderly persons account for more than 30 per cent of the population”(UN, 2015,p.8).
A recent study of the World Health Organization (WHO) comes to similar projections (WHO,
2015, pp. 43-45).
Innovation for
elderly with
dementia
183
Received 28 August 2016
Revised 26 January 2017
Accepted 9 March 2017
International Journal of
Pharmaceutical and Healthcare
Marketing
Vol. 11 No. 2, 2017
pp. 183-197
© Emerald Publishing Limited
1750-6123
DOI 10.1108/IJPHM-08-2016-0043
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/1750-6123.htm
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The distribution of elderly people around the world is not equal and could be linked to
the gross national income of countries. According to the UN:
[...] high-income countries tend to be the most aged. Japan is home to the world’s most aged
population, with 33 per cent of persons aged 60 years or over in 2015. Japan is followed by Italy
(29 per cent aged 60 years or over) [and] Germany (28 per cent) (UN, 2015, p. 10).
With the increasing age, consequently age-associated diseases like dementia will become an
increasingly important social and economic factor (Stoppe and EDCON, 2008,p.1).
Alzheimer dementia occurs rarely below the age of 65 years (Förstl et al.,2001,p.43).In
Germany, a recent study stated that the mean age of dementia onset is about 79 years for
men and 82 years for women, with a deviation of 8.1 within men and 7.6 within women
(Brinks et al.,2013, p. 4). Further, the German Federal Statistical Office assumes that the
scenario where “the number of persons with dementia increases from about 1.5 million in
2010 to more than 3.6 million in 2050”(Brinks et al., 2013, p. 67) is the most likely one. To
address these problems, intensive research is conducted in the three important fields of:
(1) early detection of dementia;
(2) diagnosis of dementia; and
(3) management of dementia (McCarberg, 2007).
Further, while “better treatment options will lead to an increasing number of mildly to
moderately affected demented patients”(Stoppe and EDCON, 2008, p. 2), a cure does not yet
seem to be in sight. Moreover, other age-related “issues such as falls, sensory impairment,
diminished mobility, isolation and medication management”(Demiris and Hensel, 2008,p.1)
will be more prevalent in society. Among these issues will also be disorientation. For now,
with information technology, we cannot fight the causes of aging and can only support the
search for a cure for dementia. However, we can try to fight symptoms, like medicine does
(Förstl et al.,2001, p. 43), and make the abovementioned issues less cumbersome. This is
where technology transfer efforts, like the contemplated one, can help the concerned parties.
Hence, the purpose of this paper is to contribute to the discussion on transferring modern
technology from industries such as logistics and transportation (source sector) into the life of
elderly with dementia and disorientation (target sector). Such a transfer should be conducted
in a way that the concerned parties of the target sector can easily understand, accept and use
the technology. A successful transfer of technology can grant them back a piece of freedom
which they lost, e.g. due to their condition. This paper will specifically analyse how
localization technology is marketed in a source sector and the target sector. Based on this,
conclusions on possible corrective or enhancing measures will be drawn.
Dementia and disorientation –problems of an aging society
Dementia is a broad term and relates to a group of syndromes rather than one single disease
entity. To date, over 200 subtypes of dementia have been defined and each one has a different
pathway or process (Stephan and Brayne, 2010). However, in general terms, the dementia
syndrome is characterized by a progressive decline in cognition of sufficient severity to
interfere with the activities of daily living (Knopman et al., 2001). The main subtypes include
Alzheimer’sdisease[1], vascular dementia, dementia with Lewy bodies, frontal lobe dementia,
Pick’s disease and alcohol-related dementia (Stephan and Brayne, 2010). Dementia is therefore a
syndrome that defies a simple definition. Perhaps, it is because of its shifting nature and
complexity that dementia has become a fear-laden term that encapsulates society’sworst
terrors (Zeilig, 2015, p. 12). Despite the general lack of consensus about what dementia “is”in
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neurological terms, there is agreement that dementia is a long-term medical disability and at
the present time, finding a cure or even effective drug treatments for it is proving elusive. In the
absence of appropriate pharmacological interventions, the social conditions in which those with
dementia live also need urgent attention (Zeilig, 2015,p.13).
Responding to this request, the analysis of transferring modern technology from other
industries into the lives of elderly people with dementia is conducted to improve their and
their caregiver’s quality of life. This paper concentrates on one single symptom of the
dementia syndrome—disorientation.
Disorientation
Disorientation is “a usually transient state of confusion especially as to time, place, or
identity often as a result of disease or drugs”(Merriam Webster Dictionary, 2016).
International Statistical Classification of Diseases and Related Health Problems, 10th revision
(ICD-10), defines it with examples of several states of disorientation, amongst others:
A mental state characterized by a lack of clear and orderly thought and behavior. A mental state
in which a person is confused, disoriented, and not able to think or remember clearly. A mental
state marked by confusion about time, place, or who one is (ICD-10, 2016, Diagnosis Code R41.0).
A very graspable description of disorientation and its stages can also be found in the
definitions of Feil (1993). She ordered disorientation issues to four stages of Alzheimer
dementia and identified three orientation issues:
(1) Loss of orientation in place, which fades already in the first phase, which Feil calls
the mal-orientation phase.
(2) Orientation in time, meaning the awareness of date and time, maybe knowledge
about a certain event and a grasp of an upcoming schedule, fades in the second
phase. Both abilities reduce early and increasingly with advancing years.
(3) In the late stages, the patient loses track of his/her own person, might think he/she is in
his/her early 30s or another time that made a great impression in his/her life (Feil, 1993).
According to the ICD-10 definition of dementia, the symptoms must be a decline of a
formerly present ability and are not expected to be transient (Förstl, 2011, p. 6). Within the
scope of this study, spatial orientation (the awareness of one’s location) is the focus,
abandoning other factors of disorientation.
The risk of getting lost
Repeated studies have shown that “the risk of patients with dementia getting lost is
substantial”(McShane et al.,1998, p. 257). These studies are generally divided between
gettinglostinone’s own home between rooms or, e.g., within an elderly home and getting lost
outdoors. It was found that about 28.2 per cent get lost inside their homes and 40
per cent of the patients suffering from dementia get lost outside their homes. It seems
reasonable to assume that an intersection between these groups exists. Evaluating the risk of
getting lost, Ballard et al. found that being lost at home is only perceived as a problem by less
than 3.2 per cent of those who suffer from dementia. Getting lost outside is, by contrast,
perceived as a problem by 20.6 per cent. With the purpose of solving these problems, this paper
will hence mainly concentrate on outdoor orientation (Ballard et al., 1991;McShane et al., 1998).
Cognitively impaired people who get lost and wander around outdoors are called
wanderers. Rowe and Glower (2001) were able to examine the “wanderer return files”from a
“safe return”programme in the USA with respect to how far away from home the wanderers
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were found. Such programs help to search for lost patients and are a communication hub for
found wanderers. Once found, the employees can hopefully find a contact person to inform
their 60,000-people database (p. 344). They found that:
[...] the majority of wanderers were found within five miles of their home, with 37 per cent found
within a one-mile radius and 50 per cent found in a one- to five-mile radius. Only 7 per cent of the
individuals were found more than ten miles from their home (Rowe and Glover, 2001, p. 346).
Unfortunately, Rowe and Glover had to report 30 injured persons from the 615 analysed
cases. Among them were “20 incidents of what appeared to be new skin injuries, four
instances of dehydration and one injury resulting from exposure to cold”(Rowe and Glover,
2001, p. 347). Additionally, four deaths from exposure to cold weather were registered, while
one elderly person was hit by a train (Rowe and Glover, 2001, p. 347).
These findings make it obvious that disorientation and wandering is a serious issue
which should be approached from as many angles as possible. By doing so, the lives of
many people might be saved, and the quality of life improved. Mitigating the
aforementioned risks shall relieve the legitimate anxiety of caregivers, and being able to
move freely without lower risk of getting lost will give the elderly a piece of freedom back.
Innovation and Rogers’innovativeness–needs paradox
The mastery of stressful situations requires resources. These resources are objective and subjective.
Objective ones include general health, material goods, competencies, family and friends, while
subjective ones are self-esteem and the perceptionofthevalueoftheobjectiveresources(Deutsches
Zentrum für Altersfragen, 2001, pp. 13-14). Technology can be seen as an objective resource, while
the confidence in handling difficult situations with the help of technology is a subjective resource.
For the well-being of society, it is important to provide useful resources for all social groups,
including groups that are in higher need of proper resources than others.
Elderly persons with disorientation represent such a group. Recently, a BBC article titled
them the “generation that tech forgot”(Wakefield, 2015). Providing them with a proper set of
resources, including access to technology that a majority of the population of the developed
economies is making or beginning to make use of, is in everyone’s best interest. The elderly
often cannot make use of recent developments because of the industries’failure of
objectively fitting it to their needs and the subjective feeling of incompetence to make use of
new technologies. Onelikely causes the other, and a vicious circle cuts a group of population
from the progress of civilization. Due to this constraint of modern resources and the decline
of basic resources like physical and mental fitness, their capability to master stressful
situations is doubly diminished.
Innovation is outlined as the process of creating resources as well as the “the act that
endows resources with a new capacity to create wealth”by Peter Drucker (1986, p. 30).
OECD and Eurostat define innovation as:
[...] the implementation of a new or significantly improved product (good or service), or process, a
new marketing method, or a new organizational method in business practices, workplace
organization or external relations (OECD and Eurostat, 2005, p. 46).
Rogers emphasizes that innovation “is perceived as new by an individual or other unit of
adoption”(Rogers, 1983,p.12).Thus,“development of a new use for a product with only minor
changes to its technical specifications is product innovation”(OECD and Eurostat, 2005,p.48).
The process of adopting innovations and the popular S-Curve-adoption model was
described by Rogers in his book Diffusion of Innovations (1962, pp. 241 ff.). Rogers defined
diffusion of innovation as “the process in which an innovation is communicated through
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certain channels over time among the members of a social system”(Rogers, 1983,p.5).He
named the four key components of the diffusion of innovations –innovation itself,
communication channels, time, and social system –and presented the stages of adoption with
therateandspeedofadoptiondepictedintheinnovation bell-shaped and s-shaped curves.
When presenting different types of innovation adopter categories, Rogers (1983) stated
the innovativeness–needs paradox:
Those individuals or other units in a social system who most need the benefits of a new
technological idea (the less educated, less wealthy, and the like) are generally the last to adopt that
innovation (p. 263).
This paradox could be related to seniors with dementia and disorientation and their need for
localization technology. A nexus of basic economic functionalities might lead to a market
failure in this specific situation. Initially, there stands a high psychological strain that urges
the caregiving customer to buy a localization device and economically represents an urgent,
strong need. Combined with a lack of time and knowledge, an uninformed consumption of
new technology is the result. Uninformed customers are known to be less loss-averse (Karle
and Peitz, 2010). “The nature of [the market] equilibrium changes drastically if consumers
are imperfectly informed. Firms now profit from ignorance in the market”(Tappata, 2009,
p. 674). This likely leads to a non-equilibrium price of such an innovation on the market for
the elderly. The market failure, visible in the form of many producers skimming the surplus
with premium pricing, in turn builds an entrance barrier for less wealthy, more needy
adopters. An indicator for such a situation could be seen in the presence of a similar but
cheaper product in a more competitive and transparent source market with more informed
customers. For localization technology, such a market can be found in the logisticssector.
Logistics localization technology
Logistics management plans, implements and controls the efficient and effective forward
and reverse flow and storage of goods, services and related information between the point of
origin and the point of consumption to meet customers’requirements (CSCMP, 2013, p. 117).
When dealing with the flow of a good, an important aspect for the control of the process is
the knowledge about its location. Therefore, logistics has absorbed and developed a deep
understanding of tracking and tracing entities. This high knowledge and high marketpower
of buyers produces a more transparent market situation and makes it a good reference for
localization solutions.
Logistics providers make use of a variety of technologies to enable automatic
identification (AutoID). AutoID functions as the interface between the real world and an IT
system (Strassner, 2005, p. 54). The identification of an entity at a certain point can be
defined as localization (Bouet and Dos Santos, 2008, p. 1).
The most common AutoID technologies to support logistic processes are optical
character recognition (OCR), barcode systems and radio frequency identification (RFID)
(Schmidt, 2006, p. 29). The most basic AutoID solutions are using one-dimensional or more-
than-one-dimensional barcodes or OCR. More sophisticated technologies include RFID,
Bluetooth low energy (BLE) and global positioning system (GPS) tracking units that usually
identify via international mobile equipment identity (IMEI). Cellular tracking is rarely used
in logistics for low accuracy and uncertainty in international applications. It might be
considered for elderly tracking though. Basic technologies require a medium to high
interaction quota, while more sophisticated technologies mainly work autonomously.
Selected logistics localization technologies and their possible applicability for localization of
the elderly are summarized in Table I.
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Logistics
localization
technology Short description Main advantages Main disadvantages Applicability to elderly localization
OCR Machine reading of human
readable text. Location is
proximity to reader
Low cost, human readable High error rate, affected
by dirt, needs line of sight
(LoS)
Need for LoS and ethical reasons
(visible mark) make it impractical
Barcode systems ID as (more-dimensional) barcode
to be scanned. Location is
proximity to reader
Low cost, can be made human
readable
Medium error rate,
affected by dirt, needs LoS
Need for line of sight and ethical
reasons make it impractical
RFID Transponders replying ID on
request to reader. Location is
proximity to reader
No sightline needed, small, can
be passive
Needs second component
to work (e.g. reader)
In predefined locations workable.
Not workable in open terrain as
building an ubiquitous reader-
transponder network is costly
BLE tracking Bluetooth beacons reply ID and if
needed status, at request to reader.
Location is proximity to reader
No sightline needed,
transponders in smartphones
widely available, low energy
use
Second component is
needed to work
Workable in predefined locations.
Large scale with help of public
tracing app on many phones,
depends on density of network
GPS localization Device estimates position based on
satellite trilateration. In
combination with a method of
communication like GSM, the
location can be transmitted
No sightline needed. Location
is determined, not only
proximity. Worldwide
localization. Communication
independent of localization
High energy need. Mode
of communication must be
installed. Eventual
imprecision of localization
Workable in free environment.
Needs maintenance, e.g. frequent
charging, global localization not
necessarily needed
Cellular
localization
Position estimated based on
trilateration of radio mast
No sightline needed. Location
instead of proximity.
Availability of network of
masts
Low accuracy, even
decreasing in less-
populated areas
Low accuracy, sometimes
hundreds of meters, makes it
unusable for this purpose
Table I.
Selected logistics
localization
technologies
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The GPS solution is the most frequently used to determine the location of an entity on the earth’s
surface. A location is a fixed concept indicating a very certain place in a space. Proximity
describes the nearness to a reference point. The reference points in the GPS system are “known
positions of satellites in space [that are used] to [identify] unknown positions on land, at sea, in air
andinspace”(Hofmann-Wellenhof et al.,2001, p. 11). The other technologies use the readers as
reference points, and the proximity to them is used as the location of the entity. The use of three
proximity ranges can be used to trilaterate a location in reference to these points. Subsequently,
when not in reach of at least three satellites, a GPS location cannot be fixed. This makes GPS
mainly usable outdoors where a clear view of the sky is present. Technologies relying on
proximity to a reference, e.g. a reader, need a rather dense network of readers to be useful in a free-
field application. On the upside, these technologies do require less energy and the entity does not
need communication capabilities when the reader in turn is connected to a network. Considering
the density of the present Bluetooth devices, BLE could become a workable solution for
localization in the future, particularly in densely populated areas.
Transferring logistics localization technology for elderly with disorientation
Designing or adapting products for the elderly has been a topic of many research articles and
books (Aarts, 2008;Abu-Assab and Baier, 2009;Bartos, 1980;Eisma et al.,2004;Fisk, 2004;
Moschis, 2003;Graafmans et al.,1998). The important issues in this process are defining the
customer, her/his needs and wants, and barriers that should be overcome to succeed.
Customer and end user
When analysing elderly care, and correspondingly, the disorientation support segment, the
structure of the customer and the end user is similar to that of pharmaceutical marketing,
where the doctor has to be convinced by a company to prescribe certain drugs, but the
patient ultimately consumes them. Similarly, in the market of elderly care, marketing
actions are aimed at two groups of customers and end users. First, is the person suffering
from disorientation and maybe other symptoms of dementia, that is actually going to carry
and use the device (evident target group). And second, is the caregiver who looks after the
elderly person, follows the device and often makes the buying decision (de facto target
group). To clearly differentiate between these two recipients is very important when
building a Persona (Aulet, 2013, pp. 49-56, pp. 69-82) and it is important to keep the views of
both target groups in mind for the market assessment.
Personas –Ellen and Lilly
The customer is a family member, the daughter of the care-dependent person. Her name is
Ellen. She is 53 years old and works part time. In her free time, she takes care of her
widowed mother Lilly who just turned 85. Lilly is still mobile and can mostly care for
herself. She goes shopping, can still deal with change and is keeping track of groceries she
needs. However, when it comes to invoices and bills, she often loses track, and new
appointments are often missed. She has a very steady week with days for each and every
thing. Changes to this routine are difficult for her to handle.
Lately, Lilly has got lost twice. The first time Ellen was waiting for Lilly in a restaurant
for several hours not knowing where she is, and the other time she did not return home until
long after sunset, which is unusual as Lilly prefers not to be outside in the dark anymore.
When asked where she was, she could not recollect. Ellen is afraid that this could happen
again and is looking for a solution to help. By finding help, she not only wants to calm her
own worries but also hopes to increase the confidence of Lilly, who has lately become more
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and more cautious about going to new places. Ellen hopes that by relieving this anxiety,
Lilly’s self-confidence, health and outdoor activity can be increased again.
Barriers to adopting new technology
Among the predominant barriers that keep elderly users from adopting new technology,
Vastenburg et al. identified the following: complexity and learnability, lack of perceived
benefit and compatibility issues (Aarts, 2008, pp. 1-13). To this list, a study of the Calouste
Gulbenkian Foundation and Independent Age (2010, p. 5) added the following: lack of home
access to the Internet, inappropriate design that relates to complexity and learnability,
inadequate marketing and anxiety. Hence, to position a new technology successfully in the
market for the elderly these factors should be addressed.
Complexity and learnability are major challenges in designing and transferring technology
for the elderly sector. Eisma et al. reported that “older people often regard this fear or perception
of complexity as their own fault and not as a failure in the design of the technology”(Eisma et
al., 2004, p. 137). This problem is significant and difficult to solve because elderly persons will
not give honest feedback on the degree of complexity and learnability that they perceive. In
terms of learning, they show “a consequent reluctance to experiment and get stuck in learned
patterns that they are afraid to leave also because of a fundamental lack of trust in the system”
(Eisma et al.,2004,p.137).Fisket al. remarked that “older users may not benefitasmuchas
younger ones from the transfer of knowledge resulting from the use of other similar
technologies”(Fisk, 2004, p. 30). Bearing this in mind, it might be the most promising approach
to design a localization device with simplicity and reduce the required learning to a minimum.
The other huge barrier is the lack of perceived benefits. To overcome this, Vastenburg
et al. presented a framework consisting of five factors (goals) contributing to a positive
development of benefit perception (Aarts, 2008, p. 4). The most important are as follows:
Short-term benefits outweighing short-term cost. For localization technology, a
good approach would be to bind the promise that a company makes to the
caregiver to a promise made to their dependents. An example could be more
time outside when the tracker is used. Also, gamification aspects, i.e. earn
medals for walking the longest distance and being home on time, can be
considered. It might be an option to link certain discounts at stores to the
possession of a tracking device, i.e. a free coffee when equipped with a tracker.
Fit the device into existing living patterns. The localization service device therefore
should be non-intrusive. When considering women, an attachment to a handbag
might be a good option. For a man, a keychain or a spectacle case might be an option.
Strengthen social inclusion. Technology should not compete with human-to-human
interaction as the elderly fear to lose the little interaction left (Aarts, 2008,p.4).
The use of a localization device should create the need for more interaction with the
caregiver and for contact with friends, co-residents or grandchildren.
Another problem that might keep elderly users from adopting localization technology is
that they lack access to the Internet. According to GfK and ARD&ZDF (2015), the number of
internet users over 60 years of age in Germany constitutes 50 per cent. To be able to use
localization technology, the Internet is frequently needed. The provision represents a cost factor
for the elderly and should be calculated by providers or bundled into the localization solution.
The barriers mentioned above show that the marketing effort of the current technology is
misled and does not address elderly interests properly. For example, the possibility of
staying in contact with others without a need to meet personally (social networks and
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instant messaging services) is barely attractive for the elderly. In fact, “some older people go
for days without seeing another person; many die alone; 16 per cent of older people in
deprived inner city areas suffer severe from loneliness”(Calouste Gulbenkian Foundation
and Independent Age, 2010,p.4).
At the same time, studies show that the elderly mostly cannot identify with the stereotype of
the frumpy old person that needs special treatment when it comes to technology. They want to
“maintain his/her youthful self-concept, [...] reinforce the perception of being the same person”
(Moschis, 2003, p. 523). Moschis’studies on marketing for the elderly enabled him to identify
sub-groups based on the attitude towards aging. He found that over two-thirds do not want
special treatment. Further, 34 per cent want to stay up to date but accept their age; they are
called the “Ailing Outgoers”and can be addressed with more juvenile marketing; 38 per cent
belong to the group of “Healthy Hermits”which “resent the isolation and the fact that they are
expected to behave like old people”(Moschis, 2003, p. 521). These elderly might even feel
offended or ignorant towards special products for the elderly.
For localization devices, it might be beneficial to not market the product like an aid that is
only there because customers are old and incapable of finding their way home. It is
important to elevate the benefits for the elderly over the costs of adaption. The study by
Mitzner with 113 seniors showed that elderly do appreciate and see the benefits of
technology, like “the reduction of physical or mental efforts”(Mitzner et al., 2010, p. 1715).
The way it is presented and made accessible to them though lacks sympathy for the market
segment. Arguably, it might be said that disoriented people are not in the position to judge
this anymore. However, we learned that disorientation can occur early in the aging process
and should certainly not be taken as a reason to disqualify the elderly of their own feelings
and judgment of what could be good or bad for them.
Ethical and legal concerns vs benefits of the solution
Making a person traceable, independent of his/her accountability, might impose a legal
problem. In general, it is part of anyone’s personal freedom whether or not to inform someone
about one’s location. Handing this freedom over to a family member or some other authorized
person like a professional caregiver causes doubts about the restriction of their freedom and the
right to informational self-determination. To clarify the issue for the jurisdiction of Germany,
the company GPS4All publicly asked a German lawyer –Detlev Driever. He elaborated that
according to the Land court Ulm, attaching a chip to locate a dementia patient would only be a
deprivation of freedom if it would be used to restrict the person from leaving a certain place. In
the intended usage scenario, the localization technique has the opposite intention: to enable the
person to leave a certain place. A deprivation of freedom is subsequently not present if not
specifically used for a deprivation purpose (Driever and GPS2All.de, 2014;LG Ulm, 2008). The
right of informational self-determination is retained by reducing the circle of people with access
to the location to those with the mandate to care for the ward. Detlev Driever hence came to the
conclusion that if used for well-intended purposes, no specific legal concerns exist against the
use of localization services. This is an appraisal for Germany. Obviously, this assessment needs
to be done in each country where such a service should be installed and lawyers should be
consulted in case of any questions.
However, not everything that is legal is also right. The constellation of this ethical
conflict is thoroughly discussed in literature from the perspectives of a patient and a
caregiver (Hughes and Louw, 2002;Welsh et al.,2003;Robinson et al.,2007). On one hand,
the authors stress the aspect of maintaining the freedom of the patient to move around
without having to inform anyone about it. Even further, to be traceable at any given
moment, maybe even without notification of being localized. On the other hand, they
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emphasize the beneficial aspects of helping the patient and a calming certainty about the
patient’s well-being for caregivers and families.
To deliberately consider such a trade-off, judgement should be based, similar to the
extensive research of Robinson et al. (2007a,2007b), on the ethical duty of caregivers,
medical personnel and mankind after Beauchamp’s and Childress’s Principles of Biomedical
Ethics (Bishop, 2007). The aim is, like Welsh formulated, not to “deny [.] patients the chance
of a better existence and fail in our own professional ethical and moral duty”(Welsh et al.,
2003, p. 375). These moral principles include to “acknowledge a person’s right to make
choices”(Bishop, 2007), keep autonomy, have justice in mind, meaning to distribute burdens
and benefits fairly, to do no harm and to do good (Bishop, 2007).
Acknowledging autonomy is easy as long as the patient is still of sound mind. In this
case, it is obligatory to ask him/her what the preferred method of dealing with the problem
of disorientation would be and then to talk through the consequences with him/her.
Unfortunately, a state where spatial coordination has become a serious problem for the
concerned might likely be a state where lucidity is not a certainty anymore either.
Actions in such a scenario have to be thoughtfully balanced because a measure to keep
track of the patient’s location would be imposed on the patient. In this situation, caretakers
will be left with the directives of justice: doing good and no harm. The aforementioned
literature has discussed the topic of harm as invading privacy and informational self-
determination. Apart from that, there is no harm exercised. The considered devices are, for
now, not implanted or irrevocably attached. As already stated, about 40 per cent of the
patients with dementia wander, and in Rowe and Glovers’studies, 5.5 per cent of wanderers
die. Hence, there exists a vital interest in finding lost patients as soon as possible to protect
them from harm. Subsequently non-physical harm of personal freedom stands against a
possible physical harm. This beneficence seems to outweigh the factors of non-maleficence.
Recapitulative solution vision
A caregiver, in this case Ellen, would probably prefer a solution that is tailored for the
elderly and finds offers for logistics tracking by accident. She assumes that these logistics
devices are not suitable for humans; also, she does not want a device for her mother that is
intended for freight containers or forklifts. At the same time, localization services offered
specifically for the elderly are very expensive. What she does not know is that most of the
devices are similar Asian imports that are just marketed differently.
After comparing offers for both, elderly and logistics services, and taking into account
price and experience, the best solution available is a logistics GPS provider that also
provides a person’s location. However, the reality of the marketing gap of not addressing
elderly needs and wants properly will most likely keep Ellen away from these solutions.
This opens the field for high-priced and technologically similar solutions that specifically
address the elderly market.
In his deliberations, Porter (1998) states to be aware of not choosing a proper path
between price and product differentiation. Porter coins the term of “becoming ‘stuck in the
middle’[...as] a recipe for disaster”(p. 14). In the elderly market for localization, a suitable,
no-frills, price-differentiated product for localization is still missing. This leads to the
expected dilemma of the innovativeness–needs paradox. The group of people that urgently
need the innovation can only enter the market in minority because of the high prices.
Gratifying scenario
Efforts of low-price marketing cannot be too excessive. However, the elderly have to be
addressed directly and it should not seem like the by-product of a logistics track-and-trace
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solution as it is today. The price should be a convincing argument for the buyer. With low-
priced market penetration, mouth-to-mouth marketing might occur once the target audience
gets to know about the benefits at a reasonable price. The concept is to market elderly
localization as a commodity rather than as an expensive luxury. Faltin (2012, pp. 157-166)
advises to draw attention with unusual marketing and authenticity as a trademark, as Karl
Lagerfeld does in fashion. Create attention by being different but without breaking moral
codes (Faltin, 2012, pp.150-152).
At best, the devices would come preconfigured and with as little interaction as possible.
However, a proper manual could build trust. Plenty of the features that come with default
devices, e.g. from Asia, might not be needed for an elderly localization use case, further
encouraging a no-frills solution.
Futuristic scenario
Envision a future where wearable trackers have broadly found their way into the life of
consumers. Bluetooth mesh networks have made it possible to have a network of devices
that always stay connected. In an Internet of Things environment, life for Lillie and Ellen
has changed drastically. Both have sensors in their homes that signal basic information of
their situation to those that have access. Ellen can always look up if Lilly is safe by checking
if she opened her refrigerator or switched on the light or TV. Door sensors that come with
the building’s security system keep track of Lilly’s comings and goings so that Ellen can
notice right away if Lillyshould not come home one evening.
Lilly is going to wear a small Bluetooth tag as a keychain accessory that is not bigger
than a trolley token, maybe can even be used as such. Via the existing Bluetooth mesh,
Lilly’s token is connected. A majority of shops will be using beacons to send out content-
aware advertising to mobile advices around them. With these signals in a tight network, the
proximity of each tag to commercial beacons and other devices in the mesh is retrievable. In
case of an emergency, it will be possible to identify the token and notify a responsible
person. The Bodensee–Hochschule Project DeSearch is currently working on a prototype of
such a solution in a defined area (DeSearch Bodensee-Hochschule, 2015). As already
outlined, large-scale diffusion is the greatest barrier to such a system.
For non-network-based localization, e.g. in sparsely populated areas, GPS will be seamlessly
supported by the European Galileo and the Russian GLONASS Satellite network, increasing
accuracy up to 30 per cent (GSA, 2014). The satellite function in Lilly’s token will only be
activated once she presses an emergency button. This preserves her privacy (in contrast to the
always-on BLE beacon localization, which will be a norm by then like 802.11 localization for
location-based services is nowadays) and battery life. Once the location is determined, Ellen
will be notified via a text message. Further, every device, personal or commercial, will be
alerted as soon as it is in reach of a mesh network and an emergency button has been pressed.
The keychain will periodically send out emergency signals to any device in the environment,
including passing cars or agricultural machinery. A person in proximity can read the keychain
with their wearable communication device, which will make Ellen’s contact information visible
on the reader’s phone. By calling her, contact between Lilly and Ellen can be established and
Lilly can be picked up or guided home.
Conclusion
It is becoming a high priority to treat elderly and dementia care as a segment that needs the
influence of more tech-savvy groups in order to establish market equilibrium for
technological innovations. In the example of localization technology, a prevalence to market
skimming could be identified when comparing prices in the source and target sectors. As
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expected, one of the most dependent groups of the disoriented elderly is inhibited in the use
of localization innovation because of two main reasons. The first is the market failure caused
by a lack of transparency. A majority of potential consumers are being crowded out by
setting prices above perfect competition equilibrium that is accepted because of uninformed
and desperate consumers. The tempting producer surplus reinforces this pattern. Second,
inappropriate marketing measures are not appealing to the segment in need.
Hence, to allow the elderly to better benefit from innovations in the future and overcome the
innovativeness–needs paradox, a broader set of understanding on how to present innovation to
them is necessary. Further, support for entrepreneurial action in the market for the elderly and
smart IT for dementia care should be provided. Entrepreneurial activity, particularly towards
price-differentiated products, has the potential to disrupt the non-transparent market.
Technology transfer represents a mode of entrepreneurialism that can benefit from technological
sophisticationgainedinasourcesectorandmarketgapsinthetargetsector.Withthiskindof
entrepreneurialism in the elderly market, not only can the deadweight loss of disequilibria
pricing be reduced, but the life of many elderly and their caregivers can also be improved.
It is, however, subject to further research if this innovativeness–needs paradox is in fact
significantly prevalent in other elderly care innovation fields. If a similar situation can be
found repeatedly, a more precise concept on combatting such market failure in the market of
innovation for the elderly will be developed. The development of an indicator on the
prevalence of the innovativeness–needs paradox situations could be beneficial for future
quantitative analyses. In the field of localization technology as well as other smart IT
solutions for the elderly, a more-inclusive study on technical and social applicability of these
efforts should be conducted. With the help of working prototypes and field tests, further
technology transfer projects and dedicated research on the suffering of dementia and aging
could be narrowed for ours and the upcoming generations.
Note
1. According to Schwarz (2012, p. 1), the commonly used term Alzheimer’s disease is with about 60-70
per cent the most common diagnosis when analysing dementia sufferings. This explains why many
confuse dementia and Alzheimer’s disease. Förstl et al. (2001) specifically warns not to confuse
Alzheimer’s disease, which is a medical diagnosis or disease, with dementia which describes the mere
accumulation of symptoms like disorientation or forgetfulness. Such an accumulation of symptoms is
called a syndrome (Förstl et al., 2001,p.43).Inotherwords,Alzheimer’s disease is accompanied by
the symptoms of the dementia syndrome, but symptoms of the dementia syndrome do not
necessarily have to be related to Alzheimer’s disease.
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About the authors
Tobias Ebbing (MSc, MA) studied Innovation Management & Entrepreneurship at the Technical
University Berlin and Management, Warsaw School of Economics. He is an Entrepreneur and
Lecturer at the Berufsakademie für Gesundheit und Sozialwesen Saarland (University of Cooperative
Education for Healthcare and Social Services Saarland) and the Business and Information
Technology School. He was working in the Supply Chain Management division of one of Europe’s
major IT consultancies, where he wrote his BSc thesis on the topic of Traceability within SAP
Systems. Currently, with the Institute for Quality and Management in Healthcare Organizations, he
conducts research in the field of home care services. Tobias Ebbing is the corresponding author and
can be contacted at: t.ebbing@fu-berlin.de
Dr Marzenna Cichosz is an Assistant Professor of Logistics at the Warsaw School of Economics,
Poland. She holds a PhD in Management and an MA in Business Administration, both from the
Warsaw School of Economics. Her research interests include innovation and applying logistics to the
service industry to build customer satisfaction and loyalty, with practical experience gained during
dedicated research projects for e-commerce and Courier, Express and Parcel industries. Together
with the Fisher College of Business, Ohio State University, USA, she conducts research on innovation
development within the logistics outsourcing relationship.
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